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  • Drug use is a growing problem in the United States and around the world. There are many cutaneous findings that suggest use, abuse, and addiction to drugs.

  • Specific findings in affected patients include dental caries, madarosis, presence of scarring, tattooing, and staining in the skin.

  • Levamisole causes a unique syndrome characterized by retiform purpura of the ears associated with neutropenia, perinuclear antineutrophil cytoplasmic antibody and anti-MPO3 antibodies.

  • Less-specific findings of drug use include morbilliform eruptions, vasculitis, and formation of autoantibodies.

  • Drug-use–related infections predominantly affect the skin and soft tissues. Staphylococcal species are the most common organisms, followed by streptococcal species, oral pathogens, and Candida.

  • Other sequelae of drug use include increased risk of infections including HIV, hepatitides B and C, and syphilis.


The term drug is defined as a medication or other substance, other than food, that has a physiologic effect when ingested or otherwise introduced into the body. Modern society is rife with medications that affect function or structure in the body, caffeine being the most widely used psychoactive substance in the world. Drug abuse is defined as the recurrent use of illegal drugs, or the misuse of nonprescription or prescription drugs, that results in negative consequences. Drug addiction is characterized by physiologic dependence and inability to consistently abstain from the drug. Tobacco and alcohol, although not illegal in the United States and most of the western world, are also considered substances of addiction and abuse.


Drugs have been used and abused for thousands of years and all over the world. Use in religious ceremonies, for healing, or by the general population for recreation has occurred since ancient times. There is evidence that opium has been used since 5000 BC and alcohol since 3500 BC. References to those and other medications are found in the Bible and other religious and historical texts. Columbus and his crew introduced tobacco into Europe when they returned from the New World.


Based on estimates released in the United Nations Office of Drugs and Crime’s (UNODC) 2015 World Drug Report, 246 million people worldwide—1 of 20 people between 15 and 64 years of age—used an illicit drug in the year 2015, which corresponds to a global prevalence of 5.2%.1 With the exception of caffeine, cannabis is the most widely used drug in the world, and its’ use is increasing. Amphetamines are the second most commonly used drugs worldwide, and their use is also increasing. The use of cocaine was in decline for several years but it too is now on the rise. Opiates, particularly prescription opioids cause the highest negative health impact.

Approximately 29.5 million people suffer from drug dependancy world wide, with the highest prevalence of illicit drug use is among those 18 to 25 years of age ...

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