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Cocaine that is diluted with a commonly used veterinary drug can cause serious skin reactions, according to a new report. The U.S. Department of Justice reports that approximately 71 percent of cocaine in the United States is contaminated with levamisole, which is used to deworm livestock.

In the new report, published in the Journal of the American Academy of Dermatology, doctors describe how six patients who smoked or snorted cocaine diluted, or “cut,” with levamisole, developed patches of purple dead skin on their ears, nose, cheeks and other parts of the body. Some of the cocaine users had permanent scarring caused by the drug, HealthDay reports.

“We believe this case series may represent the tip of the iceberg as a looming public health problem caused by levamisole,” the researchers wrote.

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