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Skin Manifestations of Cocaine Use

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Addiction Medicine FYI

Skin Manifestations of Cocaine Use

Cocaine affects many systems of the body, including the skin (Brewer et al., Journal of the American Academy of Dermatology, 2008):

  • Acute multifocal skin necrosis - pathologic death of skin cells
  • Acute generalized exanthematous pustulosis - eruption of small elevations of skin containing pus
  • Subcutaneous fat necrosis of the newborn - pathologic death of fat cells
  • Cutaneous fibrosis - fibrous tissue formation in the skin
  • Blackened hyperkeratotic palms (“crack hands”) - horny layer of the skin is blackened
  • Chronic skin ulcers
  • Scleroderma - disease where there is thickening of the skin caused by swelling and thickening of the fibrous layer
  • Cocaine - related bullous disease - blebs or enlarged air spaces in the lung
  • Palatal perforation - hole in the palate
  • Dental caries - tooth decay
  • Gingival recession - gums recede
  • Oral blisters
  • Pseudovasculitis - false inflammation of the blood vessels
  • Urticarial vasculitis - hive formation
  • Stevens-Johnson syndrome - a life-threatening condition affecting the skin in which cell death causes the epidermis to separate from the dermal layer of the skin
  • Midline destructive granulomas - nodules that destroy the underlying tissue
  • Churg-Strauss vasculitis - an extremely rare disease that results from inflammation and which causes injury to organ systems.
  • Necrotizing granulomatous vasculitis - destruction of the vascular system by granuloma
  • Schonlein-Henoch vasculitis - A systemic vasculitis that causes the blood vessels in the skin to become inflamed, causing red spots. When the blood vessels in the skin get inflamed, they can bleed, causing a rash that is called purpura.
  • Palpable purpura - hemorrhage into the skin that can be raised and thus felt
  • Necrotizing vasculitis - blood vessels are destroyed
  • Delusional parasitosis - significant itching and excoriations from scratching (see picture #1)
  • Nasal septum perforation (see picture #2)
  • Pott puffy tumor - osteomyelitis of the frontal sinus (see picture #3) - inflammation of the bone marrow and adjacent bone and cartilage
  • Raynaud phenomenon - Rare disorders that affects blood vessels. These disorders are marked by brief episodes of vasospasm (narrowing of the blood vessels - see picture #4)
  • Buergers disease - Thromboangiitis Obliterans  - an inflammatory disease of the small and medium sized arteries and veins of the extremities (see picture #5)
a photograph of a hand covered with dark spots
1. Delusional parasitosis
a photogtraph of a nose showing a hole in the septum
2. Nasal septum perforation
an x-ray showing a tumor in the sinus cavity
3. Pott puffy tumor
a photograph of two hands with the top portion of the fingers appearing to be bleached white
4. Raynaud phenomenon
a photograph of a hand showing the tips of the fingers being dark red
5. Buergers disease

Brewer et al., Journal of the American Academy of Dermatology, 2008