Substance Use Disorders and the Skin: A Narrative Review Bridging Dermatology and Addiction Psychiatry

Ayushi Saxena; Manal Hasan

doi:10.36948/ijfmr.2026.v08i05.88386

Substance Use Disorders and the Skin: A Narrative Review Bridging Dermatology and Addiction Psychiatry

Author(s)	Dr. Ayushi Saxena, Dr. Manal Hasan
Country	India
Abstract	Background. Substance use disorders (SUDs) affect a substantial and growing share of the global population, and the skin is frequently the first organ in which their consequences become visible. Cutaneous findings may precede a disclosed substance history by months or years, yet dermatological signs of substance use remain under-recognised in both dermatology and mental health settings. Objective. To synthesise the current literature on the cutaneous, mucosal, hair and nail manifestations of commonly misused substances; to describe the mechanisms through which these arise; and to outline the diagnostic pitfalls and collaborative care models relevant to clinicians working at the interface of dermatology, primary care and addiction psychiatry. Methods. A narrative review was conducted. PubMed/MEDLINE, Embase and Google Scholar were searched for English-language articles published between January 1990 and the date of writing, using combinations of the terms “substance use disorder”, “drug abuse”, “cutaneous”, “dermatologic”, “skin”, “alcohol”, “tobacco”, “methamphetamine”, “cocaine”, “opioid”, “cannabis” and “inhalant”. Landmark earlier papers and standard dermatology reference texts were included where they remain the primary source for a described sign. Reference lists of retrieved articles were hand-searched. Findings. Substance-related skin disease arises through four broadly separable routes: direct pharmacological effects on the cutaneous vasculature and adnexa; immunosuppression and impaired wound healing; infection introduced by the route of administration and by adulterants; and behaviours driven by the psychiatric sequelae of use, most notably excoriation in the context of formication and delusional infestation. Alcohol, tobacco, methamphetamine, cocaine, opioids, cannabis and inhalants each produce a recognisable, if overlapping, cutaneous signature. Diagnosis is complicated by clinical mimicry, patient non-disclosure, polysubstance use and the absence of validated screening tests for several substance classes. Conclusion. Cutaneous findings offer an accessible and often early window onto substance use. Familiarity with these signs, coupled with non-judgmental history-taking and structured referral pathways between dermatology, primary care, addiction medicine and psychiatry, can shorten time to diagnosis and reduce avoidable morbidity.
Keywords	Substance use disorder, dermatology, psychodermatology, alcohol, tobacco, methamphetamine, cocaine, opioids, cannabis, skin and soft tissue infection, delusional infestation, interdisciplinary care
Field	Medical / Pharmacy
Published In	Volume 8, Issue 5, September-October 2026
Published On	2026-10-07
DOI	https://doi.org/10.36948/ijfmr.2026.v08i05.88386

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Substance Use Disorders and the Skin: A Narrative Review Bridging Dermatology and Addiction Psychiatry

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