heroin and Skin-Ulcer

Topics: Acne Vulgaris; Adult; Aged; Anti-Bacterial Agents; Drug Eruptions; Eczema; Exostoses; Female; Heroin; Humans; Hypersensitivity; Lentigo; Lupus Erythematosus, Discoid; Male; Middle Aged; Porphyrias; Psoriasis; Scabies; Skin Diseases; Skin Neoplasms; Skin Ulcer; Tinea Versicolor; United States

The accidental leakage of the compound, in this case heroin, from the veins where it is injected, causes the formation of tissue lesions. Similar mechanisms lead to progressive tissue necrosis, which, if not immediately treated, results in the loss of the relevant function. A 57-year-old man presented a skin lesion on the posterior region of the left forearm with extensive necrosis of skin and subcutaneous layer involving the underlying muscle planes, caused by a venous extravasation of heroin that he reports having injected himself. The wound size is 15 × 10 cm; it had a sanious, fibrinous, secreting and smelly bottom. In this period, the patient was subjected to daily focused dressing before debridement of the lesion through a collagenase plus hyaluronic acid ointment: Bionect Start®; (FIDIA Pharmaceutical, Abano, Italy). The therapeutic choice was rewarded with a complete resolution of the wound through a non-invasive technique and over a short period. Avoiding the hospitalisation of the patient achieved a reduction of risks for him and of the costs for the National Health Service (NHS). The Bionect Start®; (FIDIA Pharmaceutical) as well as allowing the healing of the wound also decreased significantly the pain felt by the patient, the amount of exudate and the bad smell improving in a non-negligible way his quality of life.

Topics: Administration, Topical; Bandages; Debridement; Extravasation of Diagnostic and Therapeutic Materials; Follow-Up Studies; Heroin; Humans; Hyaluronic Acid; Injections; Male; Middle Aged; Ointments; Skin Ulcer; Viscosupplements

During the last decade, the veterinary anesthetics have gained popularity as recreational drugs. The aim of this study was to document the use of "anestecia de caballo" (xylazine) and its consequences among drug users in Puerto Rico. The study combined a cross-sectional survey with 89 drug users and two focus groups conducted in Mayagüez with frontline drug treatment providers. Drug users were recruited from communities of the San Juan metropolitan area using a variety of ethnographic and outreach strategies. A short questionnaire developed for the study collected information on sociodemographics, xylazine use, and its consequences. The two focus groups were conducted to discuss the details related to xylazine use, its consequences, and utilization awareness. The sample comprised 63 males (70.8%) and 26 females with a mean age of 37.2 years. The mean number of years of drug use was 14.3, with a mean frequency of drug use of 5.9 times daily. More than 65% reported speedball as the principal drug of use. The prevalence of xylazine use was 80.7%. More than 42% of the sample used xylazine in a mixture with speedball. The main route of administration of xylazine was injection but 14% reported the use of xylazine by inhalation. More than 35% of the sample reported skin lesions and 21.1% reported at least one overdose episode. Multiple logistic regression analysis revealed that males (OR = 3.47, CI = 1.10-12.00) and those who reported speedball as their main drug of use (OR = 9.34, CI = 2.51-34.70) were significantly more likely to be xylazine users. Focus groups revealed that drug users claimed to recognize the presence of xylaxine in a mixture of speedball based on its effects, taste, the color of the drug (dark brown), and its odor. In conclusion, the use of xylazine among drug users in Puerto Rico seems to be an emerging trend with potentially serious health consequences.

Topics: Administration, Inhalation; Adult; Cocaine; Cross-Sectional Studies; Drug Combinations; Female; Focus Groups; Heroin; Humans; Hypnotics and Sedatives; Male; Middle Aged; Prevalence; Puerto Rico; Skin Ulcer; Substance Abuse, Intravenous; Substance-Related Disorders; Surveys and Questionnaires; Xylazine; Young Adult

Topics: Adult; Heroin; Heroin Dependence; Humans; Injections; Male; Necrosis; Scalp Dermatoses; Skin; Skin Ulcer

Topics: Adult; Chronic Disease; Female; Heroin; Humans; Injections; Skin Ulcer; Substance Abuse, Intravenous

We report an ulcerative skin reaction resulting from a subcutaneous infusion of isotonic methotrimeprazine and diamorphine. Skin reactions are a recognized side effect of this treatment, although they are reduced by the use of the isotonic formulation of methotrimeprazine. Frank ulceration has not been previously reported. It occurred in our patient despite low doses of diamorphine and methotrimeprazine, an isotonic formulation, and a short infusion time.

Topics: Adult; Analgesics, Non-Narcotic; Analgesics, Opioid; Bone Neoplasms; Breast Neoplasms; Carcinoma, Ductal, Breast; Chemotherapy, Adjuvant; Female; Heroin; Humans; Injections, Subcutaneous; Isotonic Solutions; Methotrimeprazine; Pain; Palliative Care; Skin Ulcer

We studied antibiotic intake in 197 abusers of alcohol, sedatives, or parenteral heroin or cocaine. Thirteen patients, all abusers of parenteral heroin or cocaine, had taken antibiotics without prescription, obtained from friends, from old prescriptions, or by purchase on the street. Past or present street purchase of antibiotics was noted in 27 patients and was more common (P less than .02) in parenteral substance abusers. Four parenteral substance abusers had infection or colonization with methicillin-resistant Staphylococcus aureus, and three of them had purchased antibiotics on the street before the present or a recent past hospitalization. Physicians treating abusers of parenteral heroin or cocaine should be aware that such patients may be taking antibiotics without medical supervision. This practice may be an important factor in the development and spread of methicillin-resistant S aureus.

Topics: Anti-Bacterial Agents; Cocaine; Drug Resistance, Microbial; Heroin; Humans; Illicit Drugs; Injections, Intravenous; Nonprescription Drugs; Self Medication; Skin Ulcer; Staphylococcal Infections; Substance-Related Disorders; Surveys and Questionnaires

The rarity of reported cases of cutaneous ulcerations in heroin abusers prompts this report of a 25-year-old man with a painless, slightly necrotic and purulent ulcer of the dorsal shaft of the penis. The differential diagnosis of the lesion and cutaneous manifestations of heroin abuse are reviewed. To our knowledge, this is only the second reported case of penile ulcer from heroin injection.

Topics: Adult; Heroin; Heroin Dependence; Humans; Injections, Intravenous; Male; Penile Diseases; Skin Ulcer

Topics: Adult; Ampicillin; Diagnosis, Differential; Heroin; Heroin Dependence; Humans; Injections, Intravenous; Male; Penile Diseases; Skin Ulcer; Staphylococcal Infections; Substance-Related Disorders

Topics: Abscess; Acanthosis Nigricans; Adult; Burns; Edema; Heroin; Humans; Jaundice; Male; Melanosis; Pigmentation; Pruritus; Skin Manifestations; Skin Ulcer; Substance-Related Disorders

Topics: Abscess; Barbiturates; Emergency Service, Hospital; Heroin; Humans; Injections; London; Poisoning; Skin Ulcer; Substance-Related Disorders

Topics: Adult; Anti-Bacterial Agents; Chloramphenicol; Cocaine; Female; Foot Diseases; Forearm; Heroin; Humans; Infections; Injections, Intravenous; Injections, Subcutaneous; Skin Ulcer; Substance-Related Disorders; Thigh