Payne-James J J, Munro M H W, Rowland Payne C M E
Forensic Healthcare Services Ltd., 19 Speldhurst Road, London, UK.
J Forensic Leg Med. 2007 Feb;14(2):65-71. doi: 10.1016/j.jcfm.2006.01.013.
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: (i) Perniosis with cold, numb hands, sometimes with perniotic hyperkeratosis over the knuckles.(ii) Finger pulp atrophy of the distal part of the pulps of some digits, especially the thumbs and index fingers.(iii) Claw-like curvature of the nails. As the distal pulp is lost, it can no longer splint the nail straight and so the nail curves, claw-like, and reminiscent of a parrot's beak as it clings to the new contour. As the pulp atrophy progresses, the nail eventually also becomes smaller.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.
近年来，英国对强效可卡因产生依赖的人数大幅增加。一些长期使用强效可卡因的人，手部外观会出现粗糙变化。这些变化在女性中最为常见，包括：（i）冻疮，手部冰冷、麻木，有时指关节处有冻疮性角化过度。（ii）部分手指远端指腹萎缩，尤其是拇指和食指。（iii）指甲呈爪状弯曲。由于远端指腹萎缩，无法再使指甲保持笔直，于是指甲弯曲成爪状，就像鹦鹉的喙紧贴新轮廓一样。随着指腹萎缩加剧，指甲最终也会变小。这三联征可能是由于强效可卡因引起外周血管收缩导致局部缺血所致。早期改变在戒毒后可能会消失。在所述患者中，该综合征似乎与静脉注射毒品无关。无论吸食还是静脉注射，即使不伴有海洛因使用也可能发生。并非所有强效可卡因使用者都会出现该综合征。据推测，具有血管反应性循环的人（即有血管运动不稳定/冻疮的人）更容易出现这种反应模式。由冻疮、指腹萎缩和指甲呈鹦鹉喙状爪形组成的综合征应提醒临床医生注意长期滥用强效可卡因的可能性。
