Earlobes and Cocaine

Levamisole kills worms in dogs and turns your earlobes purple — what's not to like?

Levamisole is used to fight helminthic infections and to modulate immunity. It is also increasingly used to adulterate or “cut” cocaine. In 2009, 70% of seized cocaine contained levamisole. Levamisole-related vasculitis manifests rather distinctly as earlobe purpura associated with high levels of antibodies to both perinuclear antineutrophil cytoplasmic antibodies (p-ANCA) and cardiolipin, often with neutropenia and small-vessel thrombi. The authors of two recent case reports detail necrosis of the earlobes and cheeks in cocaine users.

One patient developed tender, palpable, purpuric plaques on both cheeks and earlobes, with central areas of necrosis. Another developed tender, red plaques with central necrosis on her face, legs, thighs, butt…

Reviewing Author

Mark V. Dahl, MD

Disclosures

Consultant / Advisory board Ulthera, Inc.; AuBio LifeSciences, LLC; Paris Therapeutics

Equity Elorac, Inc.; Makucell, Inc.; Paris Therapeutics

Editorial boards UpToDate

Leadership positions in professional societiesNational Rosacea Society (Chairman, Medical Board)