The skin in alcoholism

Alcohol Promotes Lipogenesis in Sebocytes-Implications for Acne

The oral consumption of alcohol (ethanol) has a long tradition in humans and is an integral part of many cultures. The causal relationship between ethanol consumption and numerous diseases is well known. In addition to the well-described harmful effects on the liver and pancreas, there is also evidence that ethanol abuse triggers pathological skin conditions, including acne. In the present study, we addressed this issue by investigating the effect of ethanol on the energy metabolism in human SZ95 sebocytes, with particular focus on qualitative and quantitative lipogenesis. It was found that ethanol is a strong trigger for lipogenesis, with moderate effects on cell proliferation and toxicity. We identified the non-oxidative metabolism of ethanol, which produced fatty acid ethyl esters (FAEEs), as relevant for the lipogenic effect-the oxidative metabolism of ethanol does not contribute to lipogenesis. Correspondingly, using the Seahorse extracellular flux analyzer, we found an inhibition of the mitochondrial oxygen consumption rate as a measure of mitochondrial ATP production by ethanol. The ATP production rate from glycolysis was not affected. These data corroborate that ethanol-induced lipogenesis is independent from oxygen. In sum, our results give a causal explanation for the prevalence of acne in heavy drinkers, confirming that alcoholism should be considered as a systemic disease. Moreover, the identification of key factors driving ethanol-dependent lipogenesis may also be relevant in the treatment of acne vulgaris.

The effects of alcohol and illicit drug use on the skin

Early identification of cutaneous manifestations of alcohol and illicit drug use can aid in the diagnosis and management of these uses, as well as their sequelae. In addition, the effects of alcohol and illicit drug use on the skin can result in significant morbidity. Alcohol misuse can present with jaundice, pruritus, pigmentary alterations, urticaria, hair and nail changes, and oral changes. It is also a risk factor for skin cancer and infections. Vascular disturbances associated with alcohol misuse include telangiectasias, palmar erythema, caput medusae, and flushing. Diseases related to alcohol misuse include nutritional deficiencies, porphyria cutanea tarda, psoriasis, seborrheic dermatitis, nummular dermatitis, and rosacea. Other conditions seen in alcohol misuse include Dupuytren contracture, Peyronie disease, and pancreatitis. Dermatologists should also be aware of hepatotoxic medications that are commonly prescribed for skin diseases so as to avoid initiating hepatoxicity in patients who use alcohol. Illicit drug use can manifest with cutaneous fibrosis, scarring, granulomas, ulceration, pruritus, infections, cocaine-levamisole-induced vasculitis, tooth decay, and oral disease. By recognizing the cutaneous stigmata of alcohol and illicit drug use, dermatologists can aid in the identification and treatment of patients suffering from these addictions.

Association of Dermatoses with Duration and Quantum of Alcohol Intake: A Comparative Cross-sectional Study

Background:

Chronic alcohol intake impacts skin directly, through organ dysfunction or by modifying preexisting dermatoses. However, dermatoses afflicting chronic alcoholics figure in a few studies only.

Aim:

This study aims to correlate the spectrum of dermatoses in chronic alcoholics with the quantum/duration of alcohol intake and raised liver transaminases.

Materials and Methods:

Adult males, totaling 196, ascertained to fulfill the Royal College of Psychiatry criteria for chronic alcoholism by the de-addiction center and referred for dermatological consult were enrolled as cases, and similar number of age-/sex-matched teetotallers, as controls. Data emanating from detailed history, clinical examination, and routine liver functions tests were summarized and subsequently analyzed, including statistically using the Chi-square, independent “t” and Spearman's rank correlation tests, and compared with data from previous studies.

Results:

Majority (104) drank 41–50 units of alcohol/week since 3–40 (mean: 20.01 ± 9.322) years. Generalized pruritus (odds ratio [OR]: 31.15, P < 0.001), xerosis (OR: 3.62, P = 0.008), and seborrheic dermatitis (OR: 12.26, P < 0.001) were significantly more common in cases than controls. Infections (73; 37.2%), eczemas (45; 22.9%), and generalized hyperpigmentation (28; 14.2%) were the major presenting complaints. Spider nevi, gynecomastia, and pellagroid dermatitis were present in 34 (17.3%), 19 (9.7%), and 8 (4.1%) respectively exclusively in cases only. Commonly seen systemic abnormalities were an alcoholic liver disease (45; 22.9%), diabetes mellitus (23; 11.7%), and peripheral neuropathy (19; 9.7%).

Conclusion:

Knowledge of cutaneous manifestations of chronic alcoholism could prompt in-depth history taking of alcohol intake, lead to specialist referral and thereby enable timely de-addiction, hopefully before serious adversities in the chronic alcoholics.

Recurrent purpura due to alcohol-related Schamberg's disease and its association with serum immunoglobulins: a longitudinal observation of a heavy drinker

Background

It is unusual for purpura to emerge as a result of drinking alcohol. Such a peculiarity was observed in a 55-year-old man with a 30-year history of heavy alcohol use.

Case presentation

The Caucasian patient was studied for 11 years during several detoxification treatments. During the last 2 years of that period, purpuric rashes were newly observed. The asymptomatic purpura was limited to both lower limbs, self-limiting with abstinence, and reoccurring swiftly with alcohol relapse. This sequence was observed six times, suggesting a causative role of alcohol or its metabolites. A skin biopsy revealed histological features of purpura pigmentosa progressiva (termed Schamberg’s disease). Additionally, alcoholic fatty liver disease markedly elevated serum immunoglobulins (immunoglobulin A and immunoglobulin E), activated T-lymphocytes, and increased C-reactive protein. In addition, moderate combined (cellular and humoral) immunodeficiency was found. Unlike the patient’s immunoglobulin A level, his serum immunoglobulin E level fell in the first days of abstinence, which corresponded to the time of purpura decline. Systemic vasculitis and clotting disorders were excluded. The benign character of the purpura was supported by missing circulating immune complexes or complement activation. An alcohol provocation test with vinegar was followed by the development of fresh “cayenne pepper” spots characteristic of Schamberg’s disease.

Conclusions

This case report demonstrates that Schamberg’s disease can be strongly related to alcohol intake, in our patient most likely as a late complication of severe alcoholism with alcoholic liver disease. Immunologic disturbances thereby acquired could have constituted a basis for a hypersensitivity-like reaction after ingestion of alcohol. Schamberg’s disease induction by vinegar may point to an involvement of acetate, a metabolite of ethanol.

Study on dermatoses and their prevalence in groups of confirmed alcoholic individuals in comparison to a non-alcoholic group of individuals

BACKGROUND

The direct relationship between alcoholism and dermatoses has been evaluated in recent researches. However, there are few objective surveys that demonstrate and prove a direct relationship between alcohol and a specific dermatosis.

OBJECTIVES

to verify the prevalence of dermatoses in alcoholics, analize the dermatological changes found in these patients and their evolution during alcoholic abstinence. Also, to compare the results obtained with a non-alcoholic control group and with the data found in medical literature.

METHODS

the dermatologic conditions of 278 alcoholic patients (250 men, 28 women) were studied over a period of 4 years, and compared to those of a control group of 271 non-alcoholic individuals (249 men, 22 women), members of the Military Police Force. The individuals in both groups were between 20 and 60 years old.

RESULTS

Pellagra, nummular eczema, purpura pigmentosa chronica (also known as pigmented purpuric dermatosis) and psoriasis were more frequent in the group of alcoholics and, apparently, occurred in parallel with alcoholism that seems to play a role in the evolution of these dermatoses. The dermatopathies were more frequent before the age of forty, regardless of factors such as profession, race or gender.

CONCLUSION

the association of dermatoses and alcoholism was extremely significant according to the statistical data. Alcoholism can be considered a risk factor for pellagra, psoriasis, nummular eczema and purpura pigmentosa chronica dermatoses, which can, as well, be considered alcoholism indicators.

Seborrheic dermatitis

Seborrheic dermatitis is a common inflammation of the skin, occurring most often on the face, scalp and chest. It is closely related to infantile seborrheic dermatitis, or diaper rash. Seborrheic dermatitis is particularly common in patients with Parkinson's disease or with HIV/AIDS. The recent resurgence of interest in Malassezia yeasts has revived the old hypothesis that seborrheic dermatitis is caused by an altered relationship between these skin commensals and the host. Moreover, the success of antifungal medications in treating seborrheic dermatitis provides new evidence for this view.

LEARNING OBJECTIVE

Upon completing this paper, the reader should be aware of the clinical presentation of seborrheic dermatitis and which populations are at particular risk of developing this disorder. In addition, s/he will be aware of the role of Malassezia yeasts in seborrheic dermatitis and the way in which knowledge of the importance of these yeasts has altered the treatment of this disorder.

Cutaneous manifestations of alcohol abuse

Alcohol consumption and abuse can have a variety of cutaneous manifestations. In addition to the well-recognized stigmata of the chronic alcoholic patient, even early abuse can result in distinctive skin changes or exacerbate existing cutaneous disorders. An accurate history of alcohol intake will facilitate recognition of these alcohol-induced cutaneous disorders and treatment resistance of dermatoses such as psoriasis as well as help decrease morbidity in surgical procedures. Familiarization with the spectrum of cutaneous manifestations of alcohol abuse and alcoholic liver disease can also allow for early detection and treatment in an attempt to minimize the medical consequences. We review the medical literature and discuss the spectrum of dermatologic disease associated with the use and abuse of alcohol.

Oral effects of drug abuse

Drug abuse is a major problem in the U.S. and most other countries of the world today. Many studies, surveys, and case reports have described the adverse social and medical effects of drug abuse; yet surprisingly little is known about the specific effects of many of these drugs in the oral cavity. This article reviews the current state of knowledge concerning the systemic and oral effects of drugs of abuse and the dental management of addicted patients.

Alcoholism and skin disease

One hundred and one patients who met criteria for alcoholism were evaluated for dermatologic signs. There were 98 men and 3 women, with an average age of 40.85 years; 40 were white and 61 black. Significant findings were no skin disease in 19, acne in 27, folliculitis in 8, seborrheic dermatitis in 12, tinea pedis in 32, and xerosis in 7. Only two patients had rosacea, which is contrary to previously held beliefs about the drinker's nose.