How Alcoholism Affects Appearance

Edmund Murphy
Dr. Celeste Small
Written by Edmund Murphy on 19 November 2021
Medically reviewed by Dr. Celeste Small on 09 September 2024

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.

Key takeaways:
  • 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.
Close-up of blue eye and wrinkled skin with visible red veins.

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.

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. 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.

Here's what Dr. Kachniarz had to say:

What are spider veins? 

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]


Dr. Bart Kachniarz

Medical advisor

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. 

What is generalized pruritus?

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]


Dr. Bart Kachniarz

Medical advisor

Porphyria cutanea tarda (PCT)

Porphyria cutanea tarda (PCT) is another indicator of liver disease and is most commonly caused by alcohol use disorder. 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).

Porphyria Cutanea Tarda (PCT)

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]


Dr. Bart Kachniarz

Medical advisor

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 and skin cancer

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]


Dr. Bart Kachniarz

Medical advisor

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.

Alcoholic nose, drinkers nose, bulbous nose

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. 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.

Yellow eye, alcohol induced jaundice, alcoholic eyes, alcoholic liver

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:

Does alcohol cause 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. [7]


Dr. Bart Kachniarz

Medical advisor

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

Alcohol itself is calorie-dense, containing 7 calories per gram compared to 4 calories per gram in carbohydrates and proteins. A standard 12-ounce beer has around 150 calories, while a glass of wine can range from 100 to 200 calories. Regularly consuming these drinks can add up to a significant calorie surplus, leading to weight gain over time. [7]

Dr. Bart Kachniarz

Medical advisor

Inhibition of fat burning

When alcohol enters the bloodstream, the body prioritizes its metabolism over other fuels like carbohydrates and fats. This means fat burning slows down, and excess calories from food and alcohol get stored as fat, potentially increasing weight. A 2015 study in the American Journal of Physiology with 233 participants found that alcohol consumption, even in moderate amounts, significantly reduced fat oxidation at rest. [7]

Dr. Bart Kachniarz

Medical advisor

Increased appetite and cravings

Alcohol disrupts hormones that regulate hunger and satiety, like leptin and ghrelin. This can lead to increased appetite and cravings for unhealthy, high-calorie foods, particularly salty and fatty snacks. A 2014 study in the Journal of Clinical Endocrinology & Metabolism with 49 participants) showed that alcohol ingestion led to increased post-meal ghrelin levels (hunger hormone) and decreased leptin levels (satiety hormone), potentially promoting overeating. [7]

Dr. Bart Kachniarz

Medical advisor

Poor dietary choices

Under the influence of alcohol, individuals are more likely to make unhealthy food choices than when sober. This can involve choosing fast-food options, high-calorie mixed drinks, or overeating due to impaired judgment. A 2011 study in the International Journal of Obesity with 201 participants) found that heavy drinkers consumed more calories from fat and saturated fat compared to moderate or non-drinkers. [7]

Dr. Bart Kachniarz

Medical advisor

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. 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. 

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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Resources:

  1. Liu SW, Lien MH, Fenske NA. The effects of alcohol and drug abuse on the skin. Clinics in Dermatology 2010; 28: 391–9.
  2. Li CP, Lee FY, Hwang SJ. Spider Angiomas in Patients with Liver Cirrhosis: Role of Alcoholism and Impaired Liver Function. Scand J Gastroenterol 1999; 5: 520–3.
  3. Saladi RN, Nektalova T, Fox JL. Induction of skin carcinogenicity by alcohol and ultraviolet light. Clin Exp Dermatol 2009;35:7–11.
  4. Abram K, Silm H, Maaroos HI et al. Risk factors associated with rosacea. JEADV 2010; 24: 565–71
  5. Smith KE, Fenske NA. Cutaneous manifestations of alcohol abuse. J Am Acad Dermatol, 2000; 43 (1 Pt 1): 1–16.
  6. Kachniarz, B. Best Plastic Surgeon Miam. (n.d.). Belcerna Plastic Surgery. Retrieved February 5, 2024, from h

Activity History - Last updated: 09 September 2024, Published date:


Reviewer

Dr. Celeste Small

Pharm.D, RPh.

Celeste Small, PharmD. is a licensed and practicing pharmacist and medical writer who specializes in different substances, the effects of substance abuse, and substance use disorder.

Activity History - Medically Reviewed on 27 November 2021 and last checked on 09 September 2024

Medically reviewed by
Dr. Celeste Small

Pharm.D, RPh.

Dr. Celeste Small

Reviewer

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