The cutaneous stigmata of chronic alcoholic liver disease have been well recognised since the nineteenth century. However, it is now clear that the skin may be affected as an early feature of alcohol misuse. In particular, psoriasis, discoid eczema and superficial infections are more common in heavy drinkers. Awareness of these early associations can alert physicians to patients at risk of future complications of alcoholism. Great advances have been made in the understanding of the physiological and pathological effects of ethanol. The implications of these changes in the skin are discussed with reference to both the new and established cutaneous signs of alcohol misuse.