Dermatological manifestations associated with chemsex

Summary

Chemsex—the use of psychoactive substances to enhance sexual activity, especially among gay, bisexual, and other men who have sex with men—is linked to a range of skin and mucosal complications. Dermatologists often encounter these manifestations first. Lesions vary by substance and route of administration: poppers dermatitis is common and frequently misdiagnosed as impetigo; MDMA causes oral mucositis and painful aphthous-like ulcers from bruxism and xerostomia; injection-related lesions from mephedrone and ketamine can resemble infections or vasculitis, leading to delayed diagnoses; cocaine with levamisole can cause cutaneous necrosis and vasculitis; GHB/GBL may lead to traumatic genital injuries due to reduced pain sensitivity; and constricting devices can cause mechanical trauma and penile deformities. Increased awareness of these signs supports earlier recognition and non-stigmatizing risk-reduction advice.

Study at a glance

Abstract

Abstract Chemsex involves the use of psychoactive substances to facilitate or enhance sexual activity, particularly among gay, bisexual, and other men who have sex with men (GBMSM). Common substances used include methamphetamine, gamma‐hydroxybutyric acid/gamma‐butyrolactone (GHB/GBL), mephedrone, ketamine, inhaled nitrites (‘poppers’), and cocaine, all of which are linked to various dermatological complications. Dermatologists are often the first to recognize skin and mucosal manifestations in chemsex users, providing an opportunity for timely intervention and risk reduction. A targeted literature search until January 2026 was conducted using PubMed/MEDLINE to identify relevant publications on chemsex‐associated dermatological manifestations. The studies included were observational, case series, case reports and clinical guidelines, focusing on the clinical presentation, substances involved and routes of administration. Cutaneous and mucosal lesions vary depending on the substance and route of administration. Poppers dermatitis , commonly seen in GBMSM, is a well‐defined manifestation and often misdiagnosed as impetigo. 3,4‐Methylenedioxymethamphetamine (MDMA), often used in chemsex, leads to oral mucositis and painful aphthous‐like ulcers due to its acute effects, such as bruxism and xerostomia. Injection‐related lesions from substances like mephedrone and ketamine are particularly concerning, often resembling infectious or vasculitic processes and frequently leading to delayed diagnoses. Cocaine use, especially when combined with levamisole, can cause cutaneous necrosis, vasculitis and soft tissue infections. GHB/GBL use may cause traumatic genital and perianal injuries due to reduced pain sensitivity, while alprostadil injections can result in localized oedema, haematomas or fibrosis. Lastly, constricting devices used in chemsex settings can lead to mechanical trauma, ischaemic injury and chronic complications like fibrosis and penile deformities. Chemsex is a significant public health concern with dermatological implications. Improved awareness of characteristic cutaneous and mucosal lesions can support earlier recognition, targeted investigation and non‐stigmatizing risk‐reduction advice and referral. More prospective studies and standardized diagnostic criteria are needed to enhance the management of chemsex‐related dermatological and systemic complications.

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