By Nicole Galan

Reviewed by J. Keith Fisher, M.D.

Some people develop a distinctive facial flush after drinking alcohol, when their face turns either slightly or very red. Why does this happen, and what does it mean?

This side effect of drinking alcohol is more common in people of East Asian descent. Although it does not cause immediate health problems, it may signal an increased risk of some serious health issues, such as high blood pressure and certain types of cancer.

In this article, we look at why some people experience facial flushing from alcohol, while others do not. We also look at the risks of this side effect and how to prevent it.

Why does it happen?

Facial flushing after drinking alcohol is a symptom of high alcohol sensitivity, which means that the body is less tolerant of alcohol.

All alcoholic drinks — including beer, wine, and liquors — contain a substance called ethanol.

After having a drink, the body begins to break down the ethanol into other substances, or metabolites, to make it easier to flush out of the body. One of these metabolites, acetaldehyde, is very toxic to the body.

When drinking in moderation, the body can usually process these metabolites relatively well. However, if a person is sensitive to alcohol or has a lot to drink, their body may not be able to manage all of those toxins, and acetaldehyde can begin to build up in the body.

The red facial flush happens because the blood vessels in the face dilate in response to these toxins. In some people, this can happen after very little alcohol.

A buildup of acetaldehyde can also cause nausea and a rapid heartbeat. These symptoms may make drinking alcohol an unpleasant experience, leading to people drinking less.

Is it dangerous?

While the red flush itself is not acutely dangerous, people who get it are at higher risk of high blood pressure and other health problems.

A 2013 study of Korean men looked at the differences in blood pressure between men who did and did not experience facial flushing when they drank alcohol.

After taking factors such as age, weight, smoking, and exercise into account, the researchers found that men who flushed after drinking alcohol had a significantly higher risk of high blood pressure when they drank four or more drinks per week.

In contrast, men who did not flush after drinking did not see an increased risk of high blood pressure until they drank eight or more drinks per week.

Studies have also associated drinking alcohol with certain types of cancer. Some researchers believe that this increased cancer risk could be due to the rise in acetaldehyde levels in the body. High levels of acetaldehyde can attack the DNA in the cells of the body, which can trigger the growth of cancer cells.

In a 2017 study, researchers looked at the link between cancer and facial flushing after drinking in people in East Asia. Men with facial flushing had a higher risk of cancer, particularly cancer of the throat, which is also called esophageal cancer. The researchers did not find the same association in women.

Who does it affect?

Whether or not a person’s face goes red after drinking seems to link to their genetic makeup.

A liver enzyme called aldehyde dehydrogenase 2 (ALDH2) breaks acetaldehyde down into less toxic substances. Some people have a genetic condition that means that they do not make this enzyme.

As a result, acetaldehyde builds up in the body after alcohol consumption, which causes the characteristic red flushing of the face.

Although anyone can lack this gene, it is more common for people from East Asia not to have it.

Can you prevent it?

There is no way to change the genes or enzyme deficiency. The only way to prevent this red flush and the associated risk for high blood pressure is to avoid or limit the intake of alcohol.

Some people use over the counter antihistamines to reduce the discoloration. However, this is not advisable. Although some people may find the flushed skin embarrassing, it is a signal that the body is accumulating toxic levels of acetaldehyde and that it is time to slow down and rehydrate with water.

It is important to recognize that even people who do not get this type of reaction when drinking are still at risk of the health complications of alcohol use, including high blood pressure, liver disease, cancer, and stomach problems.

Summary

The red flush that some people get while drinking alcohol may not seem serious, but it can indicate that someone has a higher alcohol sensitivity and may have an increased risk of high blood pressure and certain cancers.

While taking antihistamines can help reduce the redness, these drugs only hide the symptoms and do not address the underlying cause.

The Centers for Disease Control and Prevention (CDC) recommend that if people choose to drink, they do so in moderation. They define moderate amounts as one drink per day for women and two drinks per day for men.

If a person has high alcohol sensitivity, meaning a low tolerance to alcohol, they may feel the effects of alcohol more strongly and quickly and may benefit from drinking less alcohol.

People who are concerned about this symptom can talk to their doctor for advice.