Eczema And Alcohol

In recent years, there have been connections made between alcohol and the triggers of eczema. This article will review the literature to determine whether alcohol and eczema are actually linked.

What is eczema?

Eczema, also known as atopic dermatitis, is one of the most common chronic skin conditions. It is usually diagnosed in children but even adults can be affected. A study reports that 60% of people with eczema will develop symptoms in their first few years of life.¹ 

The aetiology of the disease stems from a defective skin barrier due to immune dysregulation, gene mutations and environmental factors. The skin is our largest organ and plays an important role in immune defence and support. In people with eczema, the barrier is no longer able to keep the skin hydrated. Since the barrier has been breached, people with eczema are more likely to be afflicted with infections and have a different inflammatory response, so they are more sensitive to fragrances which can cause flare-ups of the disease. 

About 50% of patients suffering from eczema tend to develop asthma, which is probably connected with sensitivity to environmental allergens. Furthermore, there has been evidence supporting an association with genetic conditions. One such gene that has been implicated is one associated with cell maturity, filaggrin. 

Normally, filaggrin creates an impermeable barrier as it flattens the skin cells and packs them in such a way that hydration is maintained within the skin. However, if this gene goes awry water can leak out because there are no gaps between the cells. An important factor to consider with eczema is that the inflammation it causes is rarely constant and usually comes and goes with time. Therefore, it tends to flare up during periods of stress. 

Symptoms

Another name for eczema is “itch that rashes” due to its particular symptoms. Symptoms are similar in children and adults, but their distribution is different. Acutely, atopic dermatitis manifests with highly itchy red patches of skin that can sometimes cause blisters which then burst.² In babies and young children, it usually presents on the cheeks and sides of their legs and arms as well as the tummy and chest area. Adolescents and adults get a similar distribution with areas in between joints being more affected, such as the crooks of the elbows, behind the knees and the back of the neck. 

As previously stated, eczema is prone to flare-ups which means that the symptoms may come and go and may be worsened by lifestyle choices. In more chronic cases, you might get thickening of the skin if it is consistently affected.

There is no concrete evidence for alcohol being an eczema trigger

There seems to be an association between consuming alcohol during pregnancy and your child developing eczema.³ 

A type of eczema that seems to be directly linked to alcohol misuse is discoid eczema. This particular type, in which circular red bumps develop, seems to be linked to the liver not functioning well due to alcohol overconsumption. This is because alcohol can have adverse effects on the vasculature of the skin leading to skin damage.⁴ 

One proposed way in which alcohol triggers eczema is via contact dermatitis. This is when a substance comes into contact with the skin and causes manifestations of skin disease, which could cause triggers for patients with eczema.⁵ However, no study concluded that drinking alcohol causes eczema, and in most cases where it does so, it is often related to alcohol abuse.

How can alcohol trigger an eczema flare-up?

Alcohol metabolism causes a release of histamine 

Alcohol and histamine are related because they share two common enzymes: aldehyde dehydrogenase and aldehyde oxidase.⁶ This means that when alcohol is metabolised it can increase histamine release from mast cells and basophils. Histamine may well likely cause eczema flare-ups as it is a cause of pruritus also known as itching. This can be unbearable, leading to scratching, which causes more inflammation in the area triggering eczema. This is an endless cycle known as the “itch-scratch” cycle, which causes more inflammation leading to the progression of the disease process.⁷

It can lead to dehydration

One of the reasons why alcohol will make you feel thirsty is because it leads to diuresis in the body. The body will try to urinate more and more, which leaves you feeling thirsty as a result.⁸ But how does this affect the skin’s hydration? A study suggests that too much alcohol consumption may decrease the hydration level of the skin, thereby increasing the chance of triggering flare-ups in a person already suffering from eczema. However, this theory has not been fully validated in studies.⁹

If you’re worried about your or your loved one’s alcohol intake

Alcohol abuse can be of concern both for yourself and for the people around you. If you are worried about a loved one’s increasing alcohol intake, do not hesitate to reach out for help. Your healthcare provider will have an array of tools and helpful links.

Conclusion

Eczema is an autoimmune disease with a genetic association, which leads to painful, itchy and red skin. Several studies show how drinking alcohol during pregnancy can lead to your child developing eczema. However, the link between moderate alcohol intake and the development of flare-ups is still not well documented, even though there is reason to believe that increased histamine release can lead to drying of the skin. On the other hand, there have been direct links between alcohol abuse and discoid eczema. If you are concerned about your own, or a person you love's, alcohol consumption, please do not hesitate to contact your healthcare provider for advice or support.