Dermatopathologic manifestations of intravenous drug use.
BACKGROUND
The rate of intravenous drug use (IVDU) has been increasing nationally; however, cutaneous manifestations of IVDU have infrequently been investigated. We report a series of the clinicopathological correlation of IVDU in the skin.


METHODS
A search of surgical pathology files between the years 2000 and 2014 was performed for cutaneous specimens from patients with a reported history of IVDU for which the histopathological findings could not be attributed to another etiology. Ten cases for which slides were available were included in the study.


RESULTS
Patients had an average age of 39.7 years and had active or recent history of IVDU. Clinical impressions included ulcer, granulomatous dermatitis, vasculitis, pyoderma gangrenosum and hyperpigmentation at injection sites. Histopathology revealed leukocytoclastic vasculitis (n = 2), dermal pigment deposition (n = 3), non-specific ulceration/scarring (n = 4) and necrobiosis lipoidica-like dermatitis (n = 1). No infectious etiology or polarizable foreign material was identified in any case.


CONCLUSIONS
Cutaneous manifestations of IVDU should be considered in the differential as an etiology for dermatopathologic findings in high-risk patients. We report histopathological findings beyond the scope of those most commonly associated with IVDU. We aim to raise awareness of the cutaneous manifestations of IVDU to improve clinicopathological correlation and patient management in light of the ongoing epidemic.
Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Julie Y
JY
Tse
Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Morayo
M
Adisa
Department of Dermatology, Boston Medical Center, Boston, MA, USA.|Department of Pathology & Laboratory Medicine, Boston Medical Center, Boston, MA, USA.
Lynne J
LJ
Goldberg
Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Rosalynn M
RM
Nazarian
D000328:Adult; D005260:Female; D006556:Heroin Dependence / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011247:Pregnancy; D012871:Skin Diseases / Q000139:chemically induced* / Q000473:pathology*; D012880:Skin Pigmentation / Q000187:drug effects; D015819:Substance Abuse, Intravenous / Q000473:pathology*
heroin; intravenous drug use; necrobiosis lipoidica; pigment deposition; vasculitis