A Systematic Review of Dermatologic Manifestations of Illicit Substance Use: Converging Vascular, Immune, and Behavioral Pathways
International Journal of Medical Toxicology and Forensic Medicine,
Vol. 16 (2026),
1 January 2026
,
Page 1-14
https://doi.org/10.22037/ijmtfm.v16.51860
Abstract
Background: Illicit substance use imposes a substantial global health burden, extending beyond well-characterised neuropsychiatric and cardiovascular sequelae to encompass clinically significant dermatological pathology. This review aims to systematically evaluate and classify the spectrum of dermatological disorders associated with major classes of illicit drugs, specifically opioids, stimulants, cannabinoids, and novel psychoactive substances (NPS).
Methods: A PRISMA-guided systematic search of PubMed, Scopus, Web of Science, and Cochrane Library was conducted. Observational studies and relevant case reports were included. Data on drug class, dermatological condition, pathophysiology, and prevalence were extracted.
Results: Of 2,847 identified records, 184 studies met the inclusion criteria. Distinct patterns emerged: Opioids were primarily linked to injection-related complications and pruritus; Stimulants were strongly associated with psychocutaneous disorders and vasculopathies; Cannabis showed milder, often allergic manifestations, with severe reactions linked to synthetic cannabinoids; NPS presented with emerging patterns of severe excoriation and rash. Indirect effects from malnutrition and associated infections were prevalent across all user groups.
Conclusion: Illicit drug use precipitates a wide range of direct and indirect cutaneous pathologies, often severe and substance-specific. The skin serves as a critical diagnostic indicator and a significant source of morbidity. In tegrated dermatological screening and management within addiction treatment frameworks are urgently needed to improve holistic care outcomes.
- Illicit drugs, Skin diseases, Soft tissue infections, Intravenous, Vasculitis, Delusional parasitosis, Wound healing
How to Cite
References
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