Necrotic Lesions Associated with Desomorphine ("Krokodil") Drug Abuse: a Systematic Review.

Abstract

Objectives: This systematic review of case reports and case series aims to identify the types of necrotic alterations caused by desomorphine ("Krokodil") and the diagnostic methods used in such cases.

Material and methods: An advanced search was conducted on 30 January 2025 in the Web of Science, Scopus, and PubMed databases using the selected keywords and MeSH terms. The research was conducted in accordance with the PRISMA guidelines. A total of 54 records were identified and screened for eligibility. After meticulous evaluation by two independent reviews, 15 articles were included in this systematic review.

Results: Of the included 251 cases, 247 discussed osteonecrosis of the facial bones. Three out of the four cases discussing limb necrosis presented a high risk of bias. The most commonly used paraclinical diagnostic methods were: radiological examination (radiographs, cone-beam computed tomography, etc.), histopathological examination, microbiological tests, and blood tests. Other less common methods included scintigraphy and C-terminal telopeptide tests. This systematic review did not identify enough cases discussing desomorphine-associated skin lesions.

Conclusions: Desomorphine ("Krokodil") is a dangerous drug that causes different local and systemic damages, including soft-tissue lesions and bone necrosis. Future studies should focus on the distribution of the necrotic lesions according to the affected tissues/organs, and the possible correlation between the drug use period and the clinical findings.