Most Common Changes In An Alcoholic's Face
The most common changes in an alcoholic's face are:
Red Skin
A physical warning sign that a person is struggling with excessive drinking is red skin [4].
This can be Rosacea, Vasoconstriction, Acetaldehyde or broken capillaries.
Rosacea
Drinking alcohol causes dehydration, resulting in increased risk of Rosacea.
Rosacea is a skin condition causing facial flushing.
Although Rosacea is not directly caused by alcohol abuse - one study found that 64% of those suffering with Rosacea only had to have one drink to have a flare up, particularly when drinking wine or beer [5].
Vaso Constriction/Dilation & Blood Vessels
High concentration of alcohol constricts blood vessels [6].
Those who drink more than 2 standard sized drinks per day, have an increased risk of inflammation due to vasoconstriction, resulting in red skin [6].
Acetaldehyde and ALDH2 Deficiency
Alcohol Flushing Syndrome affects 540 million people worldwide [7].
Facial flushing is a common reaction to drinking excessive amounts of alcohol.
It is caused by individuals metabolising alcohol less efficiently, resulting in Acetaldehyde build up.
Acetaldehyde toxins lead to an ALDH2 deficiency, causing Alcohol Flushing Syndrome [7].
Broken Capillaries
Facial flushing is caused by dilation of capillaries [8].
Dilation causes the capillaries to become damaged and broken, leaving them raised and more apparent under the skin.
Facial Flushing, Transient Flushing
Facial flushing after drinking alcohol is linked to the body's intolerance to alcohol.
For low to moderate drinkers, this suggests an alcohol sensitivity, whereas for alcoholics it is due to the high concentration of alcohol [9].
Does Red Face From Drinking Go Away?
A red face from drinking alcohol will go away if it is caused by transient flushing or an ALDH2 deficiency, as both of these symptoms are linked to toxins which can be removed from the body [9].
Rosacea sufferers can also have periods where symptoms reduce, if drinking is reduced [5].
However, if an alcoholic's red face is caused by broken capillaries and blood vessels, symptoms will not resolve completely, if at all, after a person stops drinking [8].
When Is Facial Flushing And Red Face Not Due To Alcoholism?
Facial flushing can be caused by emotions, allergic reactions, skin disorders, high temperatures, carcinoid syndrome or specific types of cancer [10].
Bloated Face
An alcoholic's face can appear bloated due to:
When alcohol causes dehydration, this leads to the body trying to retain water where possible.
The skin and vital organs retain whatever water they can - leaving the puffy face effect [11].
Heavy drinkers often appear to have a puffy face, resulting from "empty calories" in alcohol [2].
For example, there are 133kcal in a standard glass of wine and 239kcal in a pint of beer.
If alcohol use disorder remains untreated it may result in ascites (bloating of the abdomen) as well as more severe facial bloating [13].
Dark Circles
Dark circles under the eyes may result from:
Visible Blood Vessels
Visible blood vessels, otherwise known as spider veins, are a common physical symptom of alcoholism [16].
Alcohol also breaks down collagen in vein walls, resulting in "spider veins" being more apparent on the surface of the skin [16].
Jaundice
Jaundice is an indirect result of alcoholism, where excessive drinking has resulted in liver disease [17].
Jaundice is when the skin or the whites of the eyes turn yellow and is a key sign of liver disease [18].
Dry Skin
Alcohol dehydrates the skin [11].
Dehydrated, dry skin can appear dull and lead to shadows around the face [19].
This is common in alcoholics due to:
Rhinophyma
Rhinophyma, also known as "drinker's nose" or "alcohol nose", is a localised expression of Rosacea [21].
Rosacea causes skin to enlarge and thicken, leading to excess tissue on the nose, which is known as Rhinophyma.
This can leave the nose looking bulbous and swollen in comparison to the rest of the face [21].
Research suggests that there is a strong correlation between Rhinophyma and alcohol abuse [22].
Bloodshot Eyes
Bloodshot eyes are a common symptom of alcoholics both during and after drinking.
Alcohol reduces red blood cell oxygen saturation, meaning that blood vessels clumping together [23], causing bloodshot eyes.
Skin Cancer
Recent studies published in the British Journal of Dermatology suggest that regular drinking increases the risk of melanomas by 55% [24].
This may result from alcohol preventing DNA from repairing correctly.
These melanomas can often appear similar to a mole, but with a jagged border or an uneven colour.
They usually change shape and appearance, in ways that a regular mole does not [25].
Premature Ageing
Persistent dehydration of the skin can lead to wrinkles and sagging skin, increasing the appearance of ageing [26].
Puffy face and bags under the eyes, secondary to alcoholism, can lead to much less defined features.
How To Tell An Alcoholic By Their Face
Facial signs indicating heavy drinking include:
Usually these signs will be gradual, rather a sudden change [27].
The Face Of An Alcoholic vs A Moderate Drinker
Drinking only moderate amounts of alcohol (two drinks a day) may not having a long lasting effect on the face and body [28].
Reducing drinking from two drinks a day to once every three days gives the body time to process alcohol and will reduce symptoms such as bloodshot eyes and dehydrated skin [28].
An alcoholic who doesn't give their body time to recover from the alcohol, will suffer with skin conditions due to persistent dehydration [28].
Equally, once blood vessels on the skin have been damaged, it is usually not possible to reverse this damage [16].
The Face Of An Alcoholic vs A Rosacea Sufferer
Often a Rosacea sufferer can be mistaken for an alcoholic due to the stigma and stereotype that comes with the typical Rosacea symptoms [5].
An alcoholic is much more likely to have the pronounced nose, known as Rhinophyma, as well as the flushed cheeks seen with Rosacea [29].
However, dark circles and jaudice would not be expected to be seen by those with Rosacea unless they have other underlying conditions, such as liver congestion [30].
When Alcohol Addiction Becomes Visible
Alcohol addiction becomes more visible when an alcoholic's skin appears to be constantly dry - which can also lead to skin infections [31].
More obvious changes, such as jaundice and telangiectsia, become apparent at different times depending on the individual [31].
It is hard to quantify exactly when these changes become visible due to each person's liver function.
Variation In Facial Changes Between Alcoholics
For example, male bodies absorb alcohol better than female bodies due to the higher water content, so the alcohol will have less of a negative impact on the puffiness of the face in males [32].
Equally, the way in which alcohol is processed by the body depends on liver processing [33].
If the liver is coping well with the quantity of alcohol that it has to process, there will be fewer signs in the face.
Lifestyle and other health choices further impact on variation in facial changes, due to the effects of dehydration [14].
A person who maintains a healthy diet and hydration levels will experience fewer adverse affects from alcohol than someone who does not drink and eat appropriately.
When Face Changes Become Irreversible
Puffy eyes and dry skin are reversible where alcohol intake is reduced [2].
Dry skin and bloodshot eyes can be reduced where liver function is improved.
However, some changes are irreversible even if drinking ceases.
If the liver has begun to decompensate resulting in jaundice, it is unlikely changes to the face will be reversible [17].
Effects Of Alcohol On The Face vs Effects Of Drug Use On The Face
Alcohol and drug use both have side effects of bloodshot eyes [34].
Both alcohol and drug use will dehydrate the skin, however drug use more commonly leads to open sores [35].
Reducing the Effects of Alcohol on the Face
Transient flushing can be reduced by decreasing alcohol intake and drinking more water [36].
Alcoholics can see improvements in red face symptoms in as little as two weeks [36].
The best way to reduce the effects of alcohol on the face is by reducing alcohol intake and increasing water intake to tackle dehydration, including dark circles and puffy/dry skin [37].
Antihistamines, such as Brimonidine and Oxymetazoline may reduce the effects of alcohol on a flushed face or rosacea, under the guidance of a medical professional.
