drug abuse and skin popping

Last edited 04/2021 and last reviewed 05/2021

Skin popping

• is defined as the act when drugs, usually heroin or "speedballs" (heroin plus cocaine), are injected subcutaneously or intramuscularly
• is done for different reasons (1):
  • some drug abusers may have difficulties injecting intravenously because of difficulties in finding a vein,
  • others inject subcutaneously because it results in slower drug absorption, gives less of a "rush," may allow the drug to last longer,
  • can also decrease the risk of overdosing

Skin popping scars are important clues for possible drug abuse. Healthcare practitioners should be aware of and recognize the lesions associated with this practice so further testing can be performed if clinically indicated. Recognition of the lesions and thus earlier treatment of the complications could prevent the complications of skin popping in the skin and other organs

 Skin popping allows direct inoculation of bacteria and irritants into the skin, and as a result, use of this method has the greatest risk factor for the formation of suppurative skin infections versus other routes of administration (2)

• odds of abscess or cellulitis among drug users using skin popping was almost five times the odds of those who used intravenous injection
• most common bacteria cultured from these skin infections is Staphylococcus aureus either alone or in combination with anaerobic bacteria
• other infections can occur, such as Candida folliculitis, botulism, tetanus, and necrotizing fasciitis

Chronic complications of skin popping include:

• scar formation (as seen in our patient), hyperpigmentation,
• cutaneous granulomas from contaminants (such as talc),
• and even necrosis of the digits if vasoconstrictive substances (such as cocaine) are incidentally injected into small arteries
• cases have been reported of serum amyloid A amyloidosis in patients with histories of skin popping, which can lead to renal impairment

Reference:

• Skin popping scars - a telltale sign of past and present subcutaneous drug abuse. Grunebaum A, Skupski D. Case Rep Perinat Med. 2012;1:37-39
• Saporito RC et al. Recognizing Skin Popping Scars: A Complication of Illicit Drug Use. Cureus. 2018 Jun; 10(6): e2726.