Lower extremity manifestations of “skin-popping” an illicit drug use technique: A report of two cases

•Crack downs on “pill mills” have led to the resurgence of intravenous drug use.•The skin popping technique can lead to devastating wounds.•A team approach is required to manage the social and medical issues.

Presented is a rare case of tibial and fibular osteomyelitis and a case of fibular periositis, both a direct consequence of a peculiar drug use technique. The osseous manifestations secondary to presentation of necrotic wounds with indurated rim and serous drainage with associated cellulitis, both resulting from “skin popping.” Due to the complex treatment plan required, the importance of a motivated patient, a strong social support system, a controlled environment, and a multidisciplinary team cannot be overstated. Despite comprehensive efforts, devastating consequences may be unavoidable as individuals plunge downward, victimized by their addiction.Level of clinical evidence4.