Alcoholic Nose: Why is My Nose Red?

‘Alcoholic nose’, commonly known as ‘drinkers’ nose’ is characterised by a red and swollen nose. This swelling and inflammation may also appear with bumps and lumps.

The medical term for this condition is Rhinophyma. Rhinophyma causes a distortion of the lower nose, thickening the nasal valves. The upper nasal skin is largely unaffected. [1]

Rhinophyma is Greek for ‘nose growth’. Whilst benign, growths appear on the skin of the nose. Rhinophyma is also known to be a sign of the advanced stages of rosacea [2].

The precise cause of Rhinophyma is unknown, but research has shown that it may be caused by a multitude of factors.

The main aetiology is superficial vasodilation. As edema develops, so does inflammation and gland hyperplasia. Hyperplasia refers to the enlargement of an organ or its tissue due to an increase is cell reproduction. If left untreated, the nose may turn red or purple. [3] [4] [5]

Rhinophyma has long been linked to alcohol and caffeine use, as both liquids cause vasodilation. Vasodilation is the dilation and widening of blood vessels, worsening the symptoms of Rhinophyma.

Broken blood vessels and sores on the nose inflame the skin and nasal valves, causing a sore red, swollen, and bumpy nose. [6] [7]

When these vessels break, the skin becomes red and the blood becomes visible under the skin. Whilst women can be diagnosed with rhinophyma, an alcoholic nose is most common in men, those with a light skin tone, and those with a family history of rosacea.

Alcoholic Nose and Alcoholism: The Link

Alcohol and redness of the skin are closely associated, so it makes sense that Rhinophyma has long been linked to alcohol use. It is commonly known that alcohol can cause skin conditions and rashes or make them worse.

These are not life-threatening but can lead to health risks and embarrassment from social stigma.

The following are common skin conditions that can be caused or contributed to by alcohol: [8] [9]

• Flushing
• Hives
• Psoriasis
• Jaundice
• Hyperpigmentation
• Rhinophyma

Dermatological conditions (skin conditions) are one of the first visible signs of alcohol abuse. Skin reactions to alcohol can be the result of environmental factors, genetics, alcohol toxins, and interactions between medication and alcohol.

If your redness is caused by genetics, this is a sign of alcohol intolerance. Some families have a genetic inability to metabolise and process alcohol properly. This is called an ‘alcohol flush reaction’, common in those of Asian descent.

Around 40% of East Asians suffer from flushing due to alcohol, as they do not possess the correct metabolic enzyme (aldehyde dehydrase) to metabolise the alcohol.

Redness can also be caused by medication interaction. Some antibiotics result in redness or other uncomfortable side effects because of two types of interactions: [10] [11]

1. Pharmacokinetic interactions: alcohol interferes with the body’s ability to metabolise medication
2. Pharmacodynamic interactions: alcohol enhances the effects of the medication, especially on the nervous system.

Redness can also be caused by how the alcohol is prepared or consumed. Alcohol is occasionally mixed with many preservatives that damage the skin, or you may be allergic to them. Alcohol can also exacerbate any existing allergies such as rosacea and eczema.

Rhinophyma and Rosacea

Rosacea is a common inflammatory dermatological condition, characterised by: [12]

• Erythema (abnormal redness)
• Telangiectasia (dilated capillaries in a spidery appearance)
• Pimples and blisters
• Edema (excess of fluid)

Research has shown that vascular changes, such as flushing, are the first changes that signify rosacea. This is followed by inflammatory changes, causing pimples and blisters.

The later complications are characterised by the development of chronic lymphedema (localised swelling) and Rhinophyma.

Rosacea is a common condition, mostly seen in those between the ages of 30 and 50, specifically in Caucasians. Whilst women have been more commonly affected, men progress to the advanced stages of rosacea more often than women do. [13]

The cause and aetiology of rosacea are still uncertain, but studies have suggested a mixture of genetic and environmental factors: [14]

• Family history and genetics
• Drinking hot beverages
• Eating spicy food
• Taking some types of medication
• Sun exposure
• Hot or cold weather
• Wind
• Humidity
• Central heating
• Stress
• Menstruation and pregnancy
• Alcohol

Alcohol triggers a flushing reaction and worsens any erythema, exacerbating the rosacea and contributing to Rhinophyma, or ‘drinkers’ nose’. [15]

The best approach or treatment for rosacea patients is the identification and avoidance of trigger factors. The education of patients is essential as all trigger factors may change or change in intensity for each patient.

For example, some patients might be triggered by internal artificial heating, and some may be triggered by alcohol and spicy food.

Avoiding the triggers that we already know is the best form of treatment. Avoiding sun exposure and sun creams is critical, as most sun creams contain irritants that cause erythema and a stinging sensation.

Patients should aim to find cosmetics that are sensitive to the skin, as general cosmetics may dry out the skin and irritate the rosacea.

Do I Have Rhinophyma?

‘Alcoholic nose’ is an outdated term, as the word ‘alcoholic’ can be stigmatising and not all cases of rhinophyma are caused by alcohol. The condition itself is quite rare and typically affects Caucasian males during the advanced stage of rosacea.

Rhinophyma is the medical term for ‘alcoholic nose’, a condition believed to be common in those with an alcohol use disorder.

The common signs of rhinophyma are:

• Thickening of the skin
• Red skin
• Visibly broken blood vessels
• Pitting and scarring
• bulbous disfigurement of the nose

This discolouration and thickening of the skin are most likely to appear on the nose, but may also appear on the cheeks, ears, chin, forehead, and eyelids. [16]

There is a lack of evidence linking alcohol consumption to the direct cause of rhinophyma, but there is substantial backing behind alcohol being a factor that exacerbates this condition.

Despite this, social stigma has created a host of terms to refer to rhinophyma, such as:

• Alcoholic nose
• Potato nose
• Drinker’s nose
• Whiskey nose
• Gin blossom

Rosacea and rhinophyma affect a person’s skin. A long-term condition such as this may increase the risk of poor mental health, such as anxiety, due to changes in physical appearance.

Along with treatment from a dermatologist, patients are also advised to seek treatment from mental health professionals or join group therapy for social support. [17]

Treatment and Prevention for Rhinophyma

Currently, there is no cure for rhinophyma. However, there are several options and treatments that can address the condition and its appearance to help the individual’s confidence and anxiety. [18]

• Medication: if you go to your doctor, they may prescribe you tropical treatment or antibiotics to help manage you Rhinophyma. Common antibiotics that you may be prescribed are metronidazole, tetracycline, and erythromycin. There may also be specific moisturisers that are recommended to prevent the skin from drying out.
• Surgery and laser therapy: if the Rhinophyma is advanced, surgery may be advised. Doctors can offer treatment, but this treatment is not usually available on the NHS so it will be private. Often, excess tissue can be removed, and surgery is available to help reshape the nose.

If you are not at the advanced stages of rhinophyma, here are some tips on how to prevent the condition from worsening and developing.

Whilst there is no direct correlation between alcohol use and rhinophyma, drinking alcohol exacerbates these symptoms. Alcohol causes flushing and redness, which can easily aggravate skin conditions such as rhinophyma.

Doctors and medical professionals will advise you to cut back or cut out alcohol to prevent the condition from getting worse.

Doctors will suggest healthy lifestyle changes that can help manage dermatological conditions: [19]

• Eat a healthy balanced diet and maintain a healthy weight
• Exercise regularly
• Quit or cut down on smoking
• Quit or cut down on drinking alcohol
• Try to reduce stress levels
• Practice mindfulness
• See a doctor about your rhinophyma
• See a dermatologist to receive advice on medication and cosmetic products

Summary: ‘Alcoholic Nose’ or Rhinophyma

Rhinophyma is a skin disorder, characterised by a bulbous nose, thickened skin, dry skin, enlarged blood vessels, and facial redness. Also called ‘ocular rosacea’, rhinophyma is an advanced stage (severe form) of rosacea, another skin condition exacerbated by alcohol intake.

There is no cure for rosacea or rhinophyma, but reducing alcohol consumption and other risk factors will help manage the symptoms.

Symptoms of rhinophyma include:

• Thickening of skin
• Visible blood vessels
• High blood pressure
• Dilated blood vessels
• Flushed skin
• Bulbous nose

To manage symptoms, avoid too many alcoholic beverages and hot drinks, spicy food, extreme weather, general skincare products, and try to limit stress.

If you are struggling to manage the symptoms, talk to a GP or therapist about your condition.

They may be able to prescribe you medication or advise specific forms of therapy that will help you.

References

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4426765/

[2] Popa D, Osman G, Parvanescu H, Ciurea R, Ciurea M. The treatment of giant rhinophyma—case report. Curr Health Sci J. 2012;38(1):41–4.

[3] Jansen T, Plewig G. Clinical and histological variants of rhinophyma, including nonsurgical treatment modalities. Facial Plast Surg. 1998;14(4):241–53.

[4] Rohrich RJ, Griffin JR, Adams WP. Rhinophyma: review and update. Plast Reconstr Surg. 2002;110(3):860–9.

[5] Sadick H, Goepel B, Bersch C, Goessler U, Hoermann K, Riedel F. Rhinophyma: diagnosis and treatment options for a disfiguring tumor of the nose. Ann Plas Surg. 2008;61(1):114–20.

[6] Rohrich RJ, Griffin JR, Adams WP. Rhinophyma: review and update. Plast Reconstr Surg. 2002;110(3):860–9

[7] Sadick H, Goepel B, Bersch C, Goessler U, Hoermann K, Riedel F. Rhinophyma: diagnosis and treatment options for a disfiguring tumor of the nose. Ann Plas Surg. 2008;61(1):114–20.

[8] Kostović K, Lipozencić J. Skin diseases in alcoholics. Acta Dermatovenerol Croat. 2004;12(3):181-90. PMID: 15369644.

[9] Liu SW, Lien MH, Fenske NA. The effects of alcohol and drug abuse on the skin. Clin Dermatol. 2010 Jul-Aug;28(4):391-9. doi: 10.1016/j.clindermatol.2010.03.024. PMID: 20620755.

[10] Weathermon R, Crabb DW. Alcohol and medication interactions. Alcohol Res Health. 1999;23(1):40-54. PMID: 10890797; PMCID: PMC6761694.

[11] Caballeria J, Baraona E, Deulofeu R, Hernandez-Munoz R, Rodes J, Lieber CS. Effects of H-2 receptor antagonists on gastric alcohol dehydrogenase activity. Digestive Disease Sciences. 1991;36:1673–1679.

[12] Yalçın Tüzün, Ronni Wolf, Zekayi Kutlubay, Özge Karakuş, Burhan Engin,Rosacea and rhinophyma,Clinics in Dermatology,Volume 32, Issue 1,2014,Pages 35-46,ISSN 0738-081X,https://doi.org/10.1016/j.clindermatol.2013.05.024.(https://www.sciencedirect.com/science/article/pii/S0738081X13000916)

[13] S.A. Buechner, Rosacea: an update, Dermatology, 210 (2005), pp. 100-108

[14] G.H. Crawford, M.T. Pelle, W.D. James, Rosacea: etiology, pathogenesis, and subtype classification, J Am Acad Dermatol, 51 (2004), pp. 327-341

[15] K. Abram, H. Silm, H.I. Maaroos, M. Oona, Risk factors associated with rosacea, J Eur Acad Dermatol Venereol, 24 (2010), pp. 565-571

[16] Dick, M. K., & Patel, B. C. (2021). Rhinophyma. In StatPearls. StatPearls Publishing.

[17] National Institute of Arthritis and Musculoskeletal and Skin Diseases. Rosacea.

[18] Chauhan, Ruvi, Loewenstein, Scott N., and Hassanein, Aladdin H. (2020). Rhinophyma: Prevalence, Severity, Impact, and Management. Clinical, Cosmetic and Investigational Dermatology, 13, 537-551.

[19] American Academy of Dermatology Association. Living with rosacea? How to reduce your risk of other conditions.

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