When you drink red wine, does your face mirror that ruby glow? Or do your cheeks redden only when you’re drinking cocktails?

“Your face may flush from alcohol for two reasons: because of an enzyme deficiency or because of rosacea. Both are tied to your ethnicity,” explains dermatologist Alok Vij, MD.

1. Enzyme deficiency. Many Asian populations have a deficiency in alcohol dehydrogenase, the enzyme that breaks alcohol down. “Alcohol is toxic to cells, and when it gets into the cells of your blood vessels, it makes them dilate,” he says. “This reddens the skin and can make you feel warm.” Without enough of this enzyme, alcohol reaches toxic levels much earlier in your cells.

2. Rosacea. Fair-skinned people of Northern European backgrounds who flush when they drink may have some degree of rosacea. “This very common skin condition is marked by vasomotor instability or hyperactivity,” explains Dr. Vij. “That means lots of things can dilate your blood vessels: alcohol, chocolate, hot beverages and spicy foods — basically, all the good things in life.”

Does flushing from alcohol raise cancer risks?

Because alcohol is a cellular toxin, anyone who drinks excessively increases their risk for oral cancer and esophageal cancer.

“Alcohol most frequently passes through these sites,” explains Dr. Vij. “Toxicity and DNA damage can build up in cells and, eventually, a cancer can form.”

But recent studies report that those who get an alcohol flush because of an enzyme deficiency are also at heightened risk of digestive, liver and respiratory cancers.

They are more vulnerable to alcohol’s toxicity as it is processed and later eliminated in:

• The GI tract, especially the stomach, where alcohol is absorbed.
• The liver, where alcohol is sent after it is absorbed by the stomach.
• The lungs, where alcohol in the blood is released in the breath.

Is rosacea linked to cancer in any way?

“We don’t think of rosacea as a precancerous disease,” Dr. Vij says. “The biggest problems rosacea causes are a bulbous nose, like W.C. Fields had, and eye inflammation.”

(It was rosacea — not alcoholism — that made the storied comedian’s nose look large, red and bumpy, because of an overgrowth of the sebaceous glands, he adds.)

In addition, rosacea can make your eyes feel itchy, dry and chronically irritated. These eye symptoms can be managed with anti-inflammatory medication. “We typically prescribe oral antibiotics like doxycycline or minocycline, often at lower doses than are required to kill bacteria,” says Dr. Vij. 

Are some types of alcohol more likely to cause flushing?

So if your face flushes, are specific kinds of alcohol to blame?

“It’s really patient-specific. Some people with rosacea flush more with red wine; others flush more with hard liquor,” says Dr. Vij.

If you have rosacea and keep track of what happens when you drink, you’ll find your triggers, he says. 

Can facial flushing be prevented?

If an alcohol flush makes you feel self-conscious when you drink, certain treatments can help, says Dr. Vij:

• Topical medications. Medicines like Mirvaso® (brimonidine), can block blood vessels in your skin from dilating.
• Laser treatments. A series of laser treatments can shrink the superficial blood vessels in your skin. “You usually need three to 10 treatments to get the full effect, but it can last for years, and prevent broken blood vessels in the later stages of rosacea,” he says.

Because the medications and laser treatments are considered cosmetic, however, they are not covered by insurance.

“If flushing bothers you, and you know alcohol is a trigger, the easiest and most cost-effective solution is to avoid it,” says Dr. Vij.