Alcohol is very prevalent in our society — consumption ranges from a glass of wine with dinner to serious alcohol dependencies. Depending on where you get your information, alcoholism affects from 10 to 20% of the American population — a pretty substantial number of people. Most of us are familiar with the side effects of excessive drinking on our bodies but drinking has serious effects on your skin. Some of these effects can be seen with mild alcohol consumption, while some occur with alcoholism and liver damage.
What Can Happen Within a Few Hours of Drinking
Within a few hours of alcohol consumption, an allergic reaction such as urticaria can occur. Even the smallest amount of alcohol can cause an allergic reaction in a susceptible person. Regular alcohol consumption also worsens the symptoms of existing skin conditions e.g. seborrheic dermatitis (SD), eczema, psoriasis and psoriatic arthritis, and even acne.
Dilation of Blood Vessels, probably the most well known effect, seen even in infrequent drinkers, is a flushed face. In time dilation of blood vessels can become permanent, leading to formation of spider veins. These affect mainly the face, chest, abdomen, arms, and hands.
The reason for dilation is twofold: alcohol directly affects the blood vessels, but in the long run, liver damage leads to cirrhosis and portal hypertension. The portal circulation is a network of blood vessels that feed the liver, and when blood pressure increases in these vessels, resistance to blood flow in them increases, which shunts blood flow to collateral blood vessels, which then dilate.
Another stigma of long term alcoholism and liver damage is red palms (palmar erythema). Of course it makes sense that rosacea, a disease worsened by dilation of blood vessels, would be exacerbated by alcohol consumption and alcoholism.
What Else Can Happen From the Liver Damage
Liver damage can do more than just cause red palms too.
It causes a raise in bilirubin levels, leading to jaundice (yellow skin), as bilirubin has an affinity for elastin, which is abundant in the skin (it is also quite abundant in the sclera, which is why the eye whites turn yellow).
Bile stagnation accompanying liver failure causes itching (pruritus). There are no actual skin manifestations apparent, but rather itching leads to problematic scratch marks, skin thickening, infection, and skin discoloration.
A type of photosensitivity that is associated with liver damage in alcoholism is called porphyria cutanea tarda. PCT develops due to a decrease in the activity of an enzyme in the heme biosynthesis pathway (called uroporphyrinogen decarboxylase), which leads to accumulation of porphyrins in the skin. Porphyrins act like UV magnets. Sun exposed skin becomes fragile, blistered, crusted, and scarred.
What Can Happen Over Time From Prolonged Drinking
Alcoholism is also known to be associated with hyperpigmentation, especially around the eyes, around the mouth, and darkening of freckles.
Alcohol causes skin to become dry. Alcohol (like coffee, by the way!) is a diuretic. This might not be a problem with infrequent drinking, but regular, long term consumption of alcohol dries the skin, especially if water drinking is not consciously regulated. Alcohol also accelerates skin aging: at age 30, an alcoholic would look quite older than a 30 year old non-alcoholic.
Due to a combination of various nutritional deficiencies and impaired immunity, an alcoholic is also at an increased risk of skin infections, such as tinea pedis, or oral candidiasis.
Alcohol consumption causes various vitamin deficiencies, leading to many skin manifestations such as dry, thick skin (vit A), inflamed mouth angles (vit B2 and 6), or impaired wound healing (vit C)
Nail changes that are associated with alcoholism but not specific to it include clubbing, white bands (Muehrcke nails) or whitening of the majority of the nail (Terry nails).
Alcoholism is associated with many forms of cancer, among which is an increased risk of basal and squamous cell carcinoma. This increased risk may be due to an immunosuppressive effect, as well as nutritional deficiencies that are related to alcohol consumption.
Bottom Line
Alcoholism is a big obstacle to overcome. I realize there are many more things to worry about beyond the skin skin, but here is hoping that this list of skin manifestations will perhaps push someone in the right direction to save their lives, bodies, and skin, and put the minds of the ones they love at ease. Good luck always.
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Sources:
SW. Liu et al. The Effects of Alcohol and Drug Abuse on the Skin. Clinics in Dermatology 2010; 28 (4): 391-9.
AM. Tobin et al. Prevalence of Psoriasis in Patients with Alcoholic Liver Disease. Clinical and Experimetal Dermatolgoy 2009; 34 (6): 698-701.
A Jensen et al. Intake of Alcohol may Modifay Risk of Non-Melanoma Skin Cancer: Results of a Large Danish Prospective Cohort Study. Journal of Investigative Dermatology 2012; advanced publication online 14 June 2012.