After a harrowing visit to her husband in prison, no one would expect Amy Winehouse to be looking her best.
But even by her own standards, the award-winning singer appeared to be in particularly desperate shape.
Heavy make-up failed to conceal the spots and scabs on her wrinkled cheeks, chin and nose.
There were also angry red welts on her arms, leading to fears that she has started self-harming again.
Overall, she could have passed for someone twice her 24 years.
Miss Winehouse’s spokesman has insisted she is suffering from the bacterial skin infection impetigo - which is highly contagious and can develop by repetitive scratching of a sore.
He said the 24-year-old has been put on a course of antibiotics to clear it up.
But friends fear the scabs on her face are a sign that her drinking and drug taking is once again spiralling out of control.
Her love of junk food has also not helped the condition of her skin. She was pictured emerging from a fast-food outlet with fish and chips and a bottle of Lucozade.
A source said: “Her friends are worried these sores have been caused by an excessive use of crack cocaine, which can cause these kind of blemishes.
“Pete Doherty used to have similar sores under his nose.
“Her skin also suffers because Amy takes in barely any nutrients. Fruit and vegetables never pass her lips.”
Miss Winehouse’s drug-addicted husband Blake Fielder-Civil, 25, is on remand in Pentonville Prison awaiting trial on charges of GBH and conspiracy to pervert the course of justice.
Another source said: “When Blake was in solitary confinement recently they both started self harming again.
“It is like some kind of pact to show how much they love each other.”
Sally Penford, of the International Dermal Institute, said: “This is very much what impetigo looks like. However your skin mirrors what is going on inside your body.
“If you are taking medication, or you are not getting any nutrients and toxins are not being flushed out of the body, it will show on the skin.”