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Krokodil is a commonly used street name for desomorphine, an injectable opioid derivative that is associated with severe dermatologic effects. We report a case of a woman who had extensive ulcerations after a single use of this narcotic. To our knowledge, this is the first case report of the cutaneous manifestations of krokodil use in the dermatologic literature. A year-old woman with a history of intravenous drug abuse presented to the emergency department complaining of increased pain and swelling in her hands and forearms secondary to nonhealing ulcers. She injected this substance into both forearms and immediately noticed a burning sensation during infusion. The patient noted gradual progression of the ulcers over several months, which eventually became malodorous with areas of necrosis. Although she has not injected krokodil since, she does admit to occasionally injecting heroin into other body parts, which has not resulted in a similar reaction.