Table 75.1

Infections associated with drug abuse are presented in Table 75.2. A variety of cutaneous drug reactions can also develop, such as morbilliform or fixed drug eruptions, urticaria, small vessel vasculitis, and Stevens–Johnson syndrome/toxic epidermal necrolysis.

IV, intravenous; LSD, lysergic acid diethylamide; SC, subcutaneous.

Fig. 75.1 Injection sites (‘skin tracks’) in an intravenous drug user. There is overlying hyperpigmentation and scarring of veins due to inflammation from repeated nonsterile injections as well as injections of irritating drugs and adulterants. Courtesy, Mark Pittelkow, MD.

Fig. 75.2 ‘Skin popping’ scars. A–C Multiple circular depressed scars, some with rims of post-inflammatory hyperpigmentation, admixed with circular hemorrhagic crusts overlying ulcerations. Cocaine was injected into the thighs. A, Courtesy Miguel Sanchez, MD; B, C, Courtesy, Mark Pittelkow, MD.

Fig. 75.3 Retiform purpura due to levamisole-adulterated cocaine. A, B The earlobe is a common site of involvement and purpuric lesions of the earlobe had been described previously as a side effect of levamisole. At the time of writing, up to 70% of the cocaine in the United States contained levamisole, compared to <3% of the heroin. Courtesy, Jeffrey Callen, MD.

Fig. 75.4 Atrophic depressions on the thighs and extensive calcification from multiple pentazocine injections. The calcified areas are firm upon palpation. Courtesy, Mark Pittelkow, MD.