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Alcohol Itching due to Alcohol Withdrawal - Mechanism Unknown

Captain.Heroin

Bluelight Crew
Joined
Nov 3, 2008
Messages
94,868
I'm not currently drinking, and I never really had an addiction to alcohol, benzos, GHB or any other downer other than opiates (i.e. heroin, buprenorphine, which I have many years off now). In fact, I haven't drank in about two months and have no plans on drinking ever again.

My question is for a friend of mine who is an alcoholic. He drinks more often than not. Perhaps a 5L boxed wine (13.5% abv) in about two to three days (he often does beer and mixes in harder liquor, but trying to calculate the amount of alcohol from that would be a head spin/ache). He does sober up, eventually, normally for about a week, before relapsing.

During the days he tries to quit, he goes through what I believe is mild to moderate alcohol withdrawal. Malaise, insomnia, anxiety, depression, agitation, etc. He doesn't have seizures, only occasionally mild tremors in the hands (which goes away fairly quickly when he resumes eating), sweating/oily skin, and most interestingly facial itching.

The facial itching is not believed to be a tactile hallucination; it is not intense/persisting, it doesn't feel like bugs under the skin or like pins and needles. Just general itching/itchiness in the face. Specifically certain spots of the face. This effect is not present in the rest of the body.

I tried researching this, and it appears that for the more intense withdrawal there can be the tactile hallucination "bugs under the skin" for people who experience seizures and delirium tremens/hallucinations. This is not what he goes through. There's reports of people on alcohol recovery forums who report localized moderate itchiness (some say constant, some say it comes and goes in waves) - the body parts are often face, face/chest, or arms/legs/butt, but mostly extremities from what I've read. Many of these people, with the moderate itchiness, seem to wonder if there's something else wrong with them as it's an unusual symptom of withdrawal. More over, the itchiness of the face is the last persisting symptom of his withdrawal.

He has even resorted (begrudgingly) to try taking doxylamine (an antihistamine) to alleviate the itching, and it only helps him get to sleep and doesn't reduce the itching at all, whatsoever.

Most concerningly is the lack of knowledge about the mechanism behind this. I have a few theories from what I've put together...

1) related to chemicals building up in the body, i.e. corticosteroids, histamine, etc. that then are in excess and break down/metabolize/release when going through withdrawal which irritate the nerves.

2) dehydration of alcohol use leading to tightness of the facial skin, leading to tugging/itchiness. Itching in one place leads to itchiness elsewhere as it's tugging on the skin?

3) alcohol's effect on the autonomic nervous system

4) vasodilation/vasoconstriction due to level of alcohol use/withdrawal

Any ideas guys? I wanted to post this in what used to be called Advanced Drug Discussion but it might not fit will with the chemistry-heavy discussions.
 
'll have find some citations for you when I get back home but iirc elevated AST/ ALT(aspartate, alanine transaminases can cause pruritus.
 
I would guess that the crap that is in the wine may be exiting out his pores as he detoxifies.
Almost the same feeling that some people get when they have a lot of speed in their system and their skin burns a bit as they perspire.

I would have him drinking pleanty of water and some sweating. That may exasserbate it a little bit and help point to a detox mechanism.
 
I looked into this as well for you Capt'n. Don't have any references to give at the moment but it seems to be a fairly common symptom from what I have read. Rashes and hives have also been known to happen from EtOH WD. O e source hypothesized that high ALT is somewhat responsible and iirc the source said that the build up of toxins in the liver can cause a release of histamine during detox. Don't quote me just yet because I don't have the article but it sounds interesting.
 
What Speed King said about wine sulfates

It isn't rare, just not a common, or perhaps considered "serious " as opposed to convulsions or delirium tremens

Doxlyamine is more effective as a sedative/hypnotic; Try (your friend, I mean) hydroxyzine, preferably, or even promethazine; diphenhydramine if nothing else, IV reaponse would be interesting (You used to have access to hydroxyzine, Cap, so thought maybe still did) Used to read your posts long ago, you had begun reducing bupe use and eventually micro dosing. Sorry cannot assist more
 
It's got something to do with the liver detoxifying itself. We're still not 100% on how the CNS interacts with our organs to produce consciousness. So there is alot of stuff going on when one quits alcohol.

I experienced something like this due to liver damage. One thing that helped me was taking a hot shower, hot as I could bear, and blasting hot water over the areas, this makes the itching 10x stronger but then if you scratch where it itched the most and scratching the area with a loofah or something. Gently but with some pressure. Goes from intense itching to a burning sensation. Then blast ice cold water. That tends to relieve it for a few hours(until you sweat again).

If I had to take a guess I would say it's got something to do with the nerves processing pain are very similar to those that process itching. And in a way I think some nerves like that can be "shot out" so to speak with no sign or symptoms beyond a general pallor and dull skin tone until one stops drinking.
 
^yes this is similar to what I have read. The itching is due to the liver releasing toxins that have been stored, which causes a downstream histamine release (I don't know the mechanism of how this happens) which in turn causes the itching and hives. Do antihistamines help?
 
Itchy skin (pruritus) - Symptoms and causes - Mayo Clinic
Mayo Clinic ? itchy-skin ? syc-20355006

Apparently the itching is due to bile products being deposited into the skin. It seems like an early warning sign of cirrhosis IMO.
 
Well yeah. Alcoholism itself is an "early warning sign" for cirrhosis later in life. Cirrohsis is basically your liver damage repairing itself, reoccuring damage and then more repair and so on and so forth until it's basically scar tissue to the point where there's not enough liver tissue left to regenerate itself any further.

I would say that itchiness (pruritus) is more likely caused by chronic inflammation of the liver, also known as alcoholic hepatitis, as well as sometimes things like pancreas and bile issues, diet etc. It all ties into one thing and usually when a person starts abstaining from drink, if the symptoms are bothering them that much, everything goes back to normal within a few weeks upto 6 months.

People with cirrhosis are deathly ill and itching is probably one of the least of their worries.

I personally think it's something to do with the sweating not to mention the fact that those salts are literally passing from your bloodstream through your skin. Probably a weird sensation even if you weren't detoxing from alcohol simultaneously which on it's own can cause increased tactile sensation.
 
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I understand that people with severe cirrhosis have more serious issues to worry about than itching, as I watched my dad die of it. But barring that comment, I think my post was accurate when I said that the itching can be a warning sign that your liver might be being damaged from the drinking and maybe it's time to abstain and get some tests done to see what damage has been done.
 
From the moment that drinking gets problematic to when we finally make the decision to begin abstaining, the warning signs are ever so increasingly apparent and obvious. Sure we might not be in pain after a binge during the beginning, but when DOES drinking get problematic? Think about it. It's problematic when you disrespect and abuse your family, when you can no longer function at your place of work correctly, things like that. & that has nothing to really do with the immediate effects of alcohol itself but the prolonged toxicity. People can tell themselves they can function getting drunk every night because they go into work "sober" every morning but is that really sustainable? Sure you'll be getting paid and getting drunk but it's a sad life. And it's in the ever most subtle ways that these cycles of alcoholism occur over generations. That itching is just one more symptom on the bucket list that only appears when you take a break and finally see it for what it is. A true poison that makes us feel better than anything. I come from a family of drunks my man, probably who many knows how many generations back. Both sides of my (paternal) familial lineage are either batshit crazy, alcoholics or both. I've struggled with alcoholism myself so I know how it is to lose someone close to you due to something that is both a tragedy and completely out of anyone's control.

I wasn't necessarily directing that statement toward you personally, just, the fact that I don't agree with the concept of "scaring people straight". A guy comes to you, describing the nitty gritty of symptoms that's making him want to detox, you're gonna tell them its a warning sign of cirhossis? I mean, maybe if your name was Dr. Deeds, General practitioner. But it's not now is it. It's wishful thinking that you're gonna change someone's mind like that. And it's not generally a good idea to try to scare someone into abstinence, because usually they double down. I know this from experience.
 
I would guess that the crap that is in the wine may be exiting out his pores as he detoxifies.
Almost the same feeling that some people get when they have a lot of speed in their system and their skin burns a bit as they perspire.

I would have him drinking pleanty of water and some sweating. That may exasserbate it a little bit and help point to a detox mechanism.

Seems to also happen when he is drinking beer and liquor too.
 
What Speed King said about wine sulfates

It isn't rare, just not a common, or perhaps considered "serious " as opposed to convulsions or delirium tremens

Doxlyamine is more effective as a sedative/hypnotic; Try (your friend, I mean) hydroxyzine, preferably, or even promethazine; diphenhydramine if nothing else, IV reaponse would be interesting (You used to have access to hydroxyzine, Cap, so thought maybe still did) Used to read your posts long ago, you had begun reducing bupe use and eventually micro dosing. Sorry cannot assist more

I currently do not. I could get OTC Benadryl but don’t feel like it as I don’t like it.
 
I will pass on the consensus it is liver toxicity/signs that cirrhosis is in the future.

He has no intention to quit other than a few days here and there (less than 5% of the year, easily).

I know his alcohol use will kill him. He doesn’t seem to care.
 
Sorry to be a Johnny Come Lately to this thread but my own drinking has been out of control for years now and itching isn't anything I've noticed going through withdrawals. Maybe the other symptoms are so bad I don't notice the itching. I have had places where I get peeling skin and the last time I was in a hospital the doctor said it was caused by low platelet. So if he's having what looks like a rash that could be it. Anyway it's quite amazing the quantity he drinks that he doesn't have horribly miserable withdrawals like I do.

Edit: the sweating is normal and that weird rash I mentioned, once I got a patch on my forehead, the other time it was on the side of my right butt cheek.
 
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I will pass on the consensus it is liver toxicity/signs that cirrhosis is in the future.

He has no intention to quit other than a few days here and there (less than 5% of the year, easily).

I know his alcohol use will kill him. He doesn’t seem to care.

Yep. This is what id think. Also they can look for continuous very pale stool as its another possible indicator. Are they diabetic?
 
Seems to also happen when he is drinking beer and liquor too.



'll have find some citations for you when I get back home but iirc elevated AST/ ALT(aspartate, alanine transaminases can cause pruritus.


What Speed King said about wine sulfates

It isn't rare, just not a common, or perhaps considered "serious " as opposed to convulsions or delirium tremens

Doxlyamine is more effective as a sedative/hypnotic; Try (your friend, I mean) hydroxyzine, preferably, or even promethazine; diphenhydramine if nothing else

^yes this is similar to what I have read. The itching is due to the liver releasing toxins that have been stored, which causes a downstream histamine release (I don't know the mechanism of how this happens) which in turn causes the itching and hives. Do antihistamines help?


Your friend drinks mimimumly 6 bottles of wine a week. That box of wine has enough sulphates that could cause a pretty strong itchy feeling to be felt predominately in his withdrawal perioid. If he just maintained the box every three days, thats a decent 2 regulation bottle a day habit. Enough to explain all the inching and rough withdrawal peroids.

He drinks beer and liquor the entire time also? His habit is heavy enough to feel like a decent benzo withdrawal.


It sounds like he toughs it out pretty well. If he seriously got cut off, it might be seizure level if predisposed.



OT: He has every reason to itch. When things detoxify through the skin at a heavy rate, it may cause itches. That's why I tried to equate speed burns.

Back to the water. During the withdrawal period, drinking a lot of water and maybe a low dose benzo would protect him and reduce the itching.

Throwing in some liver protecting supplements including double or triple the b complex dosage, NAC, Milk Thistle wouldnt hurt.


This guy is relatively healthy or Pigpen from the Grateful Dead level drinker.
 
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I just noticed I have another one of those itchy weird rashes - this time it's almost exactly above my ass crack. It's identical to the type the doc said was caused by low platelets.
 
i want to say ive had the same thing numerous times over the years, ive usauly just explained them to myself as being bug bites, but its exactly asifl despribed it,
 
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