Rheumatic Manifestations of Cocaine Use

Jonathan Graf


Curr Opin Rheumatol. 2013;25(1):50-55. 

In This Article

Clinical Course and Treatment

The clinical course of patients who suffer from rheumatic complications linked to levamisole-adulterated cocaine is difficult to assess in light of the fact that in our experience, few patients are able to abstain from ongoing use of cocaine. In many instances, necrotic lesions will ulcerate, necessitating debridement and skin grafting. Neutropenia can be quite severe and predispose patients to superinfection of their lesions. Treatment is primarily supportive. In those patients who successfully refrain from cocaine use, skin lesions can begin to resolve over a few weeks.[3] In the setting of worsening skin disease and ongoing cocaine use, some patients have been treated with either anticoagulation, immunosupression or both with varying degrees of success.[45] Corticosteroid therapy may be beneficial for those patients with threatening skin lesions that have not fully necrosed or that, on biopsy, have significant components of inflammation and/or leukocytoclstic vasculitis. Although some patients have been treated with anticoagulation, no definitive assessment can be made as to its benefit for this particular cutaneous thrombotic angiopathy.