Cocaine is a powerful central nervous system stimulant, and its use creates a cascade of physiological effects that manifest visibly across the head and facial structures. The drug’s primary action on the body, especially its impact on blood flow, initiates a range of structural, dental, and dermatological consequences. This physical damage is often chronic and can be irreversible, affecting the nasal cavity, the mouth, and the skin. This article focuses exclusively on the visible, physical harm cocaine inflicts on the face.
Structural Damage to the Nasal Cavity
Intranasal cocaine use, commonly known as snorting, exposes the delicate internal tissues of the nose to the drug’s potent chemical effects. Cocaine acts as a strong vasoconstrictor, causing the blood vessels in the nasal lining, or mucosa, to narrow significantly. This constriction reduces the blood supply, which carries oxygen and nutrients, to the underlying cartilage and bone structure of the nose.
The resulting lack of oxygen and chronic irritation leads to a condition called ischemia, which causes the nasal tissues to become starved and inflamed. Over time, this chronic deprivation of blood flow results in necrosis, or tissue death. The initial damage often presents as persistent nosebleeds, chronic congestion, and frequent sinus infections, which can mask the severity of the structural breakdown occurring deeper within the nasal passage.
As the tissue deterioration progresses, the cartilaginous wall separating the nostrils, known as the nasal septum, begins to erode. This process ultimately leads to a septal perforation—a hole that forms through the septum. The presence of this perforation can cause a whistling sound when breathing, crusting, and a sense of nasal obstruction.
If the destruction continues, the main structural support of the nasal bridge is lost. This can cause the mid-face structure to collapse inward, resulting in a distinct disfigurement known as a saddle nose deformity. Furthermore, the vasoconstrictive process can extend beyond the nasal cavity to the roof of the mouth, creating a palatal perforation.
Oral Health and Jaw Function
Cocaine’s stimulating properties and chemical composition significantly compromise the health of the mouth, teeth, and jaw. A common consequence is xerostomia, or chronic dry mouth, often colloquially termed “coke mouth.” The reduction in saliva flow removes the mouth’s natural defense mechanism, which is essential for neutralizing acids and washing away food particles and bacteria.
This loss of protective saliva drastically accelerates the rate of tooth decay, leading to severe dental caries and gum disease, known as periodontitis. The chemical act of rubbing cocaine directly onto the gums, sometimes to intensify the numbing effect, can cause localized gingival lesions, severe gum recession, and localized bone loss due to the drug’s concentrated vasoconstriction.
Another major consequence stems from the drug’s central nervous system stimulant effect, which causes involuntary muscle activity. This manifests as bruxism, the chronic clenching and grinding of the teeth and jaw. This constant stress leads to the wearing down of tooth enamel, cracked teeth, and fractures.
Chronic bruxism also strains the temporomandibular joints (TMJ), resulting in temporomandibular joint disorders. Patients often experience chronic facial pain, headaches, and difficulty fully opening or closing the mouth.
Circulatory and Dermatological Effects
The systemic effects of cocaine on the circulatory system have a noticeable impact on the face’s complexion and skin integrity. The drug’s persistent vasoconstriction throughout the body limits blood flow, which deprives facial skin of adequate oxygenation and nourishment. This poor circulation can cause the skin to develop a grayish or unhealthy pallor, sometimes giving the face a dull or “waxy” appearance.
Chronic systemic stress and malnutrition accelerate the aging process of the skin. This results in the premature appearance of wrinkles, a loss of elasticity, and a generally worn look. The skin’s ability to heal is also compromised due to the restricted blood flow, making the user more susceptible to infections and slowing the recovery of any wounds or sores.
A more specific dermatological manifestation involves drug-induced psychological effects. Cocaine use can trigger formication, a tactile hallucination where the user feels as if insects are crawling beneath the skin, often referred to as “coke bugs.” This intense sensation leads to compulsive picking, scratching, and digging at the skin, a behavior known as excoriation.
These excoriations often result in open sores, scabs, and visible scarring across the face, neck, and other accessible areas. Additionally, some illegal adulterants used to “cut” cocaine, such as the veterinary drug levamisole, can trigger vasculitis, a severe form of inflammation in the blood vessels. This can lead to painful, dark purple patches and necrosis on the face, particularly on the earlobes and cheeks.