Photo Rounds

Sores on arms

A 19-year-old woman asked her family physician (FP) to look at the sores on her arms that had developed 2 weeks earlier. At first she denied picking at her skin. Her FP noted that there were excoriations, but no scabies burrows.

What's your diagnosis?


This patient was given a diagnosis of methamphetamine-induced self-excoriations, also known as meth mites.

The FP in this case suspected methamphetamine use and obtained a drug use history. The young woman admitted to smoking methamphetamine in a pipe, and said that when she did, her skin became itchy and she compulsively picked at it. Methamphetamine users may experience formication, the hallucination that bugs are crawling under the skin. The skin excoriations resulting from picking at the imagined bugs are known as meth mites.

Methamphetamine is known on the street as meth, crank, ice, and crystal. It is abused by smoking, injecting, snorting, and oral ingestion. Smoking or injecting the drug gives an intense, short-lived “flash” or rush. Snorting or oral ingestion creates euphoria, but no rush. Effects of methamphetamine use—euphoria, increased libido, and impaired judgment—may lead to increased high-risk sexual behaviors such as unprotected sexual intercourse and contact with multiple sexual partners. As a result, methamphetamine users are at increased risk of contracting sexually transmitted infections including human immunodeficiency virus.

Treatment involves referral to a 12-step program. Crystal Meth Anonymous is a 12-step program modeled on the 12 steps of Alcoholics Anonymous. If Crystal Meth Anonymous meetings are not available, any 12-step program can help in recovery and maintaining sobriety. While there are currently no Food and Drug Administration-approved medications to help treat methamphetamine dependence, several medications under study have shown favorable early results, including modafinil, bupropion, and some antiepileptic drugs.

In this case, the patient was given a prescription for a moderate strength topical steroid (0.1% triamcinolone cream) and encouraged to seek treatment for her drug addiction.

Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Rowe, M, Schechtman A. Methamphetamine. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. The Color Atlas of Family Medicine. New York, NY: McGraw-Hill; 2009:994-999.

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