Systemic candidiasis in heroin abusers. Cutaneous findings.

Systemic candidiasis in intravenous drug abusers (IVDA) is a new syndrome caused by Candida albicans and characterized by the sequential development of skin, eye, and osteoarticular lesions, which together form a typical clinical picture. We studied 30 patients with suggestive skin lesions: papules, nodules, and pustules in hair-bearing areas, particularly the scalp and beard area, associated with hair invasion by candidal hyphae. Ocular and osteoarticular involvement and presence of candidemia in some of the patients suggested blood-borne colonization of C. albicans. The infection has been related to "brown" heroin. The origin of C. albicans and the reasons for its exclusive localization in the skin and these organs are discussed. The characteristic clinical picture is widely different from that of classic disseminated candidiasis in immunodeficient patients. Therapy is also discussed.