Alcoholic Nose: Can Alcohol Affect the Appearance of the Nose?
Classic Hollywood cartoons and comedy bits often call upon the jolly alcoholic character to lighten the mood or provide comic relief. In an attempt to make light of a serious condition, this character may interrupt scenes with bumbling, slurring bouts of playful drunken behavior.
Classic comedians such as W.C. Fields have made entire careers playing this type of character. All of these characters also share a similar look: chubby cheeks, and a red, bulbous nose.
“Alcoholic nose,” or drinker’s nose, is a skin condition commonly identified by a red, bumpy, or swollen appearance of the nose and cheeks. It’s hard to say when exactly this condition became linked with heavy alcohol use, but stereotypes in popular media have kept this connection alive.
While alcohol can stay in your system and cause damage, there is thought to be very little connection between alcohol use and this skin condition.
So what exactly is “alcoholic nose,” and what actually causes it?
Alcoholic Nose, Nose Redness, and Rhinophyma
What is commonly called “alcoholic nose” is actually a skin condition called rhinophyma (Greek for “nose growth”). Rhinophyma is in a category of skin conditions known as rosacea, which causes chronic inflammation of the skin. This chronic inflammation is caused by broken blood vessels and sores on or around the nose, causing it to appear red, swollen, and bumpy.
When blood vessels burst, it makes the blood visible under the surface of the skin, leading to skin redness. In more severe cases, the nose and cheeks can take on a purple hue and start to become severely disfigured as they become more bulbous.
There are four subsets of rosacea, and rhinophyma is thought to be the most severe of them all. It’s a progressive condition that forms gradually over years and is thought to be the result of an untreated, less severe form of rosacea.
However, only a small percentage of people with rosacea will develop the condition. One study found that out of 108 patients with rosacea, only 15 were noted to also have rhinophyma, almost all of whom were men.
While women can be diagnosed with the condition, it is found much more commonly in men. People with fair or light skin tone, or those with a family history of rosacea, are more likely to develop rhinophyma.
The Stigma of Rhinophyma or Alcoholic Nose
Someone suffering from rhinophyma may also face stigma (shame) associated with the disorder. As with many health conditions, stigma can be a barrier to that person seeking treatment to help with their condition. Because of the very visible nature of rhinophyma, a person with the condition might feel incredibly self-conscious about their nose. They may feel hesitant about meeting new people or even going to the grocery store for fear of being made fun of or judged.
In the past, and even in modern times, rhinophyma was largely considered to be a side-effect of alcoholism or alcohol use disorder. Someone who has a bulbous, swollen red nose may suffer from incorrect judgments and assumptions about their character and substance use habits.
The truth is that studies have shown there is very little, if any, connection between alcohol use and rhinophyma. The condition is understood and treated as a condition that is totally separate from alcohol use disorder.
Does Alcoholism Cause Advanced Rosacea of the Nose?
Redness of the skin is closely associated with alcohol use, so it makes sense that rhinophyma came to be linked with alcohol use disorder. It is true that drinking alcohol can cause the cheeks and face of some people to become red or flushed. There are a couple of reasons why some people may experience skin redness when consuming alcohol.
Cleveland Clinic explored this topic and concluded that facial redness can occur for two reasons: an enzyme deficiency or rosacea. Both of these reasons are closely related to genetics and ethnic background.
- Enzyme deficiency: Cleveland Clinic skin doctor Alok Vij explains that “many Asian populations have a deficiency in alcohol dehydrogenase, the enzyme that breaks alcohol down.” As alcohol enters blood vessels’ cells, the cells dilate, making your face flushed or red. This can also make you feel warm. If you have less of this particular enzyme, it will be easier for your face to get flushed when you drink alcohol. Because many Asians are affected by this, the condition is sometimes casually referred to as “Asian flush.”
- Rosacea: Cleveland Clinic identifies fair-skinned people with Northern European ethnic backgrounds as persons who may have some degree of flush while drinking due to rosacea. Rosacea can be easily triggered by particular foods and diets. For example, things like chocolate, alcohol, hot drinks, and spicy foods can cause a person’s rosacea to flare up.
While some people may experience flushing or redness when they consume alcohol, this doesn’t mean those people all suffer from rhinophyma. Wrong assumptions based on similar traits, such as flushed skin after drinking, have led to misinformation about the true causes of the condition.
That being said, there may be some slight truth to the idea that drinking alcohol can contribute to the development of rhinophyma. Because drinking alcohol has been found to make rosacea worse in some people, it may also contribute to worsening the symptoms of rhinophyma.
What Is Rosacea?
As discussed above, rosacea can be a main contributing factor to redness and flushing of the cheeks. To understand how rosacea can lead to rhinophyma, it’s important to understand what rosacea is, its symptoms, and how it develops.
The Mayo Clinic explains that rosacea is a common skin condition that causes redness and visible blood vessels on the face. It may also produce small, red, pus-filled bumps. These signs and symptoms may flare up for weeks to months and then go away for a while.
Rosacea can often appear on the outside to be an acne outbreak or natural coloring on the cheeks. The condition tends to affect fair-skinned, middle-aged women more often, but anyone of any age or skin tone can develop the condition. There are currently no cures for rosacea, but there are options available to treat specific symptoms.
The symptoms of rosacea include:
- Facial redness: When blood vessels in the face become visible under the surface of the skin, it causes a general redness or flushed appearance on the face. In general, this redness is limited to the center of the face on the nose and surrounding areas.
- Swollen, red bumps (can be pus-filled): These swollen, red bumps can easily be mistaken for an acne outbreak. Much like acne, these bumps may become filled with pus. The bumps and surrounding skin may be hot, tender to the touch, and uncomfortable.
- Eye issues: Swelling of the face is a common symptom of rosacea. People with the condition may frequently have dry, irritated, or swollen eyelids. Rosacea that occurs strictly around the eyes is commonly referred to as “ocular rosacea.”
- Swollen, bulbous nose: If left unchecked, rosacea can progress to the point where it thickens the skin on the nose, leading to a bulbous, swollen appearance. This thickening of the skin is called rhinophyma and is the result of advanced rosacea.
Alcohol and Other Triggers for Rosacea of the Nose
A flare-up of rosacea symptoms can be triggered by the consumption of many different foods and drinks, including alcohol. Rosacea can even be triggered by environmental factors.
Some potential rosacea flare-up triggers include:
- Spicy foods
- Hot drinks
- Stress (and other strong emotions)
- Extreme temperatures (both hot and cold)
- Drugs that dilate blood vessels
- Certain cosmetic and skincare products
- Physical activity
While it’s true that alcohol use may trigger rosacea flare-ups, this does not mean that every person with rosacea will automatically develop rhinophyma. It is an extreme side effect only experienced by a small percentage of people who suffer from rosacea. That being said, someone who already has rhinophyma may find their condition is worsened by drinking alcohol.
The Truth of Alcohol’s Effect on Rhinophyma
It’s mostly false to say rhinophyma is caused by alcohol use disorder. There are many people who develop the disorder but do not drink alcohol, or drink very minimal amounts. In some cases, the stigma associated with rhinophyma can prevent people from seeking treatment for fear of being labeled an alcoholic.
The National Institutes of Health (NIH) explains the truth in the following section from its page on the condition:
“Historically, rhinophyma was erroneously considered to be linked with alcohol consumption because substances such as alcohol and caffeine can cause local vasodilation, which worsens the symptoms. This alleged association with alcohol has caused much social stigma and loss of self-esteem in patients suffering from the disease, with several nicknames for the condition such as ‘whiskey nose’ and ‘rum nose.’ ”
Treatments for ‘Alcoholic Nose’
There are two options to treat rhinophyma: medication and surgery.
Medication: While there are no medications that can fully reverse the effects of alcoholic nose (rhinophyma), some of the symptoms can be managed. Generally speaking, once rhinophyma develops, it can be very difficult to manage with medication alone. Nose redness as a side effect of rosacea can be managed with prescription medication with some degree of success.
Some medications used to treat rhinophyma include:
- Topical and oral antibiotics to reduce inflammation and redness, such as metronidazole, sulfacetamide, tetracycline, erythromycin (Erythrocin Stearate), and minocycline (Minocin)
- Topical medications that help minimize inflammation, such as tretinoin (Retin-A) and azelaic acid (Azelex)
- Oral capsules that prevent skin glands from producing oil, such as oral isotretinoin
Surgery: Surgery is the most common treatment for advanced rhinophyma. Enlarged blood vessels and tissue overgrowth are what cause the misshaping of the nose. This can be permanent if the affected area isn’t removed. Surgery is considered the most effective option for long-term success.
The following surgical treatments and methods are commonly used to treat the condition:
- Surgery using a scalpel
- Laser resurfacing with a carbon dioxide laser
- Cryosurgery, which uses extremely cold temperatures to freeze and remove unwanted tissues
- Dermabrasion, which uses a small, rotating tool to remove the top layers of skin
The longer tissue overgrowth remains on the skin, the more likely it is to become permanent. If you are suffering from rhinophyma, talk to your doctor or dermatologist to develop a plan for treatment.
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Why does alcohol cause red nose?
Alcohol use can worsen a red nose, also known as rhinophyma, but doesn’t cause it to occur. Some people become red-faced or flushed when they drink alcohol, and this is determined by ethnic background and genetics.
Can rhinophyma be reversed?
While there are no treatments that can completely reverse rhinophyma, medications and surgery can lessen the condition if caught in time. The longer rhinophyma goes without treatment, the more likely the condition will become permanent.