Cutaneous manifestations associated with substance use disorders

Substance use disorder (SUD) is a major, growing public health problem. Cutaneous lesions in relation with SUD are frequent and diverse, yet comprehensive reviews are lacking. We aim to address this gap by providing a practical overview of skin manifestations associated with commonly used substances. Cutaneous manifestations can serve as a clue to identify a specific substance or adulterant use, or can suggest substance administration mode. Eg, vascular and lymphatic complications, as well as mild to severe skin infections, are mainly associated with intravenous administration. Other skin lesions related to SUD may result from inflammatory or foreign body response triggered in the dermis or the subcutaneous tissue. Addiction specialists or other professionals may seek the expertise of dermatologists to assist in diagnosing and managing SUD. Dermatologists should also remain vigilant for cutaneous manifestations of SUD, which may be suggestive of unrecognized or undisclosed substance misuse. A thorough dermatologic evaluation is therefore advisable when clinical signs imply the possibility of SUD. Multidisciplinary dermatopsychiatric care would be beneficial for managing SUD, and the effectiveness of such a holistic approach should be continuously assessed to optimize patient care outcomes.