Cutaneous Complications of Intravenous Drug Abuse

P. Del Giudice

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

Conclusions

The skin is the tissue most evidently affected by intravenous drug addiction. Indirect skin manifestations caused by injection abuse cannot be reported in detail in this review. They would include those related to blood-borne pathogens such as HIV, viral hepatitis and other pathogens; cutaneous stigmata of drug-induced coma; and various traumatic injuries: those related to psychological troubles (suicide scars), social deficiency, alcohol, violence and accidents.^[128] The spectrum of cutaneous manifestations is increasing as much as the number of drugs available for abuse increases. It is important to develop and evaluate drug substitution and educational programmes in order to reduce these complications.

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Acknowledgments

I thank my colleagues from the departments of infectious diseases of the Hôpital L'Archet, Nice and the Hôpital Bonnet Frejus, France, for referring the patients and for helpful discussions, mainly Evelyne Bernard, Evelyne Counillon, Pierre Dellamonica, Jacques Durant, Bertrand Marion, Véronique Mondain, Pierre Marie Roger, Frédéric Vandenbos and Thierry Tartarin for reviewing the English.

Reprint Address

Pascal del Giudice. E-mail:del-giudice-p@chi-frejus-saint-raphael.fr.

Cite this: Cutaneous Complications of Intravenous Drug Abuse - Medscape - Jan 01, 2004.

Table 1. List of the main known substances that have been used for parenteral addiction (this list is not exhaustive)
Substances used for parental drug abuse	Heroin
	Cocaine
	Crack cocaine
	Morphine and derivatives
	Hydromorphone
	Triazolam
	Flunitrazepam
	Methylphenidate
	Temazepam
	Pentazocine
	Ketamine
	Amphetamines
Substitution products	Methadone syrup
Substitution products	Buprenorphine

Table 2. Characteristics of the 13 patients who had cutaneous complications related to crushed buprenorphine tablet injection
Patients (age/sex)	Clinical lesions	Microbiology	HIV serology	Cardiac exam	Medical treatment	Surgery	Outcome
1 (25/M)	Brachial abscess	Nontypeable streptococci	--	--	Antibiotics	Abscess incision	Favourable
2 (31/M)	Hand abscess	Nontypeable streptococci	--	--	Ceftriaxone	Abscess incision	Lost to follow-up
3 (43/M)	Arm abscess- superficial leg thrombophlebitis	--	HIV+	--	--	Abscess incision	Lost to follow-up
4 (33/M)	Arm abscess	Streptococcus constellatus	HIV-	--	Co-amoxiclav + ofloxacin	No	Favourable
5 (26/F)	Arm abscess	Staphylococcus aureus	HIV-	Normal	Co-amoxiclav + metronidazole	Incision	Favourable
6 (37/F)	Multiple chronic nodules-multiple thrombophlebitis- chronic oedema (lower + upper limbs)	--	HIV+	--	No	No	Persistent oedema and nodules
7 (34/M)	Foot cellulitis	--	HIV+	Normal	Co-amoxiclav + ofloxacin, enoxaparin	No	Favourable
	Leg thrombophlebitis	--			Co-amoxiclav + ofloxacin, enoxaparin	No	Favourable
	Hand cellulitis	--			Ca+	No	Favourable
8 (40/M)	Cutaneous necrosis	--	HIV+	Normal	--	No	Favourable
9 (28/M)	Arm abscess	Nontypeable streptococci	HIV-	Normal	Oxacillin + gentamycin	Surgical drainage	Favourable
10 (39/M)	Brachial intra- arterial injection	negative	HIV+	Normal	Analgesic	No	Favourable
11 (38/M)	Hand abscess	Nontypeable streptococci	HIV-	--	No	Surgical drainage	Lost to follow-up
12 (31/F)	Arm abscess	Enterococcus sp.+ Candida albicans	HIV-	Normal	Amoxicillin + gentamycin	Surgical drainage	Lost to follow-up
13 (34/M)	Cutaneous necrosis	--	HIV+	--	No	Local antisepsis	Favourable

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