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Cocaine mucosal ulcer - Oral Mucosal Lesion
Other Resources UpToDate PubMed

Cocaine mucosal ulcer - Oral Mucosal Lesion

Contributors: Vivian Wong MD, PhD, Susan Burgin MD, Carl Allen DDS, MSD, Sook-Bin Woo MS, DMD, MMSc
Other Resources UpToDate PubMed


Cocaine use is associated with mucosal disease with subsequent painful ulcerations. As cocaine is absorbed through the mucosal membrane, it produces vasoconstriction, anesthesia, and local ischemic necrosis of the mucosal tissue (and sometimes the cartilage and bone). The pathology can occur in multiple organ systems, including the ocular, nasal, oral, and gastrointestinal systems, with serious sequelae such as perforations, fistula, and stricture formation. Agranulocytosis, which can occur secondary to cocaine (and the additive levamisole), contributes to superinfections.

Related topic: Cocaine use disorder


T40.5X5A – Adverse effect of cocaine, initial encounter

403665005 – Drug-induced oral ulceration

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Trauma (eg, Corneal abrasion)
  • Cytomegalovirus retinitis
  • Herpetic keratoconjunctivitis (Herpes simplex virus keratitis, Herpes simplex virus conjunctivitis)
  • Ocular cicatricial pemphigoid (cicatricial pemphigoid)
  • Invasive fungal infections, eg, Aspergillosis, Mucormycosis, Disseminated Fusarium infection, Coccidioidomycosis, Histoplasmosis, Blastomycosis, and dematiaceous fungi infections (eg, Alternariosis, Chromoblastomycosis, Cutaneous pheohyphomycosis)
  • Rhinoscleroma (Klebsiella rhinoscleromatis)
  • Leprosy
  • Cutaneous tuberculosis
  • Tertiary syphilis
  • Giant cell arteritis
  • Buerger disease
  • Granulomatosis with polyangiitis (formerly known as Wegener granulomatosis)
  • Sarcoidosis
  • Cutaneous squamous cell carcinoma
  • Extranodal NK/T-cell lymphoma, nasal type
  • Chemotherapy-induced mucositis
  • Herpangina
  • Hand, foot, and mouth disease
  • Orofacial herpes simplex virus
  • Cytomegalovirus infection
  • Aphthous stomatitis
  • Behçet syndrome
  • Erosive Oral lichen planus
  • Necrotizing sialometaplasia
  • Oral lupus erythematosus
  • PFAPA syndrome (periodic fever, aphthae, pharyngitis, cervical adenitis)
  • MAGIC syndrome (mouth and genital ulcers with inflamed cartilage)
  • Pemphigus vulgaris
  • Mucous membrane pemphigoid (cicatricial pemphigoid)
  • Paraneoplastic pemphigus
  • Salivary gland neoplasms (Benign salivary gland tumor, Malignant salivary gland tumor)
  • Drug-induced oral ulcer (especially from NSAIDs)
  • Chemotherapy-induced mucositis
  • Helicobacter pylori infection
  • Stress-induced Gastric ulcer
  • Inflammatory bowel disease (Ulcerative colitis, Crohn disease)

Best Tests

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Management Pearls

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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Last Updated:11/19/2019
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Cocaine mucosal ulcer - Oral Mucosal Lesion
A medical illustration showing key findings of Cocaine mucosal ulcer : Cocaine use
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