Alcohol skin changes F10.1

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

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

Indirect changes are pathological secondary skin phenomena which are caused by alcohol-induced changes in other organs (see e.g. alcoholic fatty liver diseases AFDL).

• Direct (toxic) skin changes on epidermis, sebaceous glands, sweat glands and vessels of the skin:
• Launois-Bensaude syndrome: The anabolic effect on the fatty tissue leads to atypical fat distribution either as shoulder-emphasized "cushingoid" form or as abdominal form ("beer belly").
• Xerosis (in eczema, desiccation eczema) of the integument and/or reinforcement of a pre-existing sebostasis by diuretic action of alcohol.
• Nail alterations: red lunulae; leukonychia; striation ( terry nail, Muehrcke's bands).
• Dermatoses which can be aggravated by chronic alcohol consumption:
• Rosacea
• Rhinophyma
• acne vulgaris
• seborrheic eczema
• Psoriasis vulgaris.
• Indirect skin changes caused by alcohol-induced changes in other organs:
• Leukonychie (Terry nails; Muehrcke's ligaments), Koilonychie
• Feminization (as a result of the hepatic disorder of hormone metabolism, men experience a reduction of axillary, pubic and breast hair with development of a female hair type and feminization with gynecomastia and testicular atrophy).
• Porphyria cutanea tarda
• Symptomatic pellagra by malabsorption with reduced serum levels for vitamins A,_B1, B6, B12, C and D.
• Acroosteopathia ulcero-multilans non-familiaris: as a consequence of alcohol-induced polyneuropathy, dissociated sensory disturbances occur in the area of pressure points to painless ulcers up to destruction of the skeleton with spontaneous fractures.
• Hyperhidrosis pedum et manuum
• Pancreatic panniculitis
• Eruptive xanthomas (alcohol-induced hypertriglyceridemia).
• Rubeosis faciei
• ethylliac facies
• Flush
• Erythema palmare et plantar symptomaticum
• Nevus araneus
• Muscular atrophy of the lower extremity (slender legs [stork legs])
• Elastosis of the facial skin
• Hemorrhages (petechiae or ecchymoses)
• paper money skin atrophy
• caput medusae
• Salivary gland hypertrophy
• Phrynoderm (vitamin A deficiency due to chronic alcohol consumption with consecutive xerosis cutis and follicular hyperkeratosis)
• Dupuytren's contracture
• Tremor with gait insecurity.

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