Pseudosclerodermatous triad of perniosis, pulp atrophy and 'parrot-beaked'
clawing of the nails - a newly recognized syndrome of chronic crack-cocaine use

Payne-James JJ, Munro MH, Rowland Payne CM.
Forensic Physician,
Forensic Healthcare Services Ltd.,
19 Speldhurst Road, London E9 7EH, UK.
J Clin Forensic Med. 2006 Apr 5;


The number of people dependent on crack-cocaine in the UK has increased substantially in recent years. Some crack-cocaine users develop coarsening changes in the appearance of their hands after prolonged use of the drug. These changes have most often been recognized in females and include: This triad may be due to ischemia consequent upon peripheral vasoconstriction induced by crack-cocaine. Early changes may resolve with abstinence. In the patients described the syndrome does not appear to be to related to intravenous drug usage. It may occur without concomitant use of heroin, whether smoked or via the intravenous route. The syndrome does not occur in all crack-cocaine users. It is hypothesized that those with a vasoreactive circulation (i.e., those with vasomotor instability/perniosis) are more susceptible to this reaction pattern. The syndrome consisting of the triad of perniosis, pulp atrophy and parrot-beaked clawing of the nails should alert the clinician to the possibility of prolonged crack-cocaine misuse.

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