Feb. 18, 2004 -- When a common skin condition's best-known patient is also the poster boy for excessive drinking, you know there's bound to be some unflattering associations. Thank you, W.C. Fields, for helping to pair rosacea and alcohol.
Not only is his reddish and bulbous nose a telltale sign of severe rosacea left untreated, but it has become synonymous with alcohol abuse. And that leaves many of the 14 million Americans with rosacea red-faced for a reason besides their skin condition.
"It's well established that alcohol does not cause rosacea and that this condition is not the result of excessive drinking," says John E. Wolf, MD, chairman of dermatology at Baylor College of Medicine. "But the popular perception is that it is. As a result, many rosacea patients suffer embarrassment and stigmatization because other people think their red nose and red face is caused by heavy drinking, even if they don't drink at all."
A Trigger, Not a Cause
Actually, there is evidence that rosacea (pronounced "roh-ZAY-sha") is caused by a genetic and an ethnic predisposition -- it runs in families, typically those of fair-skinned heritage such as Irish, English, Scandinavian, Scottish, and similar descents.
But alcohol is among the scores of different triggers that can prompt or aggravate rosacea flare-ups in some patients. While drinking causes fewer reactions than "the big three" -- sunlight, heat, and environmental stress -- a new survey shows that just one alcoholic drink can trigger problems in two of three patients.
And, according to the survey of 700 patients by the National Rosacea Society, some drinks are worse than others. The percentage of patients reporting a skin reaction after drinking:
- Red wine, 76%
- White wine, 56%
- Beer, 41%
- Champagne, 33%
- Vodka, 33%
- Tequila, 28%
- Bourbon, gin, and rum, 24%
- Scotch, 21%
Perhaps the most significant finding: Nearly nine in 10 patients say they now limit their consumption of alcohol because of their rosacea, and 90% of those say it has helped reduce flare-ups.
"It is important that the public does not wrongly and unfairly confuse the appearance of rosacea with heavy drinking," says Diane Thiboutot, MD, of the Penn State Milton S. Hershey Medical Center. "At the same time, in managing the disorder, alcohol should be recognized as among the many factors that can trigger or aggravate the condition."
Other triggers include some 20 different foods, including avocado, cheese, and eggplant; drinks such as coffee, tea, and hot cider; skin-care products; and even exercise.
Drinking Can Worsen Symptoms
Rosacea usually begins after age 30 as redness on the cheeks, nose, chin, or forehead that may come and go. Over time, the redness becomes ruddier and more persistent, and visible blood vessels may appear. Left untreated, bumps and pimples often develop, and in severe cases the nose may grow swollen and bumpy from excess tissue, as with Fields.
These self-reported survey results are by no means scientific but are useful because to date, there are no known medical studies that have examined the "hierarchy" of alcoholic beverages to determine which is most likely to cause rosacea-related problems.
Still, these survey results come to no surprise to Wolf, who serves as editor of a rosacea web site for the American Academy of Dermatology. Neither he nor Thiboutot were involved in the survey, but both serve as spokesdoctors for the National Rosacea Society.
"Alcohol dilates blood vessels, and that will make a red face look redder," Wolf tells WebMD. "But red wine also contains chemicals called tyramines - a histamine-like compound that dilates vessels even more, so I can understand why it could be more of a problem that pure alcohol.
"And there are anecdotal observations we hear from patients and colleagues that red wine, in particular, is more likely to trigger to flare-ups or worsen rosacea than other drinks," he says.
Does that mean that rosacea patients shouldn't drink wine -- or anything else?
"My advice to patients with regard to alcohol is the same as with diet -- customize it to your own personal situation," says Wolf. "We know that many foods are implicated as possible trigger factors in rosacea, but not all those foods affect all patients. If you have a problem when you drink, don't drink. If your rosacea doesn't seem to get worse with wine at dinner, there is no reason to deprive yourself of something that is enjoyable and possibly even has health benefits."
And if you feel a flare-up brewing after drinking?
"In general, drinking water after alcohol helps dilute the alcohol, but if you have rosacea, it may be especially useful to have cool water or suck on ice chips after having wine because it can mitigate the flares and flushing," he tells WebMD. "Even if you don't, drinking a lot of water after drinking wine is a good way to prevent a hangover."