Cutaneous manifestations of injection drug use

The opioid crisis in the United States has led to a significant increase in the number of people who inject drugs (PWID) in the last 20 years.PWID have high risk of morbidity and mortality, and they experience diverse and severe cutaneous diseases.Injection drug use involves a series of steps and exposures.Each step puts a person at risk for injury and infection with cutaneous manifestations.In order for dermatologists to appropriately diagnose and treat PWID, they must understand the process of injection drug use and associated harm reduction strategies.PWID can present with cutaneous diseases including skin and soft tissue infections; systemic bacterial, fungal, and viral infections; vascular complications; injuries; pruritus and formication; and allergic disease.Drug adulterants, including levamisole and xylazine, can cause characteristic cutaneous findings.Appropriate diagnosis and management of cutaneous disease by dermatologists is a critical part of caring for PWID.( JAAD Reviews 2026;7:34-41.)