Erythematous cutaneous nodules caused by adulterated cocaine

Cutaneous complications of intravenous drug abuse

“…4,5 The list of substances used to dilute the drug is long and includes quinine, lactose, lidocaine, caffeine, inositol, dextrose, sucrose, procaine, starch, magnesium silicate (talc), mannitol and other substances. [6][7][8][9] The drug, usually in the form of a powder, may contain soil, dust and pathogens introduced during manufacturing or storage. [6][7][8][9][10] Most drug addicts use several drugs.…”

“…[6][7][8][9] The drug, usually in the form of a powder, may contain soil, dust and pathogens introduced during manufacturing or storage. [6][7][8][9][10] Most drug addicts use several drugs. Heroin has long been the most common, followed by cocaine.…”

“…The solution is heated in a spoon or another recipient until the powder dissolves and is then filtered through a cotton wool ball or a cigarette filter into a syringe. [4][5][6][7][8][9][10][11][12][13] The ritual surrounding the injection may include the use of unsterile supplies, the sharing of equipment and lack of skin antisepsis. [6][7][8][9][10][11][12][13][14][15][16][17] The normal injection route is intravenous.…”

“…The drug and adulterants can cause a dermal inflammatory reaction which may be a foreign body granuloma or a nonspecific nongranulomatous inflammation with or without detectable foreign bodies. Cutaneous nodules, panniculitis and dermal sclerosis result from the chronic dermal inflammatory process 7,82 . Hahn et al 76 .…”

“…Histopathological analysis and examination of tissues under polarized light can show the presence of birefringent material, such as starch, talc and other foreign particles 7,82,86 …”