What Drug Abuse Can Do to the Skin

Last Updated: June 17, 2019
a closeup of women scratching her arm

Drug abuse can wreak havoc on many of the body’s organs. Alcohol abuse puts tremendous strain on the liver, cocaine can significantly stress the heart, and heroin can damage the kidneys. That damage can remain hidden for many years since it is impossible to see the harm without sophisticated medical imaging systems.

You may not think of it in this way, but the skin is also an organ. It happens to be our largest organ. Abusing any of a wide range of drugs over a period of time can cause a variety of infections, sores, inflammation, or even rotting of the skin.

This damage may be caused by any of four factors, or a combination thereof:

  • The drug itself
  • Impurities used to cut the drug or that make their way into drugs sold on the street
  • How the drug is delivered (e.g., intravenous use)
  • Unhealthy behaviors that lead to skin problems, such as poor diet, lack of sufficient sleep, and failure to maintain adequate personal hygiene

Let’s look at some of the effects different drugs can have on the skin.

Cocaine’s Effect on the Skin

Cocaine can affect many different bodily systems. It can affect the skin itself and also some internal organs and systems that can result in damage to the skin.

The list of damaging dermatological diseases is a long one, but it includes:

  • Necrosis, or death of skin cells
  • The formation of fibrous tissue in the skin
  • Blackening of the palms, also called “crack hands”
  • Chronic skin ulcers
  • Pustulosis, which are small, raised areas of the skin filled with pus
  • Schonlein-Henoch vasculitis, which inflames blood vessels within the skin, causing the formation of red spots that can bleed
  • Buerger’s disease, which inflames veins in the extremities, causing them to swell and turn red
  • Bullous erythema multiforme, which creates skin eruptions
Cocaine has also been known to have been cut with a variety of substances, some of which can have serious side effects. A report from 2016 out of the United Kingdom found that approximately 65–80 percent of the cocaine sold in the UK and the United States was cut with a deworming agent for livestock called levamisole. Ingested over a long period of time, levamisole built up to sufficient levels in the systems of heavy cocaine users to cause ulcerating skin lesions and even rotting of the skin. It has also been linked to a drop in infection-fighting white blood cells, leaving some users vulnerable to any of a number of opportunistic infections.

Phenacetin is another cutting agent used in cocaine. This painkiller has been banned in the US since 1983, as it has been linked to a significantly heightened risk of contracting bladder cancer. The presence of phenacetin compounds the risks of levamisole in cocaine samples.

Skin Issues from Heroin Use

a closeup of a women scratching her arm

Probably the most commonly seen effect of heroin use on the skin is in those who inject the drug rather than smoke or snort it. Repeated penetration of the skin while seeking a vein can lead to venous sclerosis, which is a scarring of the veins, also known as “track marks.” Venous sclerosis can also lead to a range of other problems, including skin infections, abscesses and cellulitis.

The debilitating effects of heroin can be seen in several photo essays showing users years apart to illustrate the drug’s impact on the skin and overall health.

Necrotizing skin lesions have also been found in users who injected heroin subcutaneously, in a practice known as “skin popping.” Skin popping leads to tissue trauma and allows bacteria to penetrate the skin. It may also introduce cutting agents, which can irritate the skin. People who use heroin in this way are five times as likely to suffer from abscesses or cellulitis.

Heroin has been known to reduce moisture content in the epidermis, causing dry, itchy skin, often due to cutting agents.

Another common condition for heroin users is an itchy hives-like rash caused by cell degranulation and the release of histamines. Intense itching happens directly after the drug is injected and can last for several days.

Methamphetamine and the Skin

In addition to many other negative effects of meth abuse, chronic users may suffer from skin sores, which is often due to the user picking at the skin. Many meth users experience the sensation of insects crawling on or under their skin. As a result, they repeatedly pick at their skin, scratching at things that aren’t there. This is called parasitosis, or “meth mites.”

They may also suffer from dry skin and skin infections.

Users who inject methamphetamine, as well as cocaine, heroin, or any injectable drug, are at great risk for skin infections. One study published in the British Journal of Dermatology found that 11 percent of IV drug users reported at least one abscess within the previous six months.

How Alcohol Affects the Skin

close up of alcohol bottle spilling with glass

It is widely known that abuse of alcohol puts a tremendous strain on the liver and can even lead to cirrhosis, a life-threatening disease that results from scar tissue building up in the liver. But alcoholic liver disease can also cause problems visible on the skin.

One of the most common is spider angioma. These are lacy patches of red that usually appear on the hands, face and neck, or torso and are thought to be caused in part by alcohol-induced vasodilation. Caput medusa, also known as palm tree sign, is another disfiguring skin condition, resulting in swollen and distended veins, which appear around the navel and spread across the abdomen. This often indicates severe liver disease.

Jaundice, a yellow discoloration of the skin and mucus membranes, occurs when there are high levels of the serum bilirubin. Jaundice often points to many varieties of liver disease.

Alcohol has been indicated in increased activity of enzymes associated with a condition called porphyria cutanea tarda, or PCT, which can cause scarring in areas of the skin exposed to the sun.

Psoriasis in those who suffer from alcohol use disorder has been shown to have a distinct array of flat, thick, red plaques over the surfaces of the hands, fingers, palms and soles of the feet, and doctors believe that alcohol abuse may exacerbate psoriasis. Other dermatologic conditions linked to alcohol abuse include eczema, rosacea, and seborrheic dermatitis.

Krokodil’s Extreme Effects

Desomorphine got its street name, krokodil, specifically because of its effects on the skin, turning it green and scaly before it sloughs off. Krokodil is a cheap form of heroin that popped up in Russia after a shortage of true heroin, and it has wreaked havoc on those who use it. It has been called “the deadliest drug in the world.”

Ultimately, krokodil rots the skin from the inside out, causing gangrene and abscesses that can lead to a user’s muscles, tendons, and even bones being exposed after the skin has rotted away.

Marijuana and Skin Issues

cannabis weed, a joint in his hands A man smokes

Marijuana use can cause signs of premature aging, including dark circles under the eyes, graying hair, and loss of hair. Cannabis-induced arteritis is a serious condition associated with marijuana use. It can have effects on the skin, but it is sometimes misdiagnosed as atherosclerosis.

Interestingly, cannabis use can also deliver benefits to the skin. Cannabidiol (CBD), one of the compounds in cannabis (but one without psychotropic effects), might provide relief from acne by reducing the oiliness of the skin and limiting the formation of blackheads.

How to Keep Skin Healthy

The best way to prevent the harmful effects of drugs on our largest organ, the skin, is to avoid substance abuse. It is especially important to stay away from drugs that have been adulterated with compounds or fillers. To take even better care of your skin, remember to always wear sunscreen, practice good hygiene, and moisturize.

Last Updated on June 17, 2019
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