European Union Risk Assessment Report

Ethanol is widely used in all kinds of products with direct exposure to the human skin (e.g. medicinal products like hand disinfectants in occupational settings, cosmetics like hairsprays or mouthwashes, pharmaceutical preparations, and many household products). Contradictory evidence about the safety of such topical applications of the alcohol can be found in the scientific literature, yet an up-to-date risk assessment of ethanol application on the skin and inside the oral cavity is currently lacking.

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Safety evaluation of topical applications of ethanol on the skin and inside the oral cavity.

This review critically examines the literature of the past 10 years relating to the use of drugs in treating alcohol intoxication, withdrawal and dependence. Emphasis is given to those studies that have current and potential future clinical relevance. Although research regarding the pharmacological treatment of alcohol disorders still suffers from methodological flaws and lukewarm acceptance, the recognition of this area as a legitimate and fruitful field of study is increasingly apparent.

Pharmacological treatment of alcohol intoxication, withdrawal and dependence: a critical review

Disulfiram (Antabuse) is one of several aldehyde dehydrogenase (ALDH) inhibitors that raise the plasma level of acetaldehyde following ethanol ingestion. The usually pleasant reaction to ethanol is thereby changed to an unpleasant one, owing to a number of bodily reactions to acetaldehyde. Populations showing genetic polymorphism with a lack of some isozymes of ALDH have exhibited an intolerance to ethanol similar to that seen with disulfiram. A normal isozyme pattern seems to be a prerequisite for the development of alcoholism, which supports the principle of disulfiram treatment. Disulfiram is an irreversible ALDH inhibitor when administered in vivo. Diethylthiomethylcarbamate (Me-DTC) is formed from disulfiram in three metabolic steps. This compound and two further oxidized metabolites appear to be active metabolites of disulfiram. Measurements of plasma Me-DTC or the reduction of leucocyte ALDH 1 activity may be valuable markers for the proper dose titration of disulfiram and the rational use of this drug. Some toxicological points are discussed.

The pharmacology and toxicology of disulfiram and its metabolites.

In spite of not knowing the numbers of people exposed and obviously incomplete reporting, the known mechanisms of alcohol cutaneous intolerance and the literature classified according to mechanisms are listed. Testing techniques for delayed- and immediate-types are proposed.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1600-0536.1994.tb00719.x

Alcohol dermatitis: allergic contact dermatitis and contact urticaria syndrome. A review.

• Cutaneous reactions to ethyl alcohol (ethanol), N-propyl alcohol (1-propanol), isopropyl alcohol (2-propanol), and acetaldehyde were evaluated in a control group and in patients before and while they were receiving disulfiram therapy Local cutaneous erythema was observed from patch tests with ethyl alcohol, N-propyl alcohol, and isopropyl alcohol in hydrated skin, and from acetaldehyde in dry skin Since reactions noted from topically applied alcohols before and while the patients were receiving disulfiram therapy were not statistically different, a localized disulfiram-alcohol reaction is unlikely Erythema resulting from topically applied alcohols occurred in a dose-related manner and was caused by a direct vasodilatory effect on the cutaneous microvasculature We believe that all true disulfiram-alcohol reactions are systemic, rather than local, in nature and require a substantial amount of alcohol to enter the system ( Arch Dermatol 1982;118:157-159)

Neil F. Haddock

Papers

Cutaneous Reactions to Lower Aliphatic Alcohols Before and During Disulfiram Therapy