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Pyoderma Gangrenosum Linked to Contaminated Cocaine

Pyoderma Gangrenosum Linked to Contaminated Cocaine

A study published in the Journal of the American Academy of Dermatology described clinical, histopathological, and serologic findings in 8 patients with pyoderma gangrenosum (PG) associated with levamisole-contaminated cocaine. Levamisole has increasingly been used as a cutting agent in cocaine. In 2008–2009, levamisole was found in 69% of cocaine samples seized by the Drug Enforcement Administration. There have been some previous reports that have linked Levamisole-contaminated cocaine to vasculopathic skin necrosis.

Vasculopathic and vasculitic eruption induced by levamisole-tainted cocaine is widely recognized and well documented in the medical literature. However, PG has only recently been recognized as a complication of exposure to cocaine… Based on this cohort, the researchers conclude that PG may occur after exposure to levamisole-adulterated cocaine. The clinical and histopathological findings may resemble those seen in conventional forms of PG, while the serologic findings mirror those seen in other levamisole-associated vasculopathic or vasculitic eruptions. In the patients studied, none of the patients in this cohort had any of the typically associated conditions that co-occur with PG. In addition, each patient’s clinical progression, which demonstrated lesion induction soon after cocaine exposure, improvement or resolution of disease with cocaine abstinence, and recurrence with relapse, implies a significant correlation with cocaine intake.

The researchers state that it is important for clinicians to be aware of contaminated cocaine as a potential cause of PG, because cocaine avoidance represents the mainstay of treatment in these patients.

Byline: Martha L. Sikes, MS, RPh, PA-C

Posted: March 28, 2016

Source: Journal of the American Academy of Dermatology
Adapted from the original article.

[Image: Pixabay / stevepb]

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