Cocaine consumption is increasing at an alarming rate. This drug produces euphoria, anorexia, increased alertness and diminished sleep requirements. It is estimated that up to 80 % of cocaine is contaminated with levamisole, a substance which may potentiate the drug’s chemical effects [ 1 ] . Multiple mucocutaneous manifestations have been associated with cocaine use [ 2 ] , including cocaine-induced pyoderma gangre-nosum (CIPG), cocaine-induced midline destructive lesions (CIMDL) and retiform purpura (RP). We present three cases of cocaine abuse with skin lesions compatible with PG, and review the epidemiological, clinical, histopathological and immunological characteristics of CIPG and RP. We suggest that these two conditions are more closely related than previously thought. Additionally, in our opinion, no specific immunological or histological profile would be indicative of levamisole toxicity.