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Definition and Epidemiology

Cocaine is an alkaloid, derived from Erythroxilon coca leaves, which has been used for centuries for its euphoric and analgesic properties. Even though debated for its side effects, the use of cocaine as a vasoconstrictor agent in local anesthesia procedures is still licit in common medical practice (Kasemsuwan and Griffiths 1996; De et al. 2003). Cocaine abuse is a social problem of increasing importance. For instance, in the United States up to 6 million inhabitants can be considered habitual or occasional users, and 30 million have used it at least once in their life (Seyer et al. 2002).

Addiction to such a drug may have local or systemic effects, which depend on abuse duration, the form of administration, and the amount of the doses. The frequent observation of sinonasal lesions is due to the fact that inhalation (or "snorting") of cocaine powder is the most common form of administration. Nevertheless, addiction may exert also systemic negative effects, such as an increase in blood pressure and in the risk of arrhythmias and heart ischemia, due to vasoconstriction. Local damage may be attributed to several factors, including decreased mucocili ary beat frequency (Hofer et al. 2003), vasoconstriction, traumatic effect of crystals insufflated at high velocity, local superinfection, and irritant action of adulterants (Lancaster et al. 2000; Trimarchi et al. 2001; Vilela et al. 2002).

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