Cutaneous Complications of Intravenous Drug Abuse

Toxigenic Infections

Skin is an important focus for toxin-related bacterial infections. Tetanus is a rare but regularly reported complication in IDUs.^{[1,112,113,114]} Anaerobic infections, repeated septic needle injuries, chronic wounds and under-immunization render IDUs at risk for tetanus.^[112] In Italy injection drug use is the main risk factor among young individuals.^[113] Systematic vaccination is recommended for IDUs.

Wound botulism has been reported in IDUs both in the U.S.A. and Europe.^{[115,116,117]} A recent epidemic occurred in California associated with the subcutaneous or intramuscular injection of 'black tar' heroin.^{[115,116,117]}

A recent case of cutaneous anthrax complicated by meningitis in a heroin skin-popper has been reported in Norway.^[118] Exceptional cases of toxic shock syndrome attributed to the direct intravenous inoculation of Staph. aureus toxin at the time of heroin injection, and staphylococcal scalded skin syndrome have been reported.^{[119,120,121]}

Miscellaneous Complications

Other cutaneous manifestations have been reported where the causal relationship with drug use is not clear, including cases of polyarteritis nodosa^[122,123] and scleroderma.^{[124,125,126]} Needle fragment foreign bodies after needle breakage are occasionally found in the skin.^[13,58,127]

The British Journal of Dermatology. 2004;150(1) © 2004  Blackwell Publishing