How do I recognize a drug addict

The skin betrays drug addiction

NASHVILLE. Many typical skin changes as well as skin and mucous membrane infections can occur in people who consume illegal drugs. It is usually not clear whether this was caused by the drug itself or an admixture.

In people who regularly inject themselves with drugs, typical scarring and skin pigmentation can usually be found on the crook of the elbow of the non-dominant arm, but sometimes also in less conspicuous areas such as the hollow of the knee, on the foot or in the groin (J Am Acad Dermatol 2013 ; online February 11).

Interestingly, cocaine injections leave no traces of this kind, as no sclerosing substances are added to the substance. If the drug is injected under the skin, irreversible tissue damage results in irregular, whitish, atrophic scars. Hypertrophic keloids can also develop.

Further indications of drug use are edema of the back of the hand due to additives in heroin, sooty areas of skin due to flamed needles and hyperpigmentation due to stowage utensils.

Substance-typical changes

Cocaine / crack: Signs of cocaine abuse are bad breath, frequent smacking, cuts and burns of the lips from damaged crack pipes, missing lateral eyebrows that have fallen victim to the hot steam of the crack pipe, hyperkeratosis on the palms of the hands and fingers from holding the hot crack and lesions of the Nasal septum when the cocaine is sniffed.

Papillomavirus infections in the form of warts in the nose (Snorter warts) also develop in this way. They are spread through infected dollar bills used by several people to sniff cocaine. In addition, various types of vasculitis and pseudovasculitis, among others, have been described.

Heroin: 4 percent of addicts develop urticaria. In particular, the genitals and face can cause intense itching. Furthermore, reports of pemphigus vegetans, toxic necrolysis, necrolytic, migratory erythema or acanthosis nigricans have been reported.

Methamphetamine: Signs of abuse include xerosis, pruritus, strong body odor, weight loss, premature aging, and hyperhidrosis.

Teeth in particular can be affected by excessive caries formation and tooth enamel erosion that begins at the gumline (meth mouth). Excessive skin tingling, especially on the face, can lead to dermatillomania.

Cannabis: Chronic cannabis abuse can cause cannabis arteritis, which usually manifests as peripheral necrosis of the lower extremities. Presumably it arises from the vasoconstricting effect of delta-9-tetrahydrocannabinol and / or contamination with arsenic.

Raynaud's phenomenon or digital necrosis can occur. Claudication may be a harbinger of an ulcer or gangrene.

Ecstasy: Acneiform skin changes such as papules and pustules on the face without comedones are known as "ecstasy pimples". In addition, there is little evidence of skin changes typical of ecstasy in the literature.

Skin and mucosal infections

Skin and mucous membrane infections are the most common reason for hospitalization and are particularly common among addicts who use IV drugs. inject.

The injection of drugs under the skin, the use of non-sterile injection sets and mixtures of heroin and cocaine are primarily responsible for these complications. Staphylococcus aureus and Streptococcus species are the main causes of infection.

Often, however, anaerobes are also responsible. The heroin itself can also be contaminated with Clostridium spores, which survive when heated and are stimulated to germinate.

Often there is necrotizing fasciitis, which can be accompanied by severe pain, hyperthermia or hypothermia. The pain must not be misinterpreted as addictive behavior, the complaints must be surgically clarified.

Fungal infections, particularly with candida, are also common. In addition, pseudoaneurysms that can arise after injection into an artery can be misinterpreted as skin abscesses.

Effects through admixtures

Drugs are stretched with numerous substances. One of them, who was featured in 70 percent of the cocaine samples seized, is the anthelmintic levamisole. It has caused agranulocytosis and fever in several addicts.

Vasculitis with purple lesions, usually on the external auricle and cheeks, has also been reported. After stopping cocaine use, the changes disappeared within two to three weeks. (St)