Alcohol consumption and abuse can have a variety of cutaneous manifestations, including palmar erythema and spider angioma (also known as spider telangiec-tasis, arterial spider, spider nevus, or nevus araneus) . Alcohol can also induce diseases/disease states with dermatologic manifestations . Many endocrine changes are seen in patients with chronic alcoholism. Signs of hypogonadism and hyperestrogenism are seen in male patients. Hypogonadism is manifested by loss of libido and potency, testicular atrophy, reduced fertility, and reduced facial hair growth . Gynecomastia, vascular spiders, changes in fat distribution, loss of body hair, and change of pubic hair to a female distribution  manifest hyperestrogenism. In contrast, female patients with alcoholism rarely manifest signs of masculinization. They may demonstrate breast atrophy or menstrual irregularities .
1. Alcohol on breath during exam
2. Cutaneous manifestations a. Palmar erythema b. Spider angiomata
3. Endocrine changes (in males)
a. Gynecomastia b. Testicular atrophy
4. Enlarged or tender liver
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