Alcohol Flush Reaction: Why Your Face Turns Red

Although the reason people develop facial redness can vary, a red face from alcohol use can generally only be prevented by not drinking. 

Some people wonder why alcohol makes their face turn red. This effect doesn’t happen for everyone; however, some people will find that they have facial flushing every time they drink. Others will find that, over time, their drinking causes them to develop facial redness that is always present to some degree and can be worse while drinking. The reasons for this vary but can be explained.

What Causes Red Face From Alcohol?

Drinking alcohol can cause facial redness in two ways. In some people with a rare enzyme deficiency or mutation, alcohol metabolism can be altered in a way that leads to dilation of the blood vessels in the face. This is called alcohol sensitivity or alcohol flush reaction. Alcohol can also increase the risk of a skin condition called rosacea that leads to facial redness. This condition typically develops over time but can eventually lead to worse facial redness when drinking.

Alcohol Sensitivity and Redness

Alcohol sensitivity is a common reason for facial redness when drinking alcohol. Someone with this condition is deficient in the enzyme aldehyde dehydrogenase or has a mutation that affects it. This stops the enzymes from effectively converting alcohol to acetic acid, a relatively harmless substance. Instead, alcohol gets converted into acetaldehyde, a toxic compound that causes many symptoms, of which facial flushing is almost always present and prominent.

Rosacea and Alcohol-Induced Redness

Rosacea is a chronic skin condition that causes redness and visible blood vessels in the face. It can flare up periodically and may be accompanied by small, red, pus-filled bumps. Drinking alcohol increases the risk of rosacea and can trigger flare-ups. Alcohol also induces vasodilation, which increases blood flow to the skin’s surface and worsens the redness related to rosacea. Over time, this can lead to noticeably increased facial redness when drinking alcohol.

Who Is Affected by Red Face From Alcohol?

Those who get a red face from alcohol will typically either have a sensitivity to alcohol or rosacea. Alcohol sensitivity is most often genetic, although some medications can cause it. A person with a genetic variation that affects the enzyme aldehyde dehydrogenase or taking metronidazole (Flagyl) or disulfiram (Antabuse) will be sensitive to alcohol.

Anyone can develop rosacea, the other condition that can cause a red face when using alcohol. Someone who drinks is more at risk; however, someone who has been completely abstinent their whole life can also get it. Those with rosacea are more likely to have facial flushing when drinking alcohol.

Can Red Face From Alcohol Be Prevented?

A red face from alcohol use can always be prevented by not drinking alcohol. Otherwise, facial redness caused by alcohol typically can not be avoided. There are some steps that people can take to avoid flare-ups of rosacea; however, these do not actually help prevent rosacea itself. 

Preventing Alcohol Sensitivity

Alcohol sensitivity is typically genetic. If you have the gene that causes alcohol sensitivity, there is nothing that you can do to prevent it. In some cases, alcohol sensitivity can be caused by medications. Metronidazole, an antibiotic, or disulfiram, an alcohol abuse-deterrent, both cause alcohol sensitivity. Avoiding these medications can help keep alcohol sensitivity from happening in those who do not have it due to genetics.

Preventing Rosacea

Rosacea is not typically considered preventable. While you can take steps to lower your risk of developing it, like stopping alcohol, most prevention strategies are focused on avoiding flares of existing rosacea. Some ways to prevent rosacea flares include:

• Sun protection: Sun exposure is a common trigger for rosacea flares. Protect your skin by using broad-spectrum sunscreen with an SPF of 30 or higher, wearing wide-brimmed hats and seeking shade during midday hours.
• Avoid known triggers: Triggers vary from person to person, but common ones include spicy foods, alcohol, stress and extreme temperatures. Keeping a diary of your flare-ups can help you identify and avoid triggers.
• Skincare regimen: Use gentle skincare products and avoid those that burn or sting. When washing your face, use lukewarm water and don’t scrub. Good skincare can help prevent rosacea flares.
• Healthy lifestyle: Regular exercise can improve overall health and reduce stress, reducing the risk of rosacea flares. Eating a balanced diet and staying hydrated can also contribute to skin health.
• Medical help: There are medical interventions and prescription medications that can help prevent rosacea flares. Seeking medical help is important for those who have trouble controlling rosacea flares.

Treating Red Face From Alcohol

A red face caused by alcohol can be unsightly or embarrassing. Treating it, however, can be complicated. The only way to truly avoid facial flushing caused by alcohol is to stop using alcohol altogether. However, you can take steps to help reduce the facial redness alcohol can cause.

Over-The-Counter Remedies for Redness

Only a few over-the-counter remedies are likely to help reduce facial redness caused by alcohol. Antihistamine pills, such as loratadine, can help to reduce redness caused by alcohol sensitivity; however, this only helps to mask the symptoms. It does not actually address the underlying cause of alcohol sensitivity. Antihistamine creams can also help reduce facial redness, treating only the skin itself, not the systemic reaction in your body. These creams may be helpful for either alcohol sensitivity or rosacea.

Prescription Medications for Rosacea

Many prescription medications can help treat or manage rosacea. Some of these include:

• Azelaic Acid: Helps reduce inflammatory papules and pustules
• Encapsulated benzoyl peroxide cream: Treats rosacea’s inflammatory papules and pustules with a unique encapsulation process that allows for less skin irritation
• Brimonidine: Reduces persistent redness related to rosacea 
• Oral doxycycline: Treats inflammatory papules and pustules associated with rosacea
• Topical ivermectin: Treats moderate to severe rosacea, focusing on inflammatory papules and pustules
• Oxymetazoline: Treats persistent redness caused by rosacea by stimulating adrenergic receptors
• Topical minocycline: Treats inflammatory papules and pustules in rosacea
• Topical metronidazole: Treats inflammatory papules and pustules associated with rosacea
• Sulfacetamide sodium/sulfur: Treats rosacea and other skin conditions like acne and seborrheic dermatitis

It is important to keep in mind that the best prescription medications for rosacea will depend on your circumstances and that your doctor should ultimately be making prescription decisions.

Red Face From Alcohol and Alcoholism

Alcoholism can lead to an increased risk of rosacea, one of the potential causes of facial redness connected with alcoholism. Prolonged, heavy alcohol use will increase the likelihood that rosacea will develop and then can worsen flares or lead to increased rednesses whenever alcohol is used.

Understanding ALDH2 Deficiency

ALDH2 deficiency causes alcohol sensitivity. This condition causes several unpleasant symptoms whenever alcohol is used, with one of these symptoms being facial flushing. If an ALDH2 deficiency is present, it typically begins at birth and is only ever noticeable when you drink. ALDH2 deficiency is not caused by alcoholism and lowers your risk of developing alcoholism by disincentivizing drinking.

Alcoholism and Liver Damage

Alcoholism can greatly increase your risk of developing liver damage. This damage can become permanent when someone continues drinking after liver problems first appear and can eventually lead to death. While liver problems are a high risk of alcoholism, liver problems and facial flushing when drinking are not directly related.

The Impact of Acetaldehyde on Redness

Acetaldehyde is the cause of facial redness in those with alcohol sensitivity. A deficiency in the enzyme aldehyde dehydrogenase keeps the body from breaking down acetaldehyde, a byproduct of alcohol. This leads to a buildup of acetaldehyde. This toxic chemical leads to: 

• Redness in the face
• Stuffiness in the nose
• Nausea
• Vomiting
• Increased risk of cancer over time

The Connection Between Acetaldehyde and Psoriasis

Acetaldehyde can cause inflammation that can lead to psoriasis. Psoriasis causes itchy scales and can lead to redness or inflammation. This inflammation can affect the scalp but does not typically affect the face itself and is, therefore, unlikely to cause facial redness.

Blood Alcohol Concentration (BAC) and Redness

If alcohol causes facial flushing for someone, then there may be a relationship between their blood alcohol concentration (BAC) and the redness. The more someone drinks, the more dilation of their blood vessels can occur. Facial redness, however, should never be used to indicate your BAC, even if you get facial flushing when drinking.

Legal BAC Limits and Red Face

No one can reliably tell if their BAC is below or above the legal limit based on their facial redness after drinking. A BAC at or above 0.08% is legally impaired in most states, and your facial flushing will not reliably indicate if you are at that level or not while drinking.

The Impact of Gender on BAC Levels

Women cannot metabolize alcohol as quickly as men. Because of this, the amount of alcohol it takes to raise a woman’s BAC is smaller than it is for a man. Women are more likely to experience higher BAC levels given a particular amount of alcohol than men.

Frequently Asked Questions

Are some people more likely to experience this reaction than others?

Those with alcohol sensitivity will almost always have facial flushing when they drink alcohol. Those who already have rosacea are more likely than others to have facial flushing. 

Is facial flushing a sign of a more serious alcohol intolerance or allergy?

Facial flushing is the most common sign of alcohol intolerance. If someone has facial flushing when they drink, it more commonly means that alcohol intolerance is present, not whether the intolerance is a certain level of severity or not.

What is the medical explanation for why alcohol can cause facial flushing?

Alcohol can cause facial flushing in those with alcohol intolerance because it causes a buildup of acetaldehyde, a toxin that causes facial flushing. Alcohol can also dilate your blood vessels, leading to increased skin circulation in the face, potentially leading to facial flushing.

Are there any health risks associated with facial flushing when drinking alcohol?

If facial flushing caused by alcohol is due to alcohol sensitivity, then the acetaldehyde that builds up in your body can lead to an increased risk of cancer. The alcohol use needed to cause facial flushing in others can indicate excessive use of alcohol. While the facial flushing itself is not necessarily a health risk, it may suggest that alcohol use is reaching more dangerous levels.