Skin changes associated with alcohol and drug abuse can be the earliest clinical manifestation of these disorders. The signs associated with these conditions may be distinctive and easily recognizable. Alcohol abuse can present with jaundice, pruritus, hyperpigmentation, and urticaria. Commonly associated vascular changes include spider telangiectasias, angiomas, caput medusas, flushing, and palmar erythema. Disease states related to alcohol abuse include psoriasis, porphyria cutanea tarda, and nutritional deficiencies. Alcohol abuse may predispose to the development of carcinomas of the skin, oropharynx, liver, pancreas, and breast. Cutaneous signs of drug abuse include skin granulomas, ulcerations, and recurrent infections. Specifically, oral disease and tooth decay are examples of stigmata often associated with methamphetamine abuse, a popular and inexpensive drug now on the scene. By being cognizant of these cutaneous markers of alcohol and drug abuse, dermatologists are often in the unique position of being able to recognize these changes, prompting early diagnosis and intervention, hopefully resulting in a better clinical outcome for these troubled patients and their families.
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