Friday, April 8, 2011

Crack Cocaine "Sores"

Dermatological problems are common with crack cocaine users. At first I just thought the countless sores and cellulitis I was seeing among my patients was standard dermatitis.  Not so.  Crack cocaine causes 'ischemia' by vasoconstriction.  When I did emergency medicine work and was faced with severe nose bleeds I used cocaine on a medical q tip to dab the inner lining of the nasal pasages high up to induce vasoconstriction and stop the bleed.  Inhaling crack cocaine delivers the drug into the body and vasoconstriction occurs in the small vessels. On the skin vasoconstriction results in ischemia and 'infarct' beyond the point of blood stoppage. The tissue is deprived of oxygen and dies in small patches.  Similar small infarcts can be seen in muscles.  Even bigger infarcts can be seen when a person injects cocaine into the muscle and the surrounding tissue becomes ischemic and infarcts.  I imagine this process would occur in organs too but would need to do more research of pathology to confirm this.
The result is that crack cocaine use appears frequently with 'sores.  I mostly see this on the face because that is what is most commonly exposed to me.  Muscles of the neck, arms and buttocks  may be dappled and dinted from the retraction with scarring under the skin.  Further 'abscesses' are frequent.  The  increased inflammation and subsequent abscesses are a consequence of secondary bacterial infection.  It can actually lead to an early gangrenous process.  So much depends on the immune system's capacity to handle the horrendous insults.
Doxycycline 100 mg od or bid for 10 days is an oral medication that addresses the secondary infection of the skin. Fucidin Cream bid or tid (2x or 3x/day) for a week or two is a topical treatment affective for individual lesions (sores).  These medications certainly expedite the healing of the injuries.  The solution, of course, is abstinence but harm reduction is better than nothing for the person who is a slave to the drug dealer and the politics and religion of drug addiction.

7 comments:

Olivia Lopez said...

I have lesions eroding away my tongue
Have had partial removal of tongue

Anonymous said...

I smoke crack and I want to quit. I have sores and purpura all over. What will heal the sores and purple spots? Please help. I've had enough!

haykind said...

Really time to quit - see doctor - get into treatment centre - go to Narcotics Anonymous/Cocaine Anonymois - stay in recovery house - you don't need to die - you are not alone - God bless

Anonymous said...

I'm in the same situation. Did you find any meds that helped? It's been a year,tired of it.

haykind said...

The treatment for addiction is not 'drugs for drugs' anymore than you can 'spend your way out of debt'. Medications can help initially but addiction is a livelong vulnerability. Isolation perpetuates addictions, get into association with people who don't do drugs - anonymous programs, community programs , religious programs. Buspirone has been considered of some benefit in helping cocaine addicts stop. Change playmates, playpens and playthings. Best dermatological overview of skin manifestations of cocaine is Brewer et al, Journal of American Academy of Dermatology, 2008. See a dermatologist for specific treatments. Plastic surgeons have long been successfully repairing the nasal septum destruction caused by cocaine's affects on blood vessels.

Anonymous said...

I have had the same thing happen to me. Went to a dermatologist and she said its central nervous system damage and won't get better until I quit. I have thought it was scabies lice or bedbugs...none of those, even though while smoking ...I swear they are bugs...my head especially. ..feels like bugs all over my scalp..my experimentation has been...when I smoke crack...the sores are inflamed and painful,,like something really weird happens in my body...but since I haven't smoked in a week or so...they are healing...go figure

Anonymous said...

That's me exactly