By Helen Albert
Contaminated cocaine use can cause painful, necrotic skin purpura
MedWire News: Using cocaine contaminated with the animal de-worming drug levamisole can result in painful, necrotic purple skin lesions and low levels of white blood cells, report US researchers.
"We've seen a lot of cases in Rochester alone, so it is important to alert the gatekeepers of medicine, the primary care physicians who are in the trenches every day, of this diagnosis," said study author Mary Gail Mercurio from the University of Rochester in New York.
"This is one of those entities that with familiarity and recognition, can go a long way in helping physicians to quickly make a diagnosis and intervene without embarking on an elaborate workup where nothing will pan out," she said.
Co-author Noah Craft (University of California, Los Angeles) and colleagues describe a series of six patients with remarkably similar dermatological symptoms after cocaine use, treated in clinics in New York and California over the past few months.
Symptoms included net-like purple skin discoloration or purpura on the body, which included painful eruptions, skin necrosis, and scabbing, all occurring after cocaine use.
In addition, all the patients had positive perinuclear antineutrophil cytoplasmic antibody values, a common feature of many autoimmune conditions. Three also had a low white blood cell count (neutropenia), which can significantly increase infection risk.
The study authors believe that the cause of these symptoms is contamination of the cocaine with levamisole, rather than cocaine use per se, as the symptoms of purpura and neutropenia have been observed before in connection with levamisole-contaminated cocaine use.
Craft et al explain that levamisole-contaminated cocaine has been in use in the USA since 2003, and resulting toxic reactions have increased dramatically since 2008.
"When we first started seeing these patients they all had a similar clinical picture, but they were really an enigma because they weren't falling into any other pattern we'd seen before. When a colleague at the National Institutes of Health mentioned levamisole contamination, we did toxicity screens and lo-and-behold, all the patients came up positive for cocaine," said Mercurio.
She concluded: "We believe these cases of skin reactions and illnesses linked to contaminated cocaine are just the tip of the iceberg in a looming public health problem posed by levamisole."
The results of this study are published in the Journal of the American Academy of Dermatology.
MedWire (http://www.medwire-news.md/ ) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011 hepatitiscnewdrugs.blogspot.com
Oral Dis. 2005 Nov;11(6):338-49.
Number V Oral lichen planus: clinical features and management.
Dermatology Research Associates, Cincinnati, OH 45230, USA. email@example.com
Oral lichen planus (OLP) is a relatively common chronic inflammatory disorder affecting stratified squamous epithelia. Whereas in the majority of instances, cutaneous lesions of lichen planus (LP) are self-limiting and cause itching, oral lesions in OLP are chronic, rarely undergo spontaneous remission, are potentially premalignant and are often a source of morbidity. Current data suggest that OLP is a T cell-mediated autoimmune disease in which auto-cytotoxic CD8+ T cells trigger apoptosis of oral epithelial cells. The characteristic clinical aspects of OLP may be sufficient to make a correct diagnosis if there are classic skin lesions present. An oral biopsy with histopathologic study is recommended to confirm the clinical diagnosis and mainly to exclude dysplasia and malignancy. The most commonly employed and useful agents for the treatment of lichen planus (LP) are topical corticosteroids but other newer agents are available.
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AUSTRALIAN soldiers have reportedly been exposed to HIV and Hepatitis after staff at a major Defence hospital near Dubai failed to properly sterilise surgical equipmentThe Al Minhad Air Base hospital blunder continued unnoticed for two years between February 2009 and August 2010, a Fairfax newspapers investigation reveals.
But soldiers and defence contractors were only told last week.
More than 100 soldiers suffered serious combat injuries in Afghanistan in 2009 and 2010.
A memo sent to soldiers warns anyone who passed through the hospital during that time to get their blood screened.
"The al-Minhad air base health facility of Joint Task Force 633 has identified lapses in procedure in the operation of the surgical instrument steriliser," the memo reads.
"As a consequence the sterilisation of surgical instruments at the facility cannot be absolutely guaranteed to have met Australian standards during the period February 2009 to August 2010.
"Personnel who underwent a surgical procedure (eg. excision of skin lesions, minor operations) during that period are possibly at risk of acquiring a blood born disease."
Soldiers are said to be shocked by the memo with one telling the Australian the lapse in sterilisation coincides with a period of time when Australian soldiers suffered a high casualty rate.
An infectious disease expert told the Sydney Morning Herald yesterday he was concerned that took so long for Defence to notice the problem and said such lapses were rare in Australian hospitals.
"The highest risk is hepatitis C because patients cannot be vaccinated there has been the occasional report of HIV being transmitted in the operating theatre," he said. "It is unusual that it has taken that long to detect there is a problem." hepatitiscnewdrugs.blogspot.com
One of the stranger Internet-based quackery phenomenons of the last decade is Morgellon’s disease. This is a topic I haven’t visited that much on this blog, its having last come up in a big way a little more than a year ago, when I discussed it in the context of Dr. Rolando Arafiles and the other quackery he was promoting. This led to extreme unhappiness on the part of self-proclaimed Morgellons disease “expert” Marc Neumann, who later bombarded me with threatening e-mail rants. In any case, whatever Morgellons disease is, its cause is almost certainly not what patients think it is, namely the presence of tiny organisms in the skin leading to a chronic itch that leads to chronic scratching. Its adherents describe it thusly:
Sponanteously Erupting Skin lesions
Sensation of crawling,
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