[Cocaine-related localized necrotic livedo].
BACKGROUND
The cutaneous signs of toxicomania are better known since the last two decades. We describe an original case of segmental necrotic and chronic livedo of the right arm associated with cocaine use.


METHODS
A 31 year-old intravenous cocaine user presented a necrotic and painful livedo of the right arm. Two years before referral, localized recurrent edema was noted without general involvement. No local (infectious, vascular) or general (dysimmunity, coagulation abnormalities) aetiologies could be found. An amorphic substance composed of mineral bodies was found in the dermis, without damage to the vessels. Dramatic improvement was obtained with simple supportive care, while intravenous injections were stopped.


CONCLUSIONS
The vasoconstrictive properties of cocaine have been demonstrated in Raynaud's phenomenon, ischemia, focal necrosis of the extremities, and also in liver and kidney disorders. This drug has pharmacological effects on endothelial cells and coagulation, explaining the arterial and venous thrombosis reported. The foreign bodies found in our patient probably came from an intraarterial injection. The progressive and chronic evolution, without any evidence of thrombosis at the time of examination, are suggestive of the vasoconstrictive action of chronic dermal deposits.
Jouary
T
T
Service de Dermatologie, Hôpital Saint-André, Bordeaux.
Bens
G
G
Lepreux
S
S
Buzenet
C
C
Taieb
A
A
D000328:Adult; D003042:Cocaine / Q000008:administration & dosage / Q000506:poisoning*; D019970:Cocaine-Related Disorders; D018765:Dopamine Uptake Inhibitors / Q000008:administration & dosage / Q000506:poisoning*; D005260:Female; D006801:Humans; D009336:Necrosis; D017445:Skin Diseases, Vascular / Q000139:chemically induced* / Q000473:pathology*; D015819:Substance Abuse, Intravenous
D018765:Dopamine Uptake Inhibitors; D003042:Cocaine