Drugs and your skin

Drugs are more accessible than ever before. They are found at the supermarket e.g. alcohol, at local high street pharmacies e.g. birth control and on nights-out e.g. marijuana. Drugs are compounds which have a dramatic effect on an individual’s bodily functions, they can be medicines, they can be illicit drugs and they can be bodily poisons. The distinction is often in the quantity, the mode of use and the duration of treatment.

A glass or two of wine every week compared to a few bottles every night.

A short term treatment of cortisone cream versus many months of prolonged use.

A once off joint as opposed to a couple, several nights a week for the foreseeable future.

Drugs have a noticeable effect on the human body, this is often beneficial in the short-term however prolonged use rears ugly side effects. This is just as true for prescription drugs as it is for illicit drugs. Drugs such as;

  • Alcohol
  • Birth control
  • Viagra
  • Antimalarial
  • Cortisone
  • Chemotherapy
  • Marijuana
  • Methamphetamine

…being common examples of drugs which may have short term function with many prominent long term side effects. As with many drugs, consumption is by administration i.e. by tablet. Oral administration leads to drug compounds being distributed throughout an individual’s blood stream and therefore being able to effect a person’s entire body – a result visualised easily by a person’s skin.

Alcohol and your skin

Alcohol is a staple of western culture. It’s indulged in after a hard day’s work, as a celebration for special occasions and most often in excess on a night out. Alcohol is so freely available it’s easily forgotten as a drug, a toxin, a stimulant and a sedative1.

As with many drugs, the side effects of long term alcohol use will not be visualised till many years later. In the case of alcohol, this is through skin effects such as;

    • Facial flushing
    • Vascular changes such as spider telangiectasias/angiomas2
    • Exacerbation of skin disorders such as rosacea3 and psoriasis4
    • Pruritus (itching)
    • Hyperpigmentation5
    • Dry and inelastic skin caused by nutritional deficiency6
    • Skin infections due to immune suppression
    • Nummular dermatitis a form of eczema

    Vascular changes are a very common side effect of alcohol over indulgence. Abuse conditions do not need to be breeched to see their effects. Severity and risk of vascular changes are dependent in part on heritage. Persons of Asian descent have a heightened 40% chance of experiencing regular facial flushing on consumption of alcohol due to lack of the aldehyde dehydrogenase enzyme responsible for breaking down alcohol by-products.

    Normal alcohol intakes may cause short term flushing, however above average alcohol intake has the potential to lead to chronic facial erythema described as spider telangiectasias or angiomas. Alcohol provokes vasodilatation and its continued use prevents normal vasoregulatory control with prominent side effects7.

    Birth control and your skin

    Methods of birth control based upon heightened estrogen and progesterone levels are frequently associated with two skin based side effects;

      • Hyperpigmentation
      • Acne which may be worsened or bettered dependent on type of contraceptive

      Hyperpigmentation which can also present as melasma when induced by hormonal changes is commonly connected with the use of birth control8. The darkening of skin may be treated with depigmenting agents such as kojic acid, however skin effects may only become fully resolved after discontinuation of the offending medicine. Once use has been suspended the remaining pigmentation may persist for several years9.

      Acne is commonly known as a hormonal condition and in testament to this cause, is often provoked by puberty, stress and pregnancy. Therefore it comes as little surprise that contraceptives may both cause and relieve the condition dependent on the type being prescribed. Oral contraceptives such as norgestrel, norethindrone acetate and levonorgestrel are commonly linked to acne. Whereas oral contraceptives such as Yasmin (drospirenone and ethinyl estradiol) are indicated to help relieve acne. The distinction is in the type of hormone and its dose. Acne requires a heightened level of sebum production to progress and sebum levels are in turn controlled by hormone levels.

      Viagra and your skin

      With over 25 million Viagra prescriptions being filled within 10 years of its launch, it’s surprising to learn of this drugs more sinister side effects. In 2014 concerns were rising regarding the observed association between the use of sildenafil citrate (Viagra) and increased incidence of melanoma10. As with many drugs, the active nature of their ingredients is often active in more than just one biological pathway. In the case of Viagra it appears the drug is also able to increase the invasiveness of melanoma cells therefore raising a person’s melanoma risk.

      Melanoma is the most aggressive and most serious form of skin cancer accounting for the majority of skin cancer deaths. In the western population the incidence of melanoma has nearly doubled every decade11. Since the association of Viagra with melanoma further studies have gone on to confirm that in vitro sildenafil administration promotes biochemical signals for the growth and migration of melanoma cells therefore leading to increased tumour growth. Further studies are needed to evolve the exact risk, however small scale studies currently point to a 3% increase in diagnosis of melanoma.

      Antimalarial drugs and your skin

      Whether headed on holiday or living short-term in an area affected by malaria, antimalarial medication has time and time again proven to save lives. However these lifesaving benefits do not come without risk of side effects. When taking antimalarial medications, users should be aware of common skin side effects and consider switching to an alternate medication if they perceive contraction of an associated skin condition.

      Antimalarial medications such as Mefloquine are associated with a 4-10% change of pruritus commonly known as an itch and up to a 30% chance of skin rash. Less frequently observed side effects include hives, facial lesions and vasculitis12.

      Antimalerials such as chloroquine, hydrocychloroquine, amodiaquine and quinacrine are associated with an increased risk of hyperpigmentation13. This darkening of skin is experienced in up to 25% of patients with discolouration ranging from yellow-brown to grey pigmentation. Such cases of hyperpigmentation most frequently occur when antimalarial drugs are used for over 4 months. Discontinuation may decrease pigmentation changes however appropriate use of lightening and brightening skincare actives may be required for a complete resolution.

      Steroid creams and your skin

      Steroid creams such as hydrocortisone are commonly prescribed to treat inflammatory skin conditions such as allergic reaction, eczema and psoriasis. Topical glucocorticoid steroid creams work by suppressing the natural reaction or in the case of allergy, eczema and psoriasis, the overreaction of the skins immune system. By suppressing the immune system, inflammation is relieved and inflammatory skin disorders subside.

      Over use of steroid creams such as hydrocortisone eventually lead to thinning of the skin, wrinkling, broken capillaries, stretch marks in non-facial areas and skin fragility. The combination of these effects are known as steroid atrophy. Use of steroid creams inhibit the normal biological processes needed to renew skin. With skin cells averaging a lifetime of 30 days, changes caused by topical steroid creams quickly visualise. Collagen production declines, skin cell size decreases, skin thickness plummets and sebaceous gland activity drops. Within a month, dependent on the type of steroid cream used, skin may thin by up to 20%14.

      Chemotherapy and your skin

      Chemotherapy can effectively kill cancer cells however such a quickly acting treatment comes partnered with many side effects not least of which effect the skin. Most common is a condition colloquially referred to as ‘chemo rash’ – a dry rash diagnosed with dry skin scaling, rough and tight feeling skin, pimples and the feeling of itch or burn. One or many of these symptoms may be experienced.

      In addition specific chemotherapy drugs such as 5-fluorouracil, bleomycin, busulfan, cyclophosphamide, doxorubicin may cause hyperpigmentation, alongside 5-fluorouracil, methotrexate, bleomycin, doxorubicin and hydroxyurea increasing a person’s sensitivity to sunlight.

      Marijuana and your skin

      Pot, weed, cannabis or marijuana – it’s known by several names but by whatever name it is referenced, when smoked marijuana has considerably ageing skin effects. The key here, is when smoked. Smoking drugs such as marijuana causes 2 reactions to occur. Firstly, the deposition of particulate matter on skin via smoke and secondly the rapid free radical formation causing dramatic oxidative effects as a consequence of the very high temperatures reached at the tip of a cigarette.

      Smoking levies considerable oxidative stress to skin with studies showing that telomere length – an indication of age, is shortened by an increased 18% for every year of sustained smoking15. The particulate pollution matter generated by smoking is easily deposited onto skin due to the close proximity during formation. Particulate pollution particles found in smoke are commonly associated with the formation of hyperpigmentation e.g. age spots16.

      As with all types of smoking, the heat involved in cigarette combustion reaches temperatures of up to 900oC. At such temperatures free radical reactions are easily initiated and it’s these high energy atoms and molecules which provoke a very quick increase in skin ageing. An effect commonly known as the smokers pout.

      Methamphetamine and your skin

      Crack, meth and speed – look at the photos of methamphetamine users and it is clear this recreational drug considerably speeds the process of skin ageing. The use of meth initiates irregular fat metabolism and as fat is essential to every living cell of the body, considerable inflammation is provoked, a process which leads to premature ageing and finally cell senescence (cell death)17.

      Regular users of methamphetamine commonly experience pruritus or itch, colloquially known as ‘meth mites’18. The sensation of skin crawling provokes meth users to scratch and pick leading to sores, scabs, facial lesions and eventually scars.

      In addition if methamphetamine is smoked, the very same ageing side effects induced by smoking e.g. wrinkles, age spots and facial laxing will visualise themselves many years after the causing use has ceased.


      Sources and references

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

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      11. Sildenafil Potentiates a cGMP-Dependent Pathway to Promote Melanoma Growth. Dhayade S, Kaesler S, Sinnberg T, Dobrowinski H, Peters S, Naumann U, Liu H, Hunger RE, Thunemann M, Biedermann T, Schittek B, Simon HU, Feil S, Feil R. Cell Rep. 2016 Mar 22;14(11):2599-610. doi: 10.1016/j.celrep.2016.02.028.

      12. Dermatological adverse effects with the antimalarial drug mefloquine: a review of 74 published case reports. Smith HR, Croft AM, Black MM. Clin Exp Dermatol. 1999 Jul;24(4):249-54

      13. Drug- and heavy metal–induced hyperpigmentation. Granstein RD, Sober AJ. J Am Acad Dermatol. 1981 Jul;5(1):1-18

      14. Korting H, C, Unholzer A, Schäfer-Korting M, Tausch I, Gassmueller J, Nietsch K, -H, Different Skin Thinning Potential of Equipotent Medium-Strength Glucocorticoids.  2002;15:85-91

      15. Obesity, cigarette smoking, and telomere length in women. Valdes AM, Andrew T, Gardner JP, Kimura M, Oelsner E, Cherkas LF, Aviv A, Spector TD. Lancet. 2005 Aug 20-26;366(9486):662-4

      16. Mancebo, S. E. and Wang, S. Q. (2015), Recognizing the impact of ambient air pollution on skin health. J Eur Acad Dermatol Venereol, 29: 2326–2332. doi:10.1111/jdv.13250

         

      17. Giuseppe Astarita, Agnesa Avanesian, Benedetto Grimaldi, Natalia Realini, Zuzana Justinova, Leight V. Panlilio, Abdul Basit, Steven R. Goldberg, Daniele Piomelli. Methamphetamine Accelerates Cellular Senescence through Stimulation of De Novo Ceramide Biosynthesis. PLOS ONE, 2015; 10 (2): e0116961 DOI: 10.1371/journal.pone.0116961

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