Dermatology
Signs of Substance Use Disorder
Built from Dermatology, 5th Edition
What’s inside
18 sections · 83 slides
Overview
- What this topic covers
Substance Use Disorder: Definition
What the diagnosis means, and how common it is
- Defining substance use disorder
- Substance use disorder as defined by DSM-5.
- Substance use disorder as defined by DSM-5. (continued)
- Why the skin matters in addiction medicine
Classes of Substances
How each major drug class is used, and its main physical effects
- Ten classes of misused substances
- Alcohol
- Stimulants: use and acute effects
- Stimulants: chronic skin and organ effects
- Hallucinogens
- Opioids: what they are and how they are used
- "Krokodil": a dangerous adulterated opioid
- GHB and its chemical relatives
- Benzodiazepines
- Cannabis
- Anabolic steroids
- Cutaneous signs of drug abuse.
- Cutaneous signs of drug abuse. (continued)
- Cutaneous signs of drug abuse. (continued)
- Cutaneous signs of drug abuse. (continued)
- Cutaneous signs of drug abuse. (continued)
Why the Brain Gets Hooked, and How Common It Is
The brain reward system, and the global scale of substance use disorders
- The brain's reward pathway
- How common is substance use disorder
- US substance use disorder statistics, 2019 national survey
Scars, Ulcerations, and Skin Necrosis
The visible stigmata of repeated drug injection
- "Skin tracks": the classic sign of IV drug use
- Linear hyperpigmentation from speedball injections
- Injection sites migrate over time
- "Skin popping": injecting under the skin
- "Shooter's patch": a self-perpetuated ulcer
- A large scar from a previous shooter's patch
- Diluents vs adulterants: what gets mixed into drugs
- Why quinine was a popular adulterant
- Pentazocine: a distinctive injection injury
Bacterial Infections
Cellulitis, abscesses, and life-threatening deep infections
- Why drug injection predisposes to infection
- Cellulitis of the lower leg in an injection drug user
- Infectious complications of drug abuse.
- Infectious complications of drug abuse. (continued)
- Infectious complications of drug abuse. (continued)
- Infectious complications of drug abuse. (continued)
- Recognizing cellulitis in this setting
- Clostridial infections and wound botulism
- Abscesses: risk factors and appearance
- Deeper spread: bone, joint, and neck infections
- Necrotizing fasciitis: a surgical emergency
- Necrotizing fasciitis of the arm after surgical debridement
Fungal Infections
Candidiasis, aspergillosis, and zygomycosis in drug users
- Fungal infections in drug users
Granulomas
Firm nodules from injected filler particles like talc
- Foreign body granulomas from injected fillers
Mucous Membrane Lesions
Effects on the nose, mouth, teeth, and genitals
- Nasal and oral effects of snorted or smoked drugs
- Dental decay in a chronic drug user ("meth mouth")
- Genital and dental complications
Burns
Injuries from lit matches, cigarettes, and hot vapors
- Burns in an altered state of mind
Formication
The sensation of bugs crawling under the skin
- "Coke bugs" and "meth mites"
Additional Cutaneous Findings
Tourniquet marks, coma-related injury, itching, and hormone effects
- Tourniquet marks, soot tattoos, and hard skin
- Coma-related skin injury
- Itching, sweating, and other autonomic effects
- Hormone-related and acneiform effects
Drug-Induced Cutaneous Reactions
Hypersensitivity and other reactions more common in drug users
- Drug reactions are more common in drug users
- Drug-induced cutaneous reactions.
Vascular Lesions
Bruising, thrombosis, infected aneurysms, endocarditis, and levamisole vasculopathy
- Bruising and vessel injury from injection
- Intra-arterial injection: embolic complications
- Thrombophlebitis and infected pseudoaneurysms
- Infective endocarditis
- Levamisole-adulterated cocaine: three sequelae
- Retiform purpura from levamisole-adulterated cocaine
- Levamisole vasculopathy: mechanism and testing
- A large purpuric plaque from levamisole-adulterated cocaine
- Other cocaine- and xylazine-related vascular effects
Systemic Complications
Bloodborne viruses, sexually transmitted infections, and other whole-body effects
- Bloodborne viral infections
- Sexually transmitted infections and false-positive syphilis tests
Treatment
Managing skin infections, scars, and the underlying addiction
- Approaching the patient with suspected drug use
- Treatment of drug addiction.
- Treating skin infections
- Managing scars and skin grafts
Summary
Pulling the cutaneous signs of substance use disorder together
- Key takeaways
References
Source citations from the chapter
- References
- References (continued)
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- References (continued)
- Dermatology, 5th Edition (2-Volume Set)