Clinico-epidemiological Study of Mucocutaneous manifestations in Substance Users : A Cross-Sectional study
DOI:
https://doi.org/10.66344/jpad.v36i1.3199Keywords:
substance users, cutaneous manifestations, Alcohol, amphetamine, HeroinAbstract
ABSTRACT
Introduction: Skin is considered to be mirror image of the body; we can establish diagnosis of
disease involving any organ of the body by looking into skin and mucus membranes. This
principle could be applied in suspected cases of drug abuse and drug addiction. Alcohol misuse
can have long-lasting harmful effects on one's physical and mental health. Acutely, ingestion of
alcohol may lead to transient flushing,Trauma-induced ecchymoses, it is a risk factor for many
other health problems including cirrhosis, pancreatitis, and cancers.
Objectives: To study the clinical-epidemiological profile of the skin diseases in Substance Users.
Methods: This cross-sectional observational study involved 200 substance users attending Al-
Qanat Social Rehabilitation center / Baghdad - Iraq of all age?groups, irrespective of gender
were enrolled during the period from February 2024 to February 2025. Patients were subjected
to detailed history taking and clinical evaluation of skin lesion and investigations .
Results: Two hundred were enrolled in this study; 17(8.5%) were females and 183(91.5%) were
males. The mean±SD of age was 29.38±8.4 years. Single substance addiction was noticed in
129 (64.5%) and multiple substance abuse was observed in 71(35.5%). Regarding mode of drug
intake, single and multiple modes of drug administration were seen .Cutaneous lesions ranged
from tattoo, track marks to severe ulcerations and scarring, Mucosal lesions also seen in several
patients. Major bulk of skin manifestations were chronic. The highest addiction material among
the patients were alcohol 61 (30.5%) and amphetamine 46 (23%) and the lowest were heroin,
accupane and benzodiazepine 1 (0.5%).
Conclusions: Drug abusers are prone to skin diseases due to injury caused by drugs as well as by
drug practices adopted. Alcoholic patients had wide variety of skin manifestations commonest
seen due to malnutrition. The early recognition of these signs is of importance for more
effective diagnosis and treatment and to prevent long-term complications.
Key words: substance users, cutaneous manifestations, Alcohol, amphetamine, Heroin
References
Rafiq Z, Mehdi SM, Shafi U. Frequency of cutaneous manifestations in drug abuse patients. Professional Med J. 2021;28(4):497-503.
Frank N, Hennings C, & Miller J. Drug Abuse. In: Kang S, Amagai M, Bruckner N, Enk A, Margolis D, Mcmichael A, Orringer. Fitzpatrick's Dermatology. 9th ed. New York: McGraw-Hill Education.2019; pp1-18
Pourallahvirdi M, Rahmani F, Ranjbar F, Ebrahimi Bakhtavar H, Ettehadi A. Major causes of drug abuse from the viewpoint of addicted persons referred to addiction treatment centers of Tabriz City, Iran. Arch Neurosci. 2016;3(3):e37653.
Jadidi N, Nakhaee N. Etiology of drug abuse: a narrative analysis. J Addict. 2014;2014:352835. doi: 10.1155/2014/352835.
Hasan NA, Al-Hemiary N. Patterns and sociodemographic characteristics of substance abuse among hepatitis C virus-infected patients in Iraq: a cross-sectional study. Egypt J Neurol Psychiatr Neurosurg. 2024 Aug 9;60(1):94.
Sujatha K, Arundathi T, Rubina S, Ramana BV, Nagarajan G: Drug delivery methods ranking addiction potential. Int J Pharm Sci Res. 2013;4(4):1287-93.
Bewley A, Assalman I. Dermatoses induced by illicit drugs. Griffiths C .E.M, Barker J , Bleiker T, Chalmers R , Creamer D. Rook's Textbook of Dermatology. 10TH Edition. UK. Wiley Blackwell: 2024; Pages.3381-84.
Del Giudice P. Cutaneous complications of intravenous drug abuse. Br J Dermatol. 2004;150:1–10.
Yul W. Yang and Mark R. Pittelkow. Signs of Substance Use Disorder. In: Bolognia J, Schaffer J, Cerroni L. Dermatology. 5th ed. London: Elsevier, 2024;89 .pp 1611.
Matar S, Dupin N, Petit AC, Gaillard R, Aractingi S, Oulès B. Cutaneous manifestations associated with substance use disorders. JAAD Reviews. 2025 Jun 1;4:206-19.
Jain NP, Shao K, Stewart C, Grant-Kels JM. The effects of alcohol and illicit drug use on the skin. Clin Dermatol. 2021 Sep 1;39(5):772-83.
Hamamoto DT, Rhodus NL. Methamphetamine abuse and dentistry. Oral Dis. 2009;15:27-37.
Hennings C, Miller J. Illicit drugs: what dermatologists need to know. J Am Acad Dermatol. 2013 Jul 1;69(1):135-42.
Santos RP, Resende CI, Vieira AP, Brito C. Cannabis arteritis: ever more important to consider. Case Reports. 2017 Mar 10;2017:bcr2016219111.
Palaniappan V, Sadhasivamohan A, Karthikeyan K. Raynaud's phenomenon and splinter hemorrhage: an early telltale sign of cannabis arteritis. Int J Dermatol. 2022 Dec 1;61(12):e480-e483.
Murugan K, Sivakumar A. Signs and terminologies in cutaneous manifestations of substance abuse. Indian J Dermatol Venereol Leprol. 2024 Mar 15:1-5.
Muzil JA, Abdulwahid DA, Abed AH, Kammad ZA. Substance abuse in Iraq, quantifying the picture. J Popul Ther Clin Pharmacol. 2023 Jun 1;30(12):302-13.
Bansal M, Shivhare A, Kumar M. Spectrum Of Skin Dermatoses Among Patients of Substance Use Disorder-A Hospital Based Study. Int J Health Sci. 2023 Sep;6(5):489.
Sengotuven KL, Murugaiyan R, Kaliaperumal K. Cutaneous manifestations of chronic alcoholism: a cross sectional study in a tertiary care centre in South India. Int J Res Dermatol. 2016 Oct;2(4):55-63.
Al-Hemiary NJ, Al-Diwan JK, Hasson AL, Rawson RA. Drug and alcohol use in Iraq: findings of the inaugural Iraqi Community Epidemiological Workgroup. Subst Use Misuse. 2014 Nov;49(13):1759-63.
Aslam A, Rather S, Hussain A, Younus F, Saqib NU, Hassan I. Prevalence and pattern of dermatological manifestations among substance users across Kashmir Valley in North India. Indian Dermatol Online J. 2022 Jul 1;13(4):457-65.
Dhillon SS, Kaur T, Bala N. Clinico-epidemiological Aspects of Cutaneous Lesions in Injecting Drug Users Visiting an Oral Substitution Therapy Centre in Northern India: A Cross-Sectional study. Dermatol Pract Concept. 2022 Oct 1;12(4):e2022154.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Journal of Pakistan Association of Dermatologists
This work is licensed under a Creative Commons Attribution 4.0 International License.
Submission declaration
Authors retain the copyright to their work and grant the 'Journal of Pakistan Association of Dermatologists (JPAD)' the right of first publication under a Creative Commons Attribution 4.0 International (CC BY 4.0) license. This license allows others to share, adapt, and reuse the work for any purpose, including commercial use, as long as appropriate credit is given to the original authors and the journal.
By submitting a manuscript, authors confirm that the work has not been published previously (except as an abstract, lecture, or academic thesis), is not under review elsewhere, and has been approved by all authors and relevant authorities. Once accepted, the article will be openly accessible under the CC BY 4.0 license, ensuring wide dissemination and reuse with proper attribution.
