From the Guidelines
Cocaine use is associated with wounds that typically present as poorly healing ulcers with blackened, dead tissue and surrounding inflammation, often due to its vasoconstrictive properties and adulterants in street cocaine. The characteristics of a wound associated with cocaine use can be complex and varied, but generally, they involve tissue necrosis, particularly in the nasal septum from snorting or in extremities from injection. These wounds are often a result of the drug's ability to cause intense vasoconstriction by blocking norepinephrine reuptake, leading to tissue ischemia and eventual death 1.
Key Characteristics of Cocaine-Associated Wounds
- Poorly healing ulcers with blackened, dead tissue
- Surrounding inflammation
- Tissue necrosis, particularly in the nasal septum or extremities
- Increased risk of infection due to adulterants in street cocaine and poor injection techniques
Treatment and Management
Treatment of cocaine-associated wounds requires a comprehensive approach, including:
- Immediate cessation of cocaine use
- Thorough wound cleaning
- Debridement of necrotic tissue
- Appropriate dressing changes
- Antibiotics, such as cephalexin 500mg four times daily for 7-10 days, if infection is present 1
- Referrals for addiction treatment to address the underlying substance use disorder It's essential to note that the provided evidence does not directly discuss cocaine-associated wounds but rather focuses on xylazine-adulterated opioids and general skin and soft-tissue infections. However, based on general medical knowledge, cocaine's vasoconstrictive properties and the potential for adulterants in street cocaine can lead to wound complications. Therefore, the treatment approach should prioritize addressing both the physical wound and the underlying substance use disorder.
From the Research
Characteristics of Wounds Associated with Cocaine Use
- Wounds associated with cocaine use can be caused by levamisole, an immunomodulatory medication often used to cut cocaine, which can lead to a life-threatening syndrome characterized by a necrotizing purpuric rash, tissue destruction, and necrotic wounds 2
- Cocaine use is associated with vasculitis, a condition that can cause wounds, particularly in the context of levamisole-induced vasculitis 2, 3
- Wounds in individuals using cocaine can present with ischemic complications, neutrophilic dermatoses, midline destructive lesions, and vasculitis associated with antineutrophil cytoplasmic antibodies (ANCAs) 3
- Histology of wounds associated with cocaine use typically shows vascular changes, such as leukocytoclastic vasculitis, necrotizing vasculitis, and thrombi 3
Treatment Considerations
- Wound care for individuals using cocaine should be based on principles of moist wound healing, combined with judicious use of therapies with antimicrobial activity and nonadherent dressings to reduce pain 2
- Treatment of wounds associated with cocaine use should occur as part of a multidisciplinary care approach that focuses on cessation of cocaine use and other illicit substances 2