The Management of Ulcers Associated with Skin Popping: A Case Series

Introduction: Skin popping remains a common method of heroin abuse in the United States. Skin popping is an alternative to intravenous drug use, in which the user injects heroin into the skin, subcutaneous tissue, fascia, or muscle. It is associated with local and systemic infection and the development of chronic wounds and osteomyelitis. Chronic pain and untreated opioid use disorder contribute to the risk for ongoing heroin use in the perioperative period, which can impede curative wound care.

Methods: We present a case series of five patients who presented to Rush University Medical Center with infected wounds incurred by skin popping in the setting of heroin addiction between 2017 and 2019. In each case, surgery was performed for infection control in conjunction with a multidisciplinary team of medical and addiction specialists who provided treatment for pain and addiction.

Results: Each of the five cases demonstrates a facet of skin-popping ulcer care which is challenging, including noncompliance with cessation of substance abuse, noncompliance with wound care, progressive disease requiring amputation, and relapse after successful treatment.

Conclusion: Comprehensive addiction treatment is necessary in achieving a successful outcome of wound care, whereas active/recurrent addiction is associated with poor outcomes in patients who engage in skin popping. Multidisciplinary care is vital to the success of wound care efforts in this at-risk patient population. Attention to this challenging and costly issue is warranted, along with further investigation and the development of protocolized multidisciplinary care.