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Inicio Medicina Clínica (English Edition) Cutaneous and mucosal manifestations associated with cocaine use
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Vol. 146. Issue 12.
Pages 544-549 (June 2016)
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Vol. 146. Issue 12.
Pages 544-549 (June 2016)
Review
Cutaneous and mucosal manifestations associated with cocaine use
Manifestaciones cutáneas y mucosas asociadas al consumo de cocaína
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1
Adrián Imbernón-Moya
Corresponding author
adrian_imber88@hotmail.com

Corresponding author.
, Ricardo Chico, Antonio Aguilar-Martínez
Servicio de Dermatología, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain
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Table 1. Cutaneous and mucosal manifestations associated with cocaine use.
Table 2. Systemic manifestations associated with cocaine use.
Table 3. Main diagnostic differences to consider when dealing with a purpuric rash outbreak and ulceronecrotic oronasofacial lesions.
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Abstract

Complications due to cocaine are a public health problem. The typical cutaneous disease is leukocytoclastic vasculitis and/or thrombotic vasculopathy affecting mainly the ears. No intense systemic involvement is usually present, but there may be several cutaneous, mucosal and systemic manifestations. Other findings associated as arthralgia, neutropaenia or agranulocytosis, low titre positive antinuclear antibodies, antiphospholipid antibody positivity and neutrophil cytoplasmic antibodies against multiple antigens help the diagnosis. This disease requires a clinical suspicion with a clinical history, a complete physical examination and a broad differential diagnosis for an early and correct diagnosis. The course is usually self-limited. In most cases the only treatment is to discontinue the use of cocaine associated with symptomatic treatment, no proven benefit of systemic corticosteroids.

Keywords:
Cocaine
Levamisole
Vasculitis
Thrombosis
Antineutrophil cytoplasmic antibodies
Resumen

Las complicaciones secundarias a la cocaína constituyen un problema de salud pública. La manifestación cutánea característica es la vasculitis leucocitoclástica y/o la vasculopatía trombótica habitualmente poco agresiva que afecta principalmente a los pabellones auriculares. No suele presentar afectación sistémica intensa, pero puede acompañarse de múltiples manifestaciones cutáneas, mucosas y sistémicas. Otros hallazgos asociados como las artralgias, la neutropenia o la agranulocitosis, los anticuerpos antinucleares positivos a títulos bajos, y la positividad para anticuerpos antifosfolipídicos y anticuerpos anticitoplasma de neutrófilos frente a múltiples antígenos ayudan al diagnóstico. Esta entidad requiere un diagnóstico precoz, siendo fundamental la sospecha clínica, realizar una adecuada anamnesis, una exploración física completa y un diagnóstico diferencial amplio. El curso suele ser autolimitado. En la mayoría de los casos el único tratamiento necesario es la interrupción del consumo de cocaína asociado a un tratamiento sintomático, sin beneficio demostrado de los corticoides sistémicos.

Palabras clave:
Cocaína
Levamisol
Vasculitis
Trombosis
Anticuerpos anticitoplasma de neutrófilos

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