Alcohol skin changes F10.1

Alcohol-induced skin changes occur either by direct (alcohol-toxic) or by indirect effects of chronic alcohol abuse on the skin.

Direct changes on the skin are alcohol-toxic or toxic changes due to its degradation product aectaldehyde (reaction is catalyzed by alcohol dehydrogenase ) with effects on epidermis, sebaceous glands, sweat glands and vessels of the skin.

Indirect changes are pathological secondary symptoms of the skin, which result from alcohol-related changes of other organs (see e.g. alcoholic fatty liver disease AFDL; e.g. toxic cardiomyopathy).

• Direct (toxic) skin lesions of the epidermis, sebaceous glands, sweat glands, and vessels of the skin:
  • Launois-Bensaude syndrome: The anabolic effect on adipose tissue leads to atypical fat distribution either as a shoulder-accentuated "cushingoid" form or as an abdominal-accentuated form ("beer belly").
  • Xerosis (in eczema, exsiccation eczema) of the integument and/or enhancement of pre-existing sebostasis due to diuretic effect of alcohol.
  • Nail changes: red lunulae; leukonychia; striation ( Terry nail, Muehrcke bands).
• Dermatoses that may aggravate with chronic alcohol consumption:
  • Rosacea
  • Rhinophyma
  • Acne vulgaris
  • Seborrheic eczema
  • Psoriasis vulgaris.
• Indirect skin changes resulting from alcohol-related changes in other organs:
  • Leukonychia (Terry's nails; Muehrcke's bands), koilonychia
  • Feminization (as a result of the hepatic-induced disturbance of hormone metabolism, there is a reduction of axillary, pubic and chest hair in men with development of a female type of hair and feminization with gynecomastia and testicular atrophy).
  • Porphyria cutanea tarda
  • Symptomatic pellagra due to malabsorption with decreased serum levels for vitamins A,_B1, B6, B12, C, and D.
  • Acroosteopathia ulcero-multilans non-familiaris: as a consequence of an alcohol-induced poyneuropathy, dissociated sensory disturbances in the area of pressure points lead to painless ulcers up to destruction of the bone skeleton with spontaneous fractures.
  • Hyperhidrosis pedum et manuum
  • Palmar erythema
  • Pancreatic panniculitis
  • Eruptive xanthomas (alcohol-induced hypertriglyceridemia).
  • Rubeosis faciei
  • Facies ethylica
  • Flush
  • Erythema palmare et plantare symptomaticum
  • Nevus araneus (spidernaevi)
  • Muscular atrophy of the lower extremities (lanky legs -stork legs)
  • Elastosis of the facial skin
  • Hemorrhages (petechiae or ecchymoses)
  • Skin atrophy (paper money skin)
  • Caput medusae
  • Salivary gland hypertrophy (sialadenosis)
  • Parotid swelling
  • Phrynoderm (vitamin A deficiency due to chronic alcohol consumption with consecutive xerosis cutis and follicular hyperkeratosis)
  • Dupuytren's contracture
  • Tremor with gait instability.

1. Fuchs J (1999) Alcoholism, malnutrition, vitamin deficiencies, and the skin. Clin Dermatol 17: 457-461
2. Smith KE, Fenske NA (2000) Cutaneous manifestations of alcohol abuse. J Am Acad Dermatol 43: 1-16
3. Vogl A et al (2005) Skin and alcohol. J Dtsch Dermatol Ges 3: 788-790