Can Alcohol Cause Rashes?

Those who drink alcohol regularly or abuse alcohol are more likely to develop alcohol-related skin conditions and rashes. These are not dangerous or life-threatening, but they can develop into other conditions or potentially lead to health risks.

The most common skin conditions caused or exacerbated by alcohol are: [1] [2]

• Flushing and hives
• Rosacea
• Jaundice
• Hyperpigmentation
• Pruritus
• Psoriasis
• Urticarial reactions (hives)
• Porphyria cutanea tarda
• Cutaneous stigmata

People often focus on the specific health conditions that alcohol can cause, such as liver disease. However, exceeding healthy alcohol limits can easily impact your skin, affecting its appearance and leaving the skin vulnerable to other risks.

This impact is visible and can be treated long before organ damage can, so seek help as soon as you notice any changes.

Dermatological conditions are usually the first sign of alcohol abuse. Alcohol addiction or an alcohol use disorder is defined as the significant impairment of control over alcohol.

The American Psychiatric Association stated that alcoholism is characterised by: [3]

• Failure to fulfil obligations
• Use of alcohol despite physical hazards, legal problems, and social consequences
• Increased tolerance
• Withdrawal symptoms

Skin reactions are commonly associated with alcohol consumption as a result of genetics, the environment, drug and medication interactions, and the toxins in alcohol:

• Genetics (alcohol intolerance): alcohol may cause a skin reaction due to the genetic inability to process and metabolise alcohol. This is common in people of East Asian descent; individuals tend to experience red flushing of the skin, warm or hot skin, and hives on their chest, face, and neck.
• Drug interactions: some antibiotics and other drugs result in extreme flushing. For example, metronidazole (used to treat bacterial infections) leads to skin reactions when used whilst consuming alcohol. This may also lead to nausea and vomiting, headaches, and severe stomach pain.
• How alcohol is prepared and consumed: alcohol is sometimes mixed with preservatives and other impurities that may lead to skin conditions and reactions. Alcoholic drinks are also mixed with other ingredients that someone may be allergic or intolerant to, causing flushing and rashes.
• Existing allergies: existing allergies such as rosacea flares up after alcohol consumption. Alcohol does not cause rosacea, but existing skin conditions such as psoriasis and eczema can be exacerbated and cause further skin conditions.

Facial Redness, Rashes, and Flushing

Those who drink alcohol are more likely to develop a rash and skin condition caused or exacerbated by alcohol. Most reactions to alcohol are visible on the face, either from an allergic reaction, intolerance to alcohol, or pre-existing skin conditions.

These conditions may last for a short or long period of time, depending on alcohol consumption and genetic makeup.

The most common symptom of alcohol intake is facial flushing, one of the symptoms of alcohol intolerance. This reaction to alcohol is linked to a genetic mutation, originally from Asian ancestry.

Alcohol flush reaction is characterised by a red face, hives, asthma, and headaches. This usually starts on the face but may spread to the neck and chest.

People that flush from alcohol consumption struggle to metabolise alcohol properly. When the body breaks down alcohol, alcohol dehydrogenase (ADH) is converted into acetaldehyde which is toxic to the body.

The result of unmetabolised acetaldehyde is the release of histamine, triggering uncomfortable symptoms.

The redness will fade away once the alcohol leaves the person’s body. This flushing is not usually a cause for medical concern unless you are experiencing flushing and a high heart rate without consuming alcohol. If this is the case, seek medical attention.

Flushing may also be the presence of rosacea, another skin condition linked to alcohol consumption. Rosacea is characterised by redness of the skin, looking like flushing or blushing.

However, unlike flushing, alcohol does not cause rosacea but exacerbates its symptoms.

It may be hard to differentiate between rosacea and alcohol flushing. Alcohol flushing primarily occurs when an individual consumes alcohol, whereas those with rosacea tend to be permanently red or pink in the cheeks, with larger red flare-ups when they consume alcohol.

Other Skin Conditions and Alcohol Consumption

Below, we list other skin conditions that may be caused by alcohol consumption:

1. Spider Telangiectasias (angiomas)

Spider telangiectasias, or angiomas, is a vascular change that is associated with alcohol consumption. These are pink or red growths on the skin, appearing as expanded vessels. Alcohol thins the blood, stimulates blood flow, and enlarges the blood vessels, causing ‘spider veins’.

The pulsation of the vessels is visible, looking like spiders’ legs. These are common on the face, neck, chest, arms, and stomach. [4]

These are usually surrounded by other dilated veins or vascular markers of alcohol abuse. Spider telangiectasias are accompanied by flushing, ingestion, and tachycardia (fast heart rate). [5]

2. Jaundice

Jaundice is the yellowing of the skin, and discolouration due to high levels of bilirubin. When red blood cells break down, they release bilirubin into the body.

This is broken down by the liver and combined with bile and flushed into the waste system. If the liver is failing to function properly, bilirubin can accumulate in the blood and body tissue.

When the bilirubin levels are above 2.5mg/dL, jaundice is likely to set in. Bilirubin is metabolised in three different phases:[6]

1. The prehepatic
2. The intrahepatic
3. The posthepatic

Excess amounts of bilirubin bind tissues to elastin, a protein in the body. The ocular sclera (the white outer layer of the eye) has a high concentration of elastin, meaning it is the first part of the body to present with jaundice.

This is a common symptom of liver disease, caused by an excess of bilirubin.

3. Hyperpigmentation

Liver disease caused by alcohol may lead to hyperpigmentation and erythema. This is more common in people of colour and has also been linked to excess melanin. [7]

Hyperpigmentation is characterised by dark patches of skin compared to other parts. ‘Hyper’ (more), and ‘pigment’ (colour), mean that hyperpigmentation appears as black, brown, grey, red, or pink spots or areas on the skin. These may be called sunspots or liver spots.

4. Pruritus

Pruritus is a symptom of alcohol abuse, associated with alcoholic liver disease. Pruritus is chronic itchy skin, most noticeable on the palms of the hands and soles of the feet. [8] 

If the patient rubs or scratches these areas of skin, it may lead to:

• Excoriations: the tearing of the surface of the skin
• Lichenification: the skin becomes thick and leathery
• Prurigo nodules: itchy firm bumps and lumps of the skin

5. Psoriasis

The National Psoriasis Foundation has warned people that drinking alcohol can increase the chances of developing psoriasis or exacerbate already uncomfortable symptoms. Psoriasis is an inflammatory skin disease affecting around 5% of people in Western countries.

In the basal epidermal layer of the skin, there is an increased cell proliferation along with a differentiation in the apical section of the epidermis. [9]

Psoriasis is caused by both genetic and environmental factors:[10]

• Stress: stress can cause psoriasis, and psoriasis can cause stress
• Drugs: some drugs can aggravate pre-existing skin conditions
• Smoking: smoking can damage the communication between cells, and contributes to the gene response that triggers psoriasis
• Alcohol: alcohol affects the metabolism of lipids (organic compounds) and their composition of the skin barrier.

Psoriasis may develop at any point in someone’s life, affecting all parts of the body but mostly the hands and the fingers.

6. Liver Disease

Alcohol addiction and excess consumption drastically increase patients’ risk of liver damage and chronic liver disease.  The presence of skin rashes can be an early indicator of liver disease and liver damage.

Alcohol-related liver damage may cause cirrhosis of the liver, where the liver is covered in damaged scar tissue.

When the liver is not functioning properly, it is not able to break down and remove toxins or waste produces. The liver cannot then process bile, produce clotting proteins, or produce albumin.

Over one-third of people never develop symptoms of cirrhosis, but others tend to:

• feel tired and generally unwell
• lose their appetite
• lose weight
• have enlarged fingertips (clubbing)
• present with jaundice

Most patients will also present with red or purple rashes, tiny dots, or large blotches. These are caused by bleeding from blood vessels on the surface of the skin.

The skin may also become itchy, and yellow deposits of fat may appear under the skin and eyelids. Patients may also have red palms (palmar erythema), and spider angiomas as a result of faulty liver functioning.

When to Seek Help

Alcohol consumption may cause rashes and other skin conditions. These may not be high-risk or life-threatening themselves, but they may be masking other severe medical conditions such as alcohol-induced liver failure.

Skin conditions may be caused or exacerbated by heavy drinking, as a result of alcohol allergies, ingredients in alcohol, or genetic conditions.

As soon as you see the following signs and symptoms, seek medical attention and medical advice:

• Dry skin
• Red and itchy skin
• Alcohol rash
• High blood pressure and fast heart rate
• Shortness of breath
• Flushing or blushing
• Hives and sweating
• Spider veins
• Psoriasis and pruritus
• Hyperpigmentation
• Rosacea and eczema
• Red spots and patches

Treatment for alcohol rashes and other skin conditions generally consists of cutting out or down on alcohol. Once alcohol is removed from the body, most of the symptoms mentioned will disappear.

Everyone metabolises alcohol differently according to their:

• Genetics
• Body weight and fat percentage
• Hydration
• Gender
• Food intake
• Allergies

In mild cases, all patients are advised to avoid alcohol altogether. In severe cases, medical treatment and intervention may be required

References

[1] Kostović K, Lipozencić J. Skin diseases in alcoholics. Acta Dermatovenerol Croat. 2004;12(3):181-90. PMID: 15369644.

[2] Liu SW, Lien MH, Fenske NA. The effects of alcohol and drug abuse on the skin. Clin Dermatol. 2010 Jul-Aug;28(4):391-9. doi: 10.1016/j.clindermatol.2010.03.024. PMID: 20620755.

[3] American Psychiatric Association. Substance-related disorders. American Psychiatric Association: DSM-IV, diagnostic and statistical manual of mental disorders (4th ed), American Psychiatric Association (APA), Washington, DC (1994), pp. 191-296

[4] Foutch P., Sullivan J., Gaines J.Cutaneous vascular spiders in cirrhotic patients: correlation with hemorrhage from esophageal varices. Am J Gastroenterol, 83 (1988), pp. 723-726

[5] Umulis D.M., Gurmen N.M., Singh P., et al. A physiologically based model for ethanol and acetylaldehyde metabolism in human beings. Alcohol, 35 (2005), pp. 3-12

[6] Roche S.P., Kobos R. Jaundice in the adult patient. Am Fam Physician, 69 (2004), pp. 299-304

[7] Mills P., Skerrow C., MacKie R. Melanin pigmentation of the skin in primary biliary cirrhosis. J Cutan Pathol, 8 (1982), pp. 404-410

[8] Bergasa N.V., Mehlman J.K., Jones E.A. Pruritus and fatigue in primary biliary cirrhosis. Best Pract Res Clin Gastroenterol, 14 (2000), pp. 643-655

[9] gawa E, Sato Y, Minagawa A, Okuyama R. Pathogenesis of psoriasis and development of treatment. J Dermatol. 2018;45(3):264–272. doi: 10.1111/1346-8138.14139

[10] Zink A, Herrmann M, Fischer T, et al. Addiction: an underestimated problem in psoriasis health care. J Eur Acad Dermatol Venereol. 2017;31(8):1308–1315. doi: 10.1111/jdv.14326

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