Alcohol abuse can greatly affect both mental and physical health. It can also affect outward appearance, ranging from minor skin abnormalities to potentially life-threatening conditions. Recovered spoke with plastic surgeon Dr. Bart Kachniarz to understand exactly how alcohol abuse affects appearance and what can be done to rectify it.
- Also a common by-product of liver disease, jaundice is characterized by yellowing of the skin and sclera (the whites) of the eye. Some alcohol abusers suffering from jaundice will also experience darkening of the skin around the eyes, mouth, and legs.
- The appearance of rhinophyma, the large bulbous swelling of the nose, has long been associated with alcoholics, often being referred to as ‘drinkers nose’.
- ‘Alcoholic eyes’ is often used to describe the bloodshot eyes of heavy drinkers. Alcohol widens the blood vessels in the eyes, causing more blood to flow through them, increasing their appearance and volume.
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Alcohol and skin conditions
Alcohol is a diuretic, meaning it removes water from the body, causing dehydration. Excessive consumption of alcohol can cause the skin to become dry and flaky as well as causing irritation to the eyes, scalp, and other inflammation. [1]
Acne - Alcohol abuse reduces the body’s ability to process vital nutrients and vitamins that the skin needs to remain healthy. Over time, this can lead to impurities in pores and can cause aggressive acne. If left untreated, acne can lead to facial scarring.
Facial redness - Alcohol abuse reduces vascular control in the brain which can lead to blood vessels in the face becoming enlarged. Another cause of red skin around the face is due to acetaldehyde, a product of alcohol that can cause flushed skin by stimulating the release of histamine.[1] This is often referred to as ‘transient flushing’ and is common amongst alcoholics.
Jaundice - Also a common by-product of liver disease, jaundice is characterized by yellowing of the skin and sclera (the whites) of the eye. Some alcohol abusers suffering from jaundice will also experience darkening of the skin around the eyes, mouth, and legs.
Severe effects of alcohol on skin
We spoke to Dr. Bart Kachniarz from Belcerna Plastic Surgery in Miami about skin-related side effects of alcohol abuse and how they can be treated, if at all.
Spider veins
Spider telangiectasis, commonly referred to as ‘spider veins’ are characterized by a series of thin blood vessels radiating out from a larger central blood vessel. These are most commonly found on the face, chest, arms, and abdomen. Large clusters of spider veins are considered to be signs of liver disease as a result of hightened estrogen levels. [2]
Here's what Dr. Kachniarz had to say:
Alcohol dilates blood vessels, leading to enlarged visible capillaries known as spider veins. Studies report a high prevalence of spider veins in alcoholics, reaching 46.7% in one study.
How to rectify it
Laser therapy can effectively coagulate and remove visible veins. Sclerotherapy uses injections to collapse veins. Both methods show success rates exceeding 90%. Phlebectomy, a minimally invasive surgery, removes larger veins through tiny incisions. [7]
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Generalized Pruritus
Alcohol abuse causes the body to be unable to metabolize certain substances such as bile salts, corticosteroids, and histamine. The build-up of these substances causes generalized skin itching, which can lead to irritation, inflammation, and rashes.
Alcohol depletes essential nutrients like B vitamins, crucial for healthy nerve function. This can lead to nerve-related itching, known as generalized pruritus. Estimates suggest up to 25% of chronic itch cases relate to alcohol misuse.
How to rectify it
Addressing the underlying cause is key. Abstinence and B vitamin supplementation are crucial. Anti-itching creams and cooling baths can provide temporary relief. [7]
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Porphyria cutanea tarda (PCT)
Porphyria cutanea tarda (PCT) is another indicator of liver disease and is most commonly caused by alcohol use disorder. [3] Type 1 PCT occurs when porphyrins (part of red blood cells) build-up due to a deficiency in the production of the enzyme uroporphyrinogen decarboxylase (UROD), which is used to synthesis haem, a blood protein. The symptoms of PCT include fragile skin, blistering, photosensitivity, crusts, milia (small white bumps), scleroderma (hardened skin), erosions, and hypertrichosis (increased hair growth).
Alcohol disrupts iron metabolism, a major factor in PCT, a rare skin condition causing fragility, blistering, and scarring. While alcohol isn't the sole cause, studies find 70% of PCT patients have significant alcohol intake.
How to rectify it
Abstinence is critical. Phlebotomy to manage iron levels, phototherapy, and topical ointments can help manage symptoms. Blister drainage and skin resurfacing surgeries may be needed in severe cases. [7]
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Skin cancer
The links between alcohol and various types of cancer are well documented. Along with liver, breast, and pancreatic cancer, alcohol abuse also increases the risk of skin cancers such as basal cell carcinoma, squamous cell carcinoma, and melanoma.
Alcohol weakens the immune system and disrupts DNA repair, potentially increasing skin cancer risk. Research suggests a link between heavy drinking and various skin cancers, though more studies are needed to define precise risk ratios.
How to rectify it
Sun protection, regular skin checks, and addressing alcohol misuse are crucial. Topical retinoids may help prevent precancers. Standard cancer treatment options like surgery, radiation, and chemotherapy may be necessary depending on the cancer type and stage. [7]
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Alcoholism and the face
While alcohol also affects the skin on the face, there are various other symptoms that manifest specifically on different parts of the head as a result of alcohol abuse. Some of these are strong warning signs that someone might have an alcohol use disorder and are often collectively known as 'alcoholic face'. These include:
Oral changes and bad oral hygiene
Alcohol causes poor oral hygiene both through the build-up of bacteria and through dehydration. The most common oral symptoms of alcohol abuse include:
- Dry lips (cheilitis)
- Tooth decay (caries)
- Inflamed swollen gums/gingiva (gingivitis)
- Bright red and smooth tongue, mainly associated with Vitamin B deficiency
- Hairy tongue due to excessive bacteria
Combining alcohol and certain drugs causes the negative effects on oral hygiene to become worse. One of the most common forms of oral damage from substance abuse is through smoking meth, often referred to as meth mouth.
Alcoholic nose (Rhinophyma)
The appearance of rhinophyma, the large bulbous swelling of the nose, has long been associated with alcoholics, often being referred to as ‘drinkers nose’. In fact, studies have shown little support that alcohol directly causes the condition.
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Instead, most experts believe that rhinophyma can be caused over time by rosacea, a condition where the skin on the face becomes red and inflamed, hardening the skin.[4] Alcohol abuse increases vasodilation which in turn makes the effects of rosacea worse.
Alcoholic eyes
‘Alcoholic eyes’ is often used to describe the bloodshot eyes of heavy drinkers. Alcohol widens the blood vessels in the eyes, causing more blood to flow through them, increasing their appearance and volume. It can also cause yellowing of the sclera (whites) from jaundice caused by alcohol and liver complications.
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Alcohol also affects sleep, meaning eyes are often saggy and darker after long periods of alcohol consumption. It also means that individuals who abuse alcohol are more likely to be drowsy during the day, making driving and working potentially dangerous.
Thinning or dry hair
Alcohol not only dehydrates your skin but also your hair and hair follicles. This can lead to hair becoming brittle and prone to damage, as well as hair loss.
Facial bloating (puffy face)
‘Alcoholic face’ or ‘puffy face' is a result of the dehydrating effects of alcohol.
It can also cause the stomach to become swollen and bloated due to gas build-up, which can be uncomfortable and painful.
Here's what Dr. Kachniarz had to say about alcohol and facial bloating:
Yes, alcohol can cause facial bloating, and there are several studies to support this. A 2014 study in the journal Clinical Endocrinology found that alcohol disrupts the body's fluid balance, leading to water retention in the skin. This effect was observed in 52% of participants after consuming a moderate amount of alcohol. A 2020 study published in Nutrients also confirmed alcohol's diuretic effect and subsequent water retention, causing facial puffiness in 78% of individuals studied. A 2015 review article in World Journal of Gastroenterology highlighted alcohol's ability to trigger systemic inflammation, leading to swelling in various tissues, including the face.
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Alcohol and weight gain
The calories contained in alcohol are commonly referred to as ‘empty calories’, meaning they hold no nutritional value for the body. This means the body adds these calories onto the ones consumed via food every time we drink, which can often put people way over their calorie limit if they drink excessively. Our bodies also prioritize getting rid of alcohol as it is a toxin and can’t be stored like carbohydrates, proteins, or fats. This slows metabolism as the body prioritizes getting rid of alcohol calories, leading to weight gain.
Dr. Kachniarz identifies four areas in which alcohol can contribute to weight gain:
High-calorie content
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Inhibition of fat burning
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Increased appetite and cravings
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Poor dietary choices
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Other physical symptoms of alcoholism
There are many other areas of appearance outside of the skin and face that can be affected by alcohol abuse.
Odor
The liver processes most of the alcohol we drink but is unable to deal with all of it. For heavy drinkers and those with an alcohol use disorder, the remaining alcohol leaves the body via breath, sweat, and urine. This often causes an unpleasant smell that resembles rancid alcohol.
Nails, fingers, and hands
Some conditions that affect the hands, specifically the nails, are associated with liver disease and may be exacerbated by alcohol abuse.[6] These include ‘clubbing’ where the tip of the finger bulges around the nail plate, koilonychia (the nail plate is concave or spoon-shaped), and muehrcke nails which is characterized by white lines running parallel to the lunula (the moon of the nail). These conditions are linked to vasodilation and iron deficiencies which are indicators of liver disease.
Feet
As with water retention in the face and body due to the dehydrating effects of alcohol, the feet can also become swollen and discolored due to excessive alcohol abuse. Recurrent swelling may suggest an underlying issue with the kidneys, liver, or heart and should be seen by a doctor if continuing for more than two days in a row.
Alcoholic myopathy
Myopathy refers to diseases that affect the muscles. Alcoholic myopathy is a condition that causes loss of function, strength, and deterioration of muscles after prolonged excessive alcohol consumption or binge drinking.
Alcoholic myopathy can affect appearance by decreasing muscle mass, making arms and legs appear thin and weak. This is occasionally referred to as alcoholic skinny legs.
Treatment for alcohol-related physical symptoms
Alcohol-related physical symptoms can vary in how well they can be treated and how permanent the effects are. Inflammed blood vessels, rashes, sagging eyes, and odor issues can all be eased or eradicated through reduced alcohol consumption and medical treatment. Others, such as jaundice caused by liver disease and skin cancer are less treatable and are often a sign of end-stage alcoholism.
The best way to combat the physical symptoms of alcoholism is to address the underlying addiction before it becomes too late. Contacting an alcohol use disorder treatment center can help offer advice on where to begin with recovery and how to get help immediately. If you are worried that your or a loved one's drinking has become out of control, then contact a treatment provider today.
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