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Medicine Grand Rounds - Cutaneous Manifestations of Illicit Substance Use

Dr. Call examines three common illicit drug categories that cause cutaneous disorders: methamphetamines, cocaine and opiates. He describes presenting symptoms that may indicate a substance use disorder, including necrotic excoriations, dental issues, burns, abscesses, and peripheral edema. He also describes devastating systemic complications, many resulting from inadvertent intra-articular injection, “skin popping”, added contaminants and infectious agents. Dr. Call provides an excellent framework for providers who see patients who present with cutaneous lesions that may indicate underlying illicit substance use.

Activity Details
Start Date: January 18, 2019
End Date: January 18, 2021

You may claim CME credit for successful completion of this online course. In order to claim credit, you must follow these steps:

  1. Register for the learning activity by creating an account or logging in to your account.
  2. Click Continue to navigate to the Activity Material tab. Click View Presentation to view the recording.
  3. Return to this Activity page.
  4. Click Continue to navigate to the Evaluation tab; then click the Launch button to start the evaluation.
  5. Complete and Submit the evaluation and attestation form.

When the evaluation is submitted, you will be awarded credit. You may access your transcript for verification of participation at any time via Your Account. Need help? Visit the Support Page, send an Email, or call the Center for Learning and Professional Development at (603) 653-1234, Option 1.

  • J. Elliott Call, MD
    Resident Staff, Section of Dermatology
    Department of Surgery
    Dartmouth-Hitchcock Medical Center  

    Dr. Call is from the San Francisco Bay area. He attended Brigham Young University majoring in Exercise Physiology and minoring in Business, and Texas A&M Medical School at the Baylor University Medical Center. He then completed his preliminary internship in internal medicine at the University of Utah before coming to Dartmouth Hitchcock Medical Center for his residency in dermatology.  He is an avid endurance athlete having completed numerous marathons and several Ironman triathlons. 

Learning Outcome

Participants will be able to describe the clinical manifestations and pathophysiology of common cutaneous conditions associated with illicit substance use; recognize local, systemic, and vascular complications of intravenous and subcutaneous injection drug use; and identify cutaneous conditions associated with adulterants, contaminants, infectious agents, and mechanical injury related to illicit substance use.


Dartmouth-Hitchcock is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Dartmouth-Hitchcock designates this enduring material for a maximum of 1 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Requirements for Successful Completion

In order to receive credit for this Continuing Medical Education (CME) activity, you must:

  • View the entire presentation
  • Complete the online Attestation of Attendance & Evaluation Form (you must register to access).

In accordance with the disclosure policy of Dartmouth-Hitchcock/Geisel School of Medicine at Dartmouth as well as standards set forth by the Accreditation Council on Continuing Medical Education and the Nursing Continuing Education Council standards set forth by the American Nurses Credentialing Center Commission on Accreditation, continuing medical education and nursing education activity director(s), planning committee member(s), speaker(s), author(s) or anyone in a position to control the content have been asked to disclose any financial relationship* they have to a commercial interest (any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on patients). Such disclosure is not intended to suggest or condone bias in any presentation, but is elicited to provide participants with information that might be of potential importance to their evaluation of a given activity.

The following Activity Physician Director(s), planning committee member(s), speaker(s), author(s) or anyone in a position to control the content for Cutaneous Manifestations of Illicit Substance Use (Medicine Grand Rounds) have reported the following financial interest or relationship* with various companies/organizations. Dr. Call report no conflicts of interest. The Activity Director and Planning Committee member roles were resolved by altering the individual’s control over content about the products or services of the commercial interest by the Associate Dean for CME and the Department of Medicine Chair. All potential conflict(s) were resolved.

* Kelly Kieffer, MD ~ her spouse is a consultant for OcculoBio. 

* Richard I. Rothstein, MD ~ has research support from Baranova (research grant to Dartmouth-Hitchcock Medical Center) and has other financial interest from Allurion. 

Other planning committee member(s), speaker(s), activity director(s), author(s) or anyone in a position to control the content for this program report no financial interest or relationship* with any company(ies) or organizations whose product may be germane to the content of their presentations.

*A “financial interest or relationship" refers to an equity position, receipt of royalties, consultantship, funding by a research grant, receiving honoraria for educational services elsewhere, or to any other relationship to a company that provides sufficient reason for disclosure, in keeping with the spirit of the stated policy.

Provider Contact Information

Provider contact information for questions regarding accreditation of the activity:

Center for Learning and Professional Development
Dartmouth-Hitchcock Medical Center

Type:     Internet Activity (Enduring Material)
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