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The Effect Of Drugs and Alcohol On The Skin

David Hunter, MA.Ed, LPC

Medically reviewed by

David Hunter, MA.Ed, LPC

February 11, 2019

Drug and alcohol abuse can have a profound effect on the skin. Dehydration, poor health, and injection drug use pose significant risks in addition to the dangerous side effects of the substances themselves.

Dermatologic Signs and Symptoms of Substance Abuse

Many people are aware that abusing drugs and alcohol can cause long-term damage to the functioning of the brain and body. But these substances may negatively affect someone’s health in more than just functionality. Misuse of drugs and alcohol can also severely damage the skin.

Dehydration is a common result of substance abuse. The body needs proper hydration to operate normally and stay healthy. Without enough water, the skin becomes dry and less resilient. Injection drug use worsens this issue by introducing the risk of infection. Unhealthy skin may not be able to fight bacteria and is less likely to heal once it becomes damaged.

Different substances come with different risks, and many of them can lead to dermatologic conditions that may have life-threatening consequences.

Injection Drug Use And Skin Damage

The most common sign of injection drug use is “track marks,” which indicate where a substance was injected. When veins continuously experience stress, they harden. Scars develop and the skin around the injection site becomes discolored.

As track marks spread, the veins become more difficult to access. Some people switch to injecting into muscles or just below the skin, called “skin popping.” This causes small, round marks wherever the needle breaks the skin that may become irritated or infected. Skin popping commonly leads to cellulitis, a bacterial skin infection that can be fatal if not treated.

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Even when a person uses a sterile needle, injection drug use can cause skin infections. This may be from impurities in the substance or bacteria on the skin. Cleaning a needle with saliva raises this risk. People struggling with severe, long-term drug addiction may not prioritize proper hygiene, putting themselves at higher risk for bacterial infections.

Necrotizing fasciitis, also called “skin-eating disease,” is a bacterial infection that destroys tissue beneath the skin. Essentially, the skin rots from the inside out. Progressive forms of skin-eating disease can cause skin to fall off in chunks, exposing bone and possibly requiring amputation and/or leading to death.

Necrotizing fasciitis has been reported with the use of many injected drugs. Synthetic cathinones, or “bath salts” are notoriously connected to the skin-eating disease when taken by injection. Some of the worst cases of necrotizing fasciitis have resulted from injection of Krokodil, a cheap heroin knock-off originating in Russia.

The Effect Of Drugs On The Skin

While injection drug use is responsible for many negative effects on the skin with prolonged substance abuse, many drugs uniquely affect physical appearance and skin tissue. Drugs that can have a significant effect on the skin include:

  • methamphetamine
  • cocaine/crack
  • heroin and other opioids
  • desomorphine
  • barbiturates
  • anabolic steroids
  • nitrites or poppers
  • cigarettes


Methamphetamine, or meth, may be the first drug people think of when it comes to skin damage. This substance is often associated with skin picking, rotten teeth, and rapid aging. It may be injected, smoked, or snorted.

Snorting any drug can cause a great deal of damage to the nasal tissue over time, resulting in nosebleeds and possibly eroding the nasal septum (the wall between the nostrils). Dehydration and poor dental hygiene that may accompany severe substance abuse can lead to erosion of the gums and tooth enamel.

A tactile hallucination that plagues many people suffering from methamphetamine addiction causes them to feel as though bugs are crawling beneath their skin. This may be referred to as “meth mites.” It leads to excessive itching, which can cause skin sores that likely never heal because they are repeatedly broken open through more scratching.

This sensation may be caused primarily by dehydration, which can also alter a person’s appearance, aging their skin drastically in just a few months.

Cocaine / Crack Cocaine

Crack is a base form of cocaine that is made to be smoked. Powder cocaine may be injected, rubbed on the gums, or snorted. As with methamphetamine, cocaine insufflation can damage the nose, possibly causing “snorter warts” inside it. These warts result from human-papillomavirus (HPV) and may be transmitted through shared drug paraphernalia.

Also, similar to methamphetamine, cocaine or crack can cause people to experience the sensation of bugs beneath the skin, in this case called “coke bugs.” This results in the same compulsive itching and long-lasting skin sores.

Many drug dealers cut cocaine with other substances in order to stretch their product and make a higher profit. One common substance found in cocaine is levamisole, a drug formerly used in chemotherapy but now only approved for veterinary use.

Though uncommon, levamisole in cocaine has been linked to necrotizing fasciitis. When occurring as a result of levamisole, this skin-eating disease may manifest in extreme reddening of the cheeks and blackening of the outer ear. Similar effects may also occur on the chest, back, abdomen, legs, and buttocks.

“Speedballing,” or injecting a mixture of cocaine and heroin, also increases the risk of bacterial skin infections.

Heroin And Other Opioids

Any type of opioid can be injected, but often heroin is administered by needle while prescription opioids are generally taken in pill form or crushed and snorted. Beyond the risks associated with injection drug use and insufflation, opioids can have many adverse effects on a person’s skin.

Itchy hives are one uncomfortable side effect of prolonged heroin abuse. This can occur anywhere on the body, including genitalia. Hives often develop right after injection and may be present for days.

Prescription opioids, like morphine and oxycodone (OxyContin), have also been found to cause intense itching. This may be related to the release of histamine—an immune system reaction when the body is in danger.

Sometimes, heroin use leads to a large, blistering rash or dark patches on the body that have a velvety feel. It may also cause morbilliform eruptions, which are small red patches all over the body. These eruptions may result from the heroin or from a substance that has been added to it.

Black tar heroin, originating in Mexico and used in many of the United States, is dark in color because of its impurities. Contaminants in this type of heroin may include actual dirt, which can be a breeding ground for bacteria, especially in the warm, dark environment beneath the skin.


Desomorphine, or “Krokodil,” is a substance made from codeine and several toxic ingredients like gasoline, paint thinner, and lighter fluid. It is called “poor man’s heroin” because it can be made at a fraction of the cost. The low cost, however, indicates low quality and high impurity, and with this comes a great risk of horrible skin damage.

Taken by injection, Krokodil may cause the skin to become scaly and green-black in color, hence the name. This drug is extremely addictive and can cause devastating skin effects like the death of cells or tissue, inflamed blood clots, infectious abscesses, limb amputation, and death.


Long-term use of barbiturates can cause the skin to become yellowed. With regular use, as noted by Mayo Clinic, barbiturates may cause rashes or hives. They can also lead to ulcers in the mouth or bleeding sores on the lips. In rare cases, people using barbiturates have developed red, thick, scaly skin as a result.

Anabolic Steroids

Anabolic steroids cause the body to produce more sebum, an oily substance that naturally lubricates skin and hair. Excessive sebum can cause acne, which may range from mild red bumps to severe abscesses that can cause bleeding and scabs anywhere on the body.

Rosacea, an expansion of the blood vessels in the face that causes reddened skin, visible blood vessels, acne, or swelling in the nose and face, may also result from steroid use.

The quick change in the body’s muscular structure that comes from steroids may cause stretch marks. Often, these appear on the upper body—the neck, shoulder, upper arms, and torso. Stretch marks may be permanent, even after a person stops taking steroids.

Nitrites (“Poppers”)

Amyl nitrite is used to treat angina, or decreased blood flow to the heart. Other forms of nitrites are used as recreational drugs. These substances relax the muscles, and have been found to be especially popular among homosexual men.

Nitrites, or poppers, are taken by inhalation. This can cause flushing of the skin and may lead to contact dermatitis, a mild to severe skin rash on the face. The face may also break out in hives. Nitrites can be very damaging upon skin contact. One man developed an ulcer on his penis after using poppers, likely as a result of touching the skin with the toxic substance still on his hands, as reported by the Journal of the American Medical Association.


Though most people know the dangers that cigarettes pose, 37.8 million people in the United States still smoked them in 2016, notes the Centers for Disease Control and Prevention (CDC). Nearly 16 million people suffer from a disease connected to tobacco smoking. Long-term cigarette smoking also causes the skin to age more quickly.

Nicotine narrows outer blood vessels, which means that less blood gets to the skin. Blood is responsible for carrying vitamins and oxygen to keep the skin healthy. Other ingredients in cigarettes cause harm to the body’s natural collagen and elastin. These keep the skin firm, so the skin sags and wrinkles when they are depleted.

The Effect Of Alcohol On The Skin

When many people drink alcohol, their face flushes. This may be why some people believe that alcohol abuse causes rosacea, referred to in this instance as “alcoholic nose”. Alcohol use does not actually cause this condition, but may increase someone’s chances of developing it.

A big problem with alcohol is that it dehydrates the body. This is one reason that someone may experience a hangover the following day. In the long term, as with many other drugs, dehydration from alcohol can cause serious skin and health issues.

Because of dehydration, alcohol abuse has been linked to:

  • Psoriasispatches of very dry skin
  • Nummular eczemaround skin sores
  • Seborrheic dermatitisdry, itchy scalp

Long-term alcohol abuse can cause problems in the liver, the organ responsible for processing the substance and removing it from the body. Cirrhosis is a serious liver disease that involves scar tissue and decreased liver function. This disease can contribute to liver cancer and may cause a person to require a liver transplant.

Symptoms of cirrhosis may include:

  • Spider veins – enlarged purple-blue veins that show through the skin, often stretching out from a reddish center like a web
  • Palmar erythema – a reddening of the palms of soles of the feet, possibly in a grouping of small red dots
  • Jaundice – a yellowing of the eyes and skin that is a common indicator of liver disease

The Effect Of Drugs And Alcohol On Health

Many drugs are made from poisonous substances that should not be breathed, yet people ingest them. This can be extremely damaging to the body. The negative health effects that accompany drug and alcohol abuse are often paired with poor nutrition, lack of sleep, and bad hygiene. These factors all weaken the immune system, opening the door for more health problems.

Injection drug users are at a higher risk for diseases like human immunodeficiency virus (HIV) and Hepatitis C. These can be transmitted between people by sharing needles or through unsafe sexual practices. Regardless of the mode of ingestion, many drugs can lead to dangerous behaviors and disease transmission through blood, saliva, and other bodily fluids.

A weakened immune system is not equipped to fight off normal illness, much less a deadly disease or repeated ingestion of toxic substances. If the immune system is not functioning properly, skin damage like sores, lesions, and infections are more likely to occur and less likely to heal.

The negative health effects that accompany drug and alcohol abuse are often paired with poor nutrition, lack of sleep, and bad hygiene.

Treatment For Substance Abuse And Addiction

Substance abuse can have devastating effects on a person’s physical appearance. More than that, it can severely damage the body, causing visible health issues that may lead to loss of limbs or death. But it doesn’t have to be that way. Addiction treatment can help someone struggling with substance abuse to heal their body, mind, and spirit.

Many drug and alcohol rehab centers work with people to make treatment affordable and suited to their individual needs. Treatment programs may include a variety of methods like behavioral therapy, counseling, and support groups to help a person learn coping skills and change their lives for the better.

Outpatient drug rehab programs give people the option of living at home during treatment if they have work or family obligations. Sometimes, though, it is best for a person to be removed from their home environment, especially if they suffer from a severe or long-term addiction, polysubstance abuse, or a co-occurring mental disorder.

Inpatient addiction treatment immerses someone in a substance-free environment. Treatment plans can be tailored to a person’s specific struggles in order to meet their needs more effectively. This allows treatment to be relevant and comprehensive. Long-term residential treatment is what many people need to truly overcome addiction and prevent relapse.

To learn more about drug or alcohol addiction and treatment, contact one of our specialists today.

Mayo Clinic - Barbiturate (Oral Route, Parenteral Route, Rectal Route)

Center for Disease Control - Current Cigarette Smoking Among Adults in the United States

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