Dermatological findings in chronic alcoholics

Sudhir Kumar

 Department of Neurological Sciences, Christian Medical College, Vellore - 632 004, India

Correspondence Address:
Sudhir Kumar
Department of Neurological Sciences, Christian Medical College Hospital, Vellore - 632004, Tamilnadu
India

Sir,

I read with great interest the recent article by Dr. G.S. Rao describing the changes in the skin, nails, hair and oral cavity.[1]

The author′s efforts are commendable. However, I would like to make certain observations and draw attention to other dermatological manifestations in alcoholics not reported by the author. These include type I allergic skin manifestations, palmoplantar hyperhidrosis (PPH), spontaneous skin necrosis,[2] and increased risk of basal cell carcinoma (BCC). Allergic skin manifestations in alcoholics occur due to a combination of a direct effect of alcohol and an indirect effect through elevation of IgE.[3] Alcoholics are frequently noted to have PPH. As the findings of peripheral nerve conduction (sympathetic skin responses) studies do not differ between alcoholics with PPH and those with primary PPH, hyperhidrosis is believed to occur due to impaired central sweat control mechanisms.[4] In a large prospective cohort study, the total alcohol and white wine intake were associated with a higher risk of occurrence of BCC in both men and women.[5]

In addition, chronic alcohol consumption affects the clinical presentation and treatment responsiveness of certain dermatological conditions. Excess alcohol consumption is associated with the onset and flare-up of psoriasis and discoid eczema.[6] Alcoholism also leads to a poor response to anti-psoriatic treatment,[7] and contributes to an excess mortality in patients with psoriasis.[8]

1.	Rao GS. Cutaneous changes in chronic alcoholics. Indian J Dermatol Venereol Leprol 2004;70:79-81. [Google Scholar]
2.	Tee WS, Chan HL, Suri R. Spontaneous skin necrosis in alcoholic liver cirrhosis. Int J Dermatol 1998;37:78-9. [Google Scholar]
3.	Mujagic H, Prnjavorac B, Mujagic Z, Festa G. Alcohol in alcoholic liver disease is a causative factor for development of allergic skin manifestations. Med Arh 2003;57:273-8. [Google Scholar]
4.	Tugnoli V, Eleopra R, De Grandis D. Hyperhidrosis and sympathetic skin response in chronic alcoholic patients. Clin Auton Res 1999;9:17-22. [Google Scholar]
5.	Fung TT, Hunter DJ, Spiegelman D, Colditz GA, Rimm EB, Willett WC. Intake of alcohol and alcoholic beverages and the risk of basal cell carcinoma of the skin. Cancer Epidemiol Biomarkers Prev 2002;11:1119-22. [Google Scholar]
6.	Higgins EM, du Vivier AW. Cutaneous disease and alcohol misuse. Br Med Bull 1994;50:85-98. [Google Scholar]
7.	Gupta MA, Schork NJ, Gupta AK, Ellis CN. Alcohol intake and treatment responsiveness of psoriasis: A prospective study. J Am Acad Dermatol 1993;28:730-2. [Google Scholar]
8.	Poikolainen K, Karvonen J, Pukkala E. Excess mortality related to alcohol and smoking among hospital-treated patients with psoriasis. Arch Dermatol 1999;135:1490-3. [Google Scholar]