A necklace of telangiectases: an early clinical sign of alcohol abuse.

The prevalence of a necklace of telangiectases increases with the quantity and duration of regular alcohol intake. The necklace was present in 7%, 61.4%, 88.6%, and 98.5% of four groups of patients acknowledging less than 27 grams of ethanol intake per day for ten years, 77 grams per day for seven years, 112 grams per day for 11 years, and 113 grams per day for 15 years, respectively. The necklace first appeared after three to eight years of drinking 77 grams of ethanol (five to six drinks) per day, seems to be permanent and to appear before other skin changes associated with alcohol abuse such as `gooseflesh', palmar erythema, and spider nevi. Recognition of the necklace indicates the need for further assessment, to determine if alcohol abuse is contributing significantly to any other symptoms or signs (e.g., hypertension, intellectual impairment, or gastrointestinal disease). If the patient is taught to recognize the necklace, he or she may be able to differentiate `social drinking' from `alcohol abuse', and be motivated to seek treatment early.