ACNE AND ECSTASY

Spots might show that drugs are destroying your liver

A RASH that looks like acne may identify people who risk suffering severe
side effects if they take ecstasy, according to a German dermatologist.

Uwe Wollina of the University of Jena first noticed the symptoms when a
woman was admitted to the university hospital with liver failure after
taking ecstasy. "She developed a facial rash that resembled acne, but
wasn't," says Wollina. The rash vanished when the woman received treatment
for her liver failure.

Another ecstasy user being treated for drug-induced psychosis developed a
similar rash. It cleared up within a few days, by which time the drug had
left the patient's system. In both cases, the reddish pimples only appeared
on the face and throat (Dermatology, vol 197, p 171).

Wollina suspects he knows why ecstasy users can be plagued with spots. "The
underlying mechanism may be in the seratonin pathways," he says. Ecstasy
stops nerve cells reabsorbing the neurotransmitter seratonin, so high
concentrations can build up in the brain and other tissues. Wollina suggests
that high levels of seratonin enhance blood flow to the face, boosting the
activity of the sebaceous glands that can produce spots when they become
blocked.

While it may be difficult to distinguish normal teenage spots from the
drug-fuelled variety, Wollina believes the pimples can reveal ecstasy use
among older people. "If a patient with acne turns up in the surgery who has
never before had spots on the face, one should be wary," he says. However,
only a urine test for metabolites of the drug can prove someone is using
ecstacy.

Wollina believes the condition indicates that the body is under stress from
taking the drug. He suspects that people who break out in spots after taking
ecstasy will develop other symptoms more readily, even if they are not heavy
users. "The side effects are not dose-dependent," he says.

Other researchers are intrigued by the idea that Wollina has found a marker
for ecstasy-induced liver damage. "There have been several cases of liver
failures from ecstasy that went on to require liver transplants," says
Robert Forrest, a forensic pathologist at the University of Sheffield who
has been called in to investigate a number of ecstasy-related deaths.

Forrest says that up to 10 per cent of Caucasians lack an enzyme that
protects the liver from damage by ecstasy. But they are not the only ones at
risk: a letter published in The Lancet (vol 353, p 593) earlier this month
describes three cases of ecstasy-induced liver failure in people with
apparently normal enzymes. If spots on the face really do identify those at
risk, users could receive an early warning of the dangers they face.