• History of Kava Dermopathy
• Signs and Symptoms of Kava Dermopathy
• Mechanisms of Kava Dermopathy
• Factors Influencing the Development of Kava Dermopathy
• How to Treat and Manage Kava Dermopathy
• How to Avoid Kava Dermopathy  

Scientific interest in kava started to grow in the mid-20th century. Researchers began to study its pharmacological properties and potential health benefits, including its anxiolytic and sedative effects.

In the latter half of the 20th century, the first case of kava dermopathy was documented. Initially, it was primarily reported in regions where daily kava consumption was highly prevalent, such as the South Pacific Islands. Clinicians began noticing characteristic skin dryness changes in individuals who were heavy and long-term consumers of kava.

As cases of kava dermopathy became more widely recognized, healthcare professionals and researchers started to investigate the condition. Studies were conducted to understand its prevalence, risk factors, and potential mechanisms.

Kava dermopathy is a skin condition associated with consumption of kava. It is characterized by various skin-related signs and symptoms. These symptoms often manifest in individuals who have consumed kava in excessive amounts or over prolonged periods of time. The following are the common signs and symptoms of kava dermopathy:

• Dry, Scaly Skin: Individuals with kava dermopathy often experience dry and scaly skin. This dryness may be particularly noticeable on the palms of the hands, soles of the feet, and other parts of the body that have more sweat glands than normal. (These areas have 15-20x the amount of sweat glands as other parts of the body)
• Yellowing of the Skin: The skin can take on a yellowish tint, a condition sometimes referred to as "kava yellow." This yellowing can affect various areas of the skin.
• Papules: Small raised bumps, known as papules, can develop on the skin. These papules are often reddish or brownish in color and can vary in size. This is usually said to be trapped sweat waste.
• Pustules: Pimple-like lesions, called pustules, may also appear on the skin. These pustules can be red, inflamed, and filled with pus. Similar to the papules, this is related to the kava waste.
• Thickened Skin: In some cases, the skin affected by kava dermopathy may become thickened and rough in texture. This thickening can give the skin a hardened appearance.
• Hair and Nail Changes: Changes in hair and nails are sometimes associated with kava dermopathy. This can include hair loss, changes in the texture of hair, and nail thickening.

The exact mechanisms of kava dermopathy are not fully understood, but several factors are believed to contribute to its development:

• Kavalactones Accumulation: The kavalactones in kava are believed to be responsible for its psychoactive effects. These compounds are not only present in the drink but can also accumulate in the body with chronic use. It is thought that the accumulation of kavalactones may play a role in the development of dermopathy as when one intakes more kava than their body is able to process, it will start being expelled through other waste processing areas, such as through the sweat glands. Which makes sense why once you stop the dermopathy almost immediately dissappears.
• Hepatotoxicity: Kava has been associated with liver toxicity, and there is evidence to suggest that liver dysfunction may contribute to skin changes in kava dermopathy. The liver is responsible for metabolizing kavalactones, and chronic consumption of kava can potentially overload the liver, leading to altered metabolism and, in some cases, liver damage. However, it should be noted that this statement was made regarding kava concentrate supplements in tincture and pill form, and is not representative of traditionally made kava.
• Immune Response: Some researchers believe that the skin changes seen in kava dermopathy could be related to an immune response triggered by the accumulation of kavalactones. It's possible that the body's immune system reacts to the presence of these compounds in the skin, leading to skin discoloration and other symptoms.
• Pigmentation Changes: Kava dermopathy is often characterized by skin discoloration, which may be related to the effects of kavalactones on melanocytes, the cells responsible for skin pigmentation. Chronic exposure to kavalactones may temporarily interfere with melanin production, leading to temporary changes in skin color.
• Microcirculation Effects: Some research suggests that kavalactones may have an impact on microcirculation, affecting the blood vessels in the skin. This could potentially lead to temporary changes in skin appearance and texture.

There are several factors that may influence the development of kava dermopathy and these include the following:

• Dose and Duration of Consumption: The primary factor contributing to kava dermopathy is the quantity and duration of kava consumption. The condition is more likely to occur in individuals who consume large amounts of kava regularly over an extended period, often well above what is considered a safe and moderate level.

• Kavalactone Content: Kava contains compounds called kavalactones, which are responsible for its psychoactive effects. Higher concentrations of certain kavalactones, particularly kavain and yangonin, are associated with a higher risk of dermopathy. Varieties of kava with elevated levels of these specific kavalactones may pose a greater risk.

• Liver Function: Just likes alcohol, chronic and excessive kava consumption can strain the liver, which plays a crucial role in metabolizing kavalactones. Impaired liver function may contribute to the development of kava dermopathy, as well as other health issues associated with kava.

• Individual Variation: Individual factors, such as genetics and overall health, can influence susceptibility to kava dermopathy. Some individuals may be more genetically predisposed to develop skin changes in response to kava consumption, while others may be more resilient.

• Preparation Methods: The way kava is prepared and consumed can impact its kavalactone content and, consequently, the risk of dermopathy. Traditional methods of kava preparation may result in lower kavalactone concentrations compared to commercial or industrial processes.

• Cultural Practices: The cultural context in which kava is consumed can also influence the risk of dermopathy. In some cultures, kava is consumed as part of traditional rituals or ceremonies, and the frequency and quantity of consumption may differ significantly from individual to individual.

• Kava Variety: Different varieties or strains of kava may have varying kavalactone profiles, which can affect their potential to cause dermopathy. Some kava varieties are known to have higher levels of certain kavalactones, increasing the risk.

• Other Health Factors: Underlying health conditions, such as liver disease, may exacerbate the effects of kava consumption and increase the likelihood of dermopathy. Individuals with pre-existing liver conditions may be at higher risk.

• Interactions with Medications and Substances: Kava can interact with medications and other substances, potentially compounding its effects on the body, including the skin. These interactions can increase the risk of dermopathy.

If you suspect you have kava dermopathy or are experiencing skin changes related to kava consumption, it's essential to seek medical advice. A healthcare professional can provide a proper diagnosis and guidance on managing the condition. Here are some general steps for treating and managing kava dermopathy:

• Discontinue Kava Consumption: The most crucial step in managing kava dermopathy is to stop consuming kava immediately and take a break. Continued consumption can exacerbate the condition. This single factor will usually make it all go away as it gives your liver time to catch up to processing the kavalactones. Do NOT drink alcohol during this time as it will put more stress on your liver.

• Get hydrated: Staying hydrated is very important for skin health, especially if you live in a hot airid/dry climate . Make sure to take electrolytes so the water can stay in your system instead of being quickly excreted out.
• Nutrition: Maintaining a healthy diet can support overall skin health. Eating a balanced diet rich in vitamins and antioxidants may aid in skin healing.

• Consult a Healthcare Professional: Schedule an appointment with a dermatologist or healthcare provider experienced in skin conditions. They can evaluate the extent of the dermopathy and provide guidance on treatment.

• Topical Treatments: Depending on the severity of the skin changes, a dermatologist may recommend topical treatments to alleviate symptoms. These treatments may include emollients (moisturizers) to hydrate the skin and reduce dryness or itching.

• Addressing Underlying Liver Function: If liver function is compromised due to kava consumption, addressing liver health is essential. Your healthcare provider may recommend liver function tests and potentially liver-protective medications or interventions.

• Skin Protection: Protecting the affected skin from further damage is important. Avoid excessive sun exposure, which can worsen skin changes. Use sunscreen and protective clothing when outdoors.

• Avoid Irritants: Avoid using skincare products or cosmetics that may irritate the skin. Choose gentle, fragrance-free products.

• Patient Education: Be open to learning about the potential risks and side effects of kava consumption. Understanding the causes of kava dermopathy can help prevent its recurrence.

• Follow Medical Advice: Adhere to the recommendations provided by your healthcare provider. They may suggest regular follow-up appointments to monitor progress.

• Supportive Care: In some cases, your healthcare provider may recommend supportive care, such as oral antihistamines to alleviate itching or discomfort.

It's important to note that kava dermopathy typically improves after discontinuing kava consumption. However, the rate of improvement may vary depending on individual factors and the severity of the condition. In some cases, skin changes may gradually fade over time.

To avoid kava dermopathy and other potential health risks associated with kava consumption, it is important to be aware of its safety guidelines and regulations. Here are some key safety concerns and regulations related to kava:

• Dosage and Duration: Safety concerns often arise when kava is consumed in excessive quantities or for extended periods. To minimize the risk of kava dermopathy and other adverse effects, it is crucial to adhere to recommended dosage guidelines. Avoid prolonged and heavy consumption.
• Quality and Source: The quality and source of kava are crucial factors in safety. It is important to obtain kava products from reputable and trusted suppliers who adhere to quality control standards. Make sure that the kava you purchase is sourced from known cultivars and is free from contaminants.
• Variety and Strain: Different varieties or strains of kava may have varying kavalactone profiles, which can influence their safety. Some varieties are known to have higher levels of specific kavalactones associated with adverse effects. Consider choosing kava varieties that are traditionally regarded as safe.
• Avoid Tudei Kava: Tudei kava, also known as "two-day" kava, is a variety that contains higher levels of potentially harmful kavalactones or cytokines. It is generally considered less safe for consumption and is associated with increased health risks. It is better to avoid using tudei kava products.
• Liver Function: Individuals with pre-existing liver conditions or those taking medications that affect liver function should exercise caution when considering kava consumption. Consult with a healthcare provider to assess the safety of kava use.
• Avoid Mixing with Alcohol or Medications: Kava should not be consumed alongside alcohol or medications that affect the central nervous system. Such combinations can potentiate the effects of kava and may lead to adverse reactions.
• Regulatory Compliance: Be aware of the regulatory environment surrounding kava in your region. Some countries have restrictions or bans on the importation, sale, or consumption of kava due to safety concerns. Ensure compliance with local regulations.
• Monitoring for Adverse Effects: If you choose to consume kava, be vigilant for any adverse effects, including skin changes, liver-related symptoms, or allergic reactions. Discontinue use if you experience any adverse reactions and seek medical advice.
• Moderate and Responsible Use: Consume kava in moderation and follow responsible use practices. Avoid excessive consumption and adhere to traditional methods of preparation and consumption when possible.
• Consult a Healthcare Provider: If you have underlying health conditions, are taking medications, or have concerns about kava's safety, consult with a healthcare provider before using kava. They can provide personalized guidance based on your health status.
• Stay Informed: Stay informed about the latest research and safety information regarding kava. The understanding of kava's safety profile is evolving, and new findings may influence safety recommendations.

Remember that safety concerns related to kava can vary by region and may be subject to change based on new research and regulatory dfevelopments. It's essential to prioritize safety and make informed choices when considering kava consumption, and consulting with healthcare professionals can provide valuable guidance in this regard.

In conclusion, kava dermopathy is a condition associated with excessive or prolonged kava consumption. But again, if you get it under small amounts of kava, it can be the canary in the coal mine. It presents various skin-related signs and symptoms which includes dry, scaly skin, yellowing of the skin (often referred to as "kava yellow"), papules, pustules, thickened skin, and hair and nail changes. While the exact mechanisms behind kava dermopathy are not fully understood, factors such as kavalactones, hepatotoxicity, immune responses, pigmentation changes, and microcirculation effects are believed to play a role. 

Several factors influence the development of kava dermopathy, including the consumer's liver health, consumers level of hydration, the dose and duration of consumption, kavalactone content, liver function, individual variation, preparation methods, cultural practices, kava variety, other health conditions, and interactions with medications and substances. To manage kava dermopathy effectively, individuals should take a break from kava, consult healthcare professionals, consider topical treatments, address underlying liver function, protect the skin, maintain a healthy diet, and avoid irritants.

To prevent kava dermopathy and other potential health risks associated with kava, it's crucial to adhere to safety guidelines and regulations. These include following recommended dosage and duration, sourcing high-quality kava, avoiding tudei kava, considering individual health factors, avoiding alcohol and medication interactions, adhering to local regulations, monitoring for adverse effects, practicing moderate and responsible use, consulting healthcare providers when necessary, and staying informed about the latest research and safety information.

Research into kava and kava dermopathy is ongoing. Efforts are being made to better understand the factors that contribute to kava dermopathy and to develop guidelines for safe kava use.

Reference:

1. Norton SA, Ruze P. Kava dermopathy. J Am Acad Dermatol. 1994 Jul;31(1):89-97. doi: 10.1016/s0190-9622(94)70142-3. PMID: 8021378. https://pubmed.ncbi.nlm.nih.gov/8021378/
2. Clough AR, Jacups SP, Wang Z, Burns CB, Bailie RS, Cairney SJ, Collie A, Guyula T, McDonald SP, Currie BJ. Health effects of kava use in an eastern Arnhem Land Aboriginal community. Intern Med J. 2003 Aug;33(8):336-40. doi: 10.1046/j.1444-0903.2003.00405.x. PMID: 12895162. https://pubmed.ncbi.nlm.nih.gov/12895162/
3. Sarah Hannam1 , MBBS, Michael Murray2 , B Pharm (Hons I), PhD, Dsc, Lucia Romani3 , MSD, Meciusela Tuicakau4 , MBBS, DDM, and Margot J Whitfeld5,6, MBBS, FACD, DTM&H. Kava dermopathy in Fiji: an acquired ichthyosis?. International Journal of Dermatology 2014, 53, 1490–1494. https://onlinelibrary.wiley.com/doi/pdf/10.1111/ijd.12546