Connecting Alcohol and Rosacea
JULY 13, 1999, Carolyn J. Strange, A Woman’s Body Archive
Q: When I drink alcohol, my face turns a fierce red and gets very hot. I know the obvious response would be to stop drinking, but this occurs even after a single beer, which unfortunately rules out social drinking, or a drink with dinner. I have never been a heavy drinker, and there’s no history of liver problems in my family. Why does this occur, and is there anything I can do to alleviate this problem?
A: There are at least a couple of possibilities here. It’s great you drink only in moderation. Experts recommend no more than one drink a day for women. It’s two per day for men because the sexes handle alcohol differently.
This isn’t about liver problems, but it may have something to do with how your body copes with alcohol, as a woman and as an individual. It’s also possible that you’ve got the beginnings of a skin disorder. Let’s tackle alcohol metabolism first.
Women are more sensitive to alcohol than men for several reasons. We’re generally smaller, so equivalent doses produce higher concentrations in our bodies. Even if you correct for size, a woman’s body composition still causes higher alcohol concentrations. We tend to have a higher proportion of fat, leaving less water for the alcohol to dissolve in. Women also have less of a stomach enzyme that begins processing alcohol. So we absorb more of what we drink as pure alcohol. Finally, we may absorb alcohol more quickly before the menstrual period. Alcohol is absorbed quickly and its effects may be felt within 10 minutes, peaking at 40 to 60 minutes. People tend to soak up alcohol in bubbly drinks faster. Food, especially protein and fat, tends to slow absorption.
Alcohol remains in the bloodstream until metabolised by liver enzymes. Two enzymes are mainly responsible for this, let’s call them E1 and E2. Like that stomach enzyme, E1 converts alcohol into acetaldehyde — and that’s the chemical culprit behind facial flushing; E2 then breaks down acetaldehyde. An enzyme imbalance (high E1 or low E2) causes excessive acetaldehyde build-up, and uncomfortable facial flushing. Many people of Asian descent have low E2 activity. Fiery flushing is enough to make some people avoid alcohol altogether.
You can’t do anything about your enzymes, if that’s what’s going on. But you can sip your one drink slowly, always on top of food, and make sure you’re not dehydrated. You mention that even a drink with dinner causes flushing, but slowing your absorption might still help a little.
There’s something else to consider. “Facial flushing following alcohol is often a sign of a skin disorder called rosacea,” says dermatologist Dr. Garry Gewirtzman of Skin and Cancer Associates in Plantation, Fla. This flushing is probably both more noticeable and more common in fair-skinned people.
Rosacea can crop up at any time, but usually appears in the mid-30s or later. “It’s more frequent in women, although women tend to have lesser severity,” Dr. Gewirtzman says. Rosacea can’t be cured, but it can be controlled, and the earlier it’s treated, the better. Occasional flushing can progress to blotches, bumps and chronic inflammation, with tiny veins eventually appearing on the face. Women don’t usually get the severe complication of a bulbous, deformed W.C. Fields nose, called rhinophyma.
Most experts think rosacea is a vascular disorder, but nobody knows what causes it. Topical metronidazole and oral tetracycline are the most common treatments, Dr. Gewirtzman says.
