Dry July Foundation is a registered charity dedicated to raising funds to provide comfort and support for those affected by cancer. For the participants, having 31 alcohol-free days may include many benefits such as increased energy, better quality sleep and a chance to reassess their lifestyle choices.1
This could also be a good opportunity to reflect on the effects of alcohol on the body. Long-term or heavy consumption of alcohol impacts the body in many ways including vitamin depletion, tissue damage, disruption of inflammatory responses and a diminished ability of fibroblasts to make Type I collagen.2 3
Ethanol metabolism occurs primarily in the liver and involves the production of acetaldehyde, a highly reactive and toxic metabolite. Acetaldehyde mediates fibrogenic and mutagenic changes through functional impairment of key proteins such as enzymes and DNA.4
In addition to the detrimental effects on the liver, ethanol can directly vasodilate blood vessels through enhancement of ionic currents and nitric oxide release leading to chronic dilation of blood vessels.3
This is associated with a long list of health conditions affecting many of the body’s organs including the liver, the cardiovascular system and the body’s largest organ, the skin.
Alcohol and the Skin
A systematic review and meta-analysis of the risk factors associated with skin aging found that less severe skin aging, photoaging, wrinkling and dryness were associated with the micronutrients present in a healthful diet.5
Alcoholic liver damage leads to the loss of vital nutrients from the diet through decreased nutrient absorption and storage and the inability to convert the nutrients to their bioactive forms.3 Common nutrients of concern directly associated with skin care include:
Lipids – skin lipids provide a flexible barrier and are crucial to the structure and function of the skin, essential for skin hydration and maintenance of the skin barrier.6 Acetaldehyde and AGE adducts (AA-AGE) can be observed after chronic alcohol exposure, increasing lipid peroxidation. AGE accumulation and interaction with RAGEs interfere with cell signalling pathways contributing to organ and tissue pathophysiologies.7
Vitamin A – a lipid-soluble nutrient integral in the skin’s antioxidant defence system; dermal carotenoid concentration is diminished through alcohol consumption.2 Skin becomes vulnerable to follicular hyperkeratosis, dry scaling and deep fissures.3
B vitamins – water-soluble vitamins are critically essential for energy metabolism and biochemical processes in the body; alcohol consumption disrupts absorption, storage and active conversion of Vitamin B1, B6 and folic acid. Deficiency can lead to peripheral oedema, waxy skin and glossitis. 3 8
Zinc – is an essential micronutrient involved as a component of the many metalloenzymes and transcription factors required for the regulation of lipid, protein and nucleic acid metabolism and gene transcription. 9 Poor absorption, transportation into cells and increased excretion as a result of excessive alcohol ingestion are detrimental to all bodily systems, manifesting as poor wound healing, eczematous plaques, hair loss, inflammation around the mouth and lips and beau lines on the fingernails. 3 10
Pathologies affecting skin
Flushing – transient reddening on the face, neck and upper arms as a direct result of the accumulation of acetaldehyde in the body. 3
Spider angiomas – an abnormal grouping of dilated blood vessels close to the surface of the skin due to the direct vasodilatory effects of alcohol. 3
Urticaria – abnormal red swollen patches of skin on the upper part of the trunk and extremities that can occur within 10 minutes of exposure to ethanol metabolites. 3
Skin Cancer – there is an association with alcohol use possibly due to the combined effect of acetaldehyde cytotoxicity, the production of reactive oxygen (ROS) and nitrogen species (RNS), nutritional deficiencies, immunosuppression and changes in folate metabolism. The risk of basal cell and squamous cell carcinoma increases with alcohol consumption due to reduced UV protection in the skin from an alcohol-induced carotenoid reduction and the accumulation of alcohol metabolites in the skin acting as photosensitizer. 3
Pigment changes – hyperpigmented patches from excess melanin production, worse in sun-exposed areas of the body, may develop in people with alcohol-induced chronic liver disease. 3
Hair and Nail Changes – chronic misuse of alcohol can lead to hair loss and thinning through nutritional deficiency and hormonal changes. Clubbing, thickening of nails, longitudinal ridging, brittle nails and splinter haemorrhages are some of the nail changes associated with alcoholic cirrhosis. 3
Psoriasis – local proinflammatory cytokine production from concentrated cutaneous alcohol in addition to lymphocyte and keratinocyte proliferation. 3
Rosacea – alcohol consumption is cited as both a risk factor and exacerbating factor through vasodilation of blood vessels. Consumption as low as 1 – 4 grams of alcohol per day is associated with an increased risk of rosacea in women. Microbiota homeostasis is significantly affected by the acetaldehyde created through gut microbiota oxidation of ethanol leading to small intestinal bacterial overgrowth, a factor involved in the pathogenesis of Rosacea. 3
Damage to the Barrier Function – alcohol metabolites can promote the proliferation of skin keratinocytes leading to increased skin permeability. Skin lipid composition is also compromised through the altered metabolism of triglycerides and cholesterol. 11
Skin Wrinkling – consumption of more than 40 g of ethanol per day is significantly associated with skin wrinkling and increased upper facial lines. 2
Under-eye puffiness – heavy alcohol use is associated with under-eye puffiness, oral commissures, and midface volume loss. Alcohol abuse is associated with reduced fat mass, which may indirectly cause the unveiling of suborbital fat pads as the midface volume diminishes. 2
Advanced Glycation End Products (AGEs) – produced under conditions that increase lipid peroxidation, polyol pathway and Maillard reaction such as exposure to alcohol. Ethanol and its reactive metabolites are also likely involved in AGE synthesis pathways. AGEs have the ability to produce ROS and RNS in addition to oxidative stress and inflammation, leading to structural and functional protein alterations, cellular disfunction and apoptosis. Cross-linking of AGEs with connective tissue proteins such as elastin and collagen can alter the elasticity and function of the protein. 7
Dehydration – alcohol works as a diuretic through suppression of vasopressin (antidiuretic hormone) release. 12 Cutaneous water content plays a role in skin barrier function as a major component of cells and tissues. It is required as a solvent for organic compounds and solutes and as a carrier with a central role in cell homeostasis. Dehydration of the skin through diuretics such as alcohol may negatively impact the mechanisms of normal skin physiology13 leading to premature aging and dry skin.
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FROM THE LAB | DRY SKIN + HYDRATION
From the Lab - Author: Dale Savins, BNat, BAppSc(FoodTech)
2. GOODMAN, D. et al. Impact of Smoking and Alcohol Use on Facial Aging in Women: Results of a Large Multinational, Multiracial, Cross-sectional Survey. The Journal of clinical and aesthetic dermatology, v. 12, n. 8, 2019 Aug 2019. ISSN 1941-2789.
7. RUNGRATANAWANICH, W. et al. Advanced glycation end products (AGEs) and other adducts in aging-related diseases and alcohol-mediated tissue injury. Experimental & Molecular Medicine, v. 53, n. 2, p. 168-188, 2021-02-10 2021. ISSN 2092-6413.
13. PALMA, L. et al. Dietary water affects human skin hydration and biomechanics. Clinical, Cosmetic and Investigational Dermatology, v. 8, p. 413-421, 2015.