All about alcohol and the skin in this blogpost!

Do you unwind with a glass of wine or a cocktail? If you notice that your skin turns red and heart rate increases with small amounts of alcohol, especially if you’re Asian, this might be because of a genetic response to how the body breaks down alcohol differently. Known as Asian Flushing Syndrome, this reaction is more alarming than just the usual blush from the vasodilation effects of alcohol. In this blogpost, we’ll discuss the Asian Flushing Syndrome and how drinking alcohol affects your skin. Cheers!

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Facial flushing in a 22-year-old ALDH2 heterozygote before (left) and after (right) drinking alcohol. Image credit: The alcohol flushing response: an unrecognized risk factor for esophageal cancer from alcohol consumption. Brooks et al. PLoS Med. 2009 Mar 24;6(3):e50.

WHAT IS THE ASIAN FLUSHING SYNDROME 

The Asian Flushing Syndrome is a condition where some people experience facial redness after drinking alcohol¹. The facial redness is accompanied by increased heart rate and nausea. Asian Flushing Syndrome, is as its name suggests, more common among East Asians; and due to a genetic deficiency in an enzyme called aldehyde dehydrogenase 2 (ALDH2)^1,2. Studies estimate that this Alcohol Flushing Syndrome occurs in 36–45% of East Asians^1,2.

What happens in patients with alcohol flushing syndrome.  Image credit: Can Gene Therapy Be Used to Prevent Cancer? Gene Therapy for Aldehyde Dehydrogenase 2 Deficiency. Montel et al. Cancer Gene Ther. 2021 Nov 19;29(7):889–896.

Normally, after alcohol consumption, the liver breaks metabolises alcohol through a two-step process:

• First, an enzyme called alcohol dehydrogenase (ADH) converts alcohol into acetaldehyde, a toxic metabolite.

• Secondly, another enzyme called aldehyde dehydrogenase 2 (ALDH2) converts acetaldehyde into acetate, a harmless substance that the body removes.

In people with defective or deficiencies in aldehyde dehydrogenase 2 (ALDH2) their bodies accumulate acetaldehyde^3,4. Acetaldehyde is also found in nicotine products such as cigarettes and e-cigarettes. The buildup of acetaldehyde causes facial redness, nausea, headache, and increased heart rate aka Asian Flushing Syndrome^1,3,4.

Acetyladehyde causes oxidative stress to cells and cell structures like DNA^5,6. Asian Flushing Syndrome is associated with an increased risk of diseases, including esophageal cancer^,1.

Alcohol is associated with rosacea.

HOW ELSE DOES DRINKING ALCOHOL AFFECT OUR SKIN?

 Even if you’re lucky to avoid the Asian Flushing syndrome, alcohol and its metabolites can affect the skin in several ways:

• Dry skin. Alcohol is a diuretic, meaning that it causes urine production to increase⁷. This potentially dehydrates the body and skin to accentuate dullness and fine lines.

• Alcohol increases inflammation and oxidative stress by affecting the cytokine mileu^8-10. This has an impact on inflammatory skin diseases such as psoriasis and rosacea. Psoriasis has been found to be more severe in heavy drinkers^,11,12; and drinking is also associated with a higher risk of rosacea¹³.

• The impact of alcohol consumption on acne, another inflammatory skin disease, is less consistent. Some studies suggest an association between drinking alcohol and developing acne, but studies also show otherwise^14-19.

• Alcohol has also been linked to the development skin cancers. Studies have found a positive association for alcohol consumption and the development of melanoma, squamous cell cancer and basal cell carcinomas^,20,21.

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How does alcohol in skincare affect the skin? Explaining the skincare science in Female Singapore. Link here.

CONCLUSION ON ALCOHOL AND THE SKIN

Next time you notice a flush when you drink alcohol; it may mean more than a rosy blush! Alcohol Flushing Syndrome is not uncommon among East Asians; and drinking alcohol can also increase your risk of other diseases.

References:

1. The alcohol flushing response: an unrecognized risk factor for esophageal cancer from alcohol consumption. Brooks et al. PLoS Med. 2009 Mar 24;6(3):e50.

2. Genetic influences on response to alcohol and response to pharmacotherapies for alcoholism. Enoch. Pharmacol Biochem Behav. 2014 Aug:123:17-24.

3. Relationship between facial flushing and blood acetaldehyde levels after alcohol intake. Mizoi et al. Pharmacol Biochem Behav. 1979 Feb;10(2):303-11.

4. Targeting aldehyde dehydrogenase 2: new therapeutic opportunities. Chen et al. Physiol Rev. 2014 Jan;94(1):1-34.

5. Aldehyde-Induced DNA and Protein Adducts as Biomarker Tools for Alcohol Use Disorder. Heymann et al. Trends Mol Med. 2018 Feb;24(2):144-155.

6. E-cigarette aerosol exacerbates cardiovascular oxidative stress in mice with an inactive aldehyde dehydrogenase 2 enzyme. Yu et al. Redox Biol. 2022 Aug:54:102369.

7. The Diuretic Action of Weak and Strong Alcoholic Beverages in Elderly Men: A Randomized Diet-Controlled Crossover Trial. Polhuis et al. Nutrients. 2017 Jun 28;9(7):660.

8. Increased tumor necrosis factor production by monocytes in alcoholic hepatitis. McClain and Cohen. Hepatology. 1989 Mar;9(3):349-51.

9. Alcoholic hepatitis. Lucey et al.N Engl J Med. 2009 Jun 25;360(26):2758-69.

10. Psoriasis and alcohol: is cutaneous ethanol one of the missing links? Farkas and Kemény. Br J Dermatol. 2010 Apr;162(4):711-6.

11. Alcohol and the skin. Higgins and Vivier. Alcohol Alcohol. 1992 Nov;27(6):595-602.

12. Cutaneous disease and alcohol misuse. Higgins and Vivier. Br Med Bull. 1994 Jan;50(1):85-98.

13. Alcohol intake and risk of incident rosacea in US women. Li et al. J Am Acad Dermatol. 2017 Apr 20;76(6):1061–1067.e2.

14. Modifiable and non-modifiable epidemiological risk factors for acne, acne severity and acne scarring among Malaysian Chinese: a cross-sectional study. Say et al. BMC Public Health. 2021;21(1):601.

15. A multicenter epidemiological study of acne vulgaris in Korea. Suh et al. Int J Dermatol. 2011;50(6):673–681

16. Is the association between acne and mental distress influenced by diet? Results from a cross-sectional population study among 3775 late adolescents in Oslo, Norway. Halvorsen et al. BMC Public Health. 2009;9(1):340

17. The role of exposome in acne: results from an international patient survey. Dreno et al. J Eur Acad Dermatol Venereol. 2020;34(5):1057–1064.

18. Prevalence of acne vulgaris in Chinese adolescents and adults: a community-based study of 17,345 subjects in six cities. Shen et al. Acta Dermato Venereologica. 2012;92(1):40–44.

19. The prevalence and risk factors of adolescent acne among schoolchildren in Lithuania: a cross-sectional study. Karciauskiene et al. J Eur Acad Dermatol Venereol. 2014;28(6):733–740.

20. Baseline and lifetime alcohol consumption and risk of skin cancer in the European Prospective Investigation into Cancer and Nutrition cohort (EPIC). Mahamat‐Saleh et al.Int J Cancer. 2022 Aug 30;152(3):348–362.

21. Alcohol intake and risk of nonmelanoma skin cancer: a systematic review and dose-response meta-analysis. Yen et al. Br J Dermatol. 2017 Sep;177(3):696-707.