[SavageGlow]

Source. Patient one:

This is a 31-year-old woman with a history of intravenous drug abuse (IVDA) with wounds on the dorsal surface of both hands. These lesions, where she previously injected heroin, progressed over several months. They began as erythema with associated pain and advanced to solitary ulcers. She denied the use of any other substances and was certain that her dealer used fiber supplements as a bulking agent. On presentation, there was marked erythema and significant tenderness around the lesions as seen in Figure 1. The remainder of her physical exam was normal. She was hemodynamically stable and afebrile. She denied any primary psychiatric history, self-harming practices, or systemic autoimmune disease. Wound culture identified a methicillin-resistant Staphylococcus aureus (MRSA) infection. She underwent bilateral debridement and grafting of the wounds and was treated with intravenous (IV) antibiotics. Following treatment, she did not follow up and has not been seen since hospital discharge. No pathology was obtained for this patient.

Patient two:

This is a 44-year-old woman with a history of IVDA with wounds on the ventral aspects of her upper and lower extremities. These lesions, where she previously injected heroin, progressed over weeks. They began with erythema and associated pain. Over time, ulcerations developed, which began to coalesce with necrotic tissue and large alternating black and brown scales as seen in Figure 2. The remainder of her physical exam was normal. She was hemodynamically stable and afebrile. She denied any primary psychiatric history, self-harming practices, or systemic autoimmune disease. She was started on IV antibiotics while in the emergency department and transferred to the medical floor for further workup and observation. Shortly after beginning treatment, she left against medical advice (AMA). She has not followed up since that time. No pathology or microbiology results were obtained for this patient.

Patient three:

This is a 31-year-old man with a history of IVDA with multiple wounds on the dorsal aspect of his bilateral upper extremities. These lesions began as erythema and pain at sites of “gray heroin” injection, which progressed to scattered ulcerations. On discovering the lesions, he attempted a home debridement with a knife and pair of scissors. At presentation, there was marked erythema around most of the ulcers and multiple, contained, black necrotic tissue as seen in Figure 3. The remainder of his physical exam was normal. He was hemodynamically stable and afebrile. He denied any primary psychiatric history, self-harming practices, or systemic autoimmune disease. Tissue debridement showed MRSA infection and necrosis without vasculitis. He received IV antibiotic therapy and underwent a skin grafting procedure. He was healing well at discharge.

[marcos_69]

That's almost enough to make you want to stop shooting up with dirty needles.

[ride]

Patient 1 - “And this…is a chemical burn”. -Tyler Durden-

Patient 2 - A scab picker’s wet dream.

Patient 3 - Those 3D tattoo artists are getting really good.

[WonderMomma]

Amazing that a substance could be THAT addictive.

Great post Kim. Lots of good info.

[Suicide_Note]

Nice. The only good junkies are dead junkies.

[Mr.NoCredit]

A.M.A.Z.I.N.G

[GODREKR]

These people just don't get it.

[Pyramid_Head]

Ugh, I'll never understand the appeal of drugs.

[LadyCPlum]

It's weird but I see pictures like this and it makes me think of how insulin-dependent diabetics don't suffer from this more often. I know they rotate injection sites, but still, you have to run out of skin at some point.

[acid_punx]

No sympathy for smackheads