Everything You Need to Know About Alcoholic Nose

“Alcoholic nose” is a colloquial term for a form of rosacea, a skin condition that affects 5.4% of adults in North America.

But, alcoholic nose is rarer. This type of rosacea causes severe tissue inflammation, swelling, redness, and bumps on the nose and cheeks. The clinical term for the condition is rhinophyma. 

Researchers have been unable to determine the true prevalence of rhinophyma. The National Rosacea Society surveyed rosacea patients and found 11% of respondents had rhinophyma symptoms. 

According to recent analyses, alcoholic nose isn’t strongly correlated to alcohol misuse or heavy drinking. Instead, it happens when a person cannot (or does not) effectively treat rosacea for several years. 

Unfortunately, alcohol use disorder can cause you to neglect your physical health. Moreover, alcohol disorders can harm your cardiovascular system and cause tissue inflammation—both of which worsen rosacea.

Read on to learn the underlying causes of alcoholic nose. Then, learn about effective medical approaches to the problem, and discover how to treat rhinophyma and alcohol use concurrently.

What is Alcoholic Nose?

Rhinophyma is a deformity of the nose and nasal passages. The disfigurement is caused by Sebaceous hyperplasia. The sebaceous glands are the glands in your skin that produce oil (sebum).

The Science of Alcoholic Nose

All mammals have sebaceous glands. When you’re healthy, these glands produce just enough oil to keep your body from losing too much water, so you stay hydrated. They also create a protective barrier on the skin.

When a person has rhinophyma, they have too many sebaceous glands. The glands become inflamed. Underneath the skin, connective tissue breaks down, and vascularity increases. 

The excess sebum is prone to infection. Combined, the sebum, inflammation, and connective tissue degradation create tumor-like bulbs. These bumps can be painful.

The nasal airway lining can also become inflamed, or blocked by the tumors, which causes respiratory distress. 

Rhinophyma and Rosacea

Rosacea is a precondition of rhinophyma. Typical progression of rosacea, untreated, begins with pre-rosacea. This simply manifests as a tendency to blush easily. 

Then, the condition moves through the following stages: 

• Vascular rosacea
• Inflammatory rosacea
• Acne rosacea
• Rhinophyma

Rosacea and alcohol use disorders are not necessarily connected. But, there are a few reasons they seem to correlate in popular conversation.

Alcohol as Rosacea Trigger

According to the National Rosacea Society, drinking alcohol triggers rosacea “flare-ups” for many patients. 76% of patients surveyed experienced worsened rosacea symptoms immediately after drinking.

Notably, this happens even after a safe-for-most level of alcohol consumption. The patients surveyed noted rosacea flares happened most frequently after a single glass of red wine. Some experienced symptoms after only half a glass. 

Alcohol Flush

Some people are predisposed to flush or blush when drinking alcohol. This predisposition is most common in individuals with East Asian and Northern European ancestry.

Alcohol flush is a short-term experience. And, it can happen quickly—often, after a single drink.

This blushing tendency may be why the general public associated rosacea (and, eventually, rhinophyma) with alcohol use. 

But, flushing when drinking is not, in and of itself, a sign of alcohol misuse or dependency. Instead, it’s a sign that an individual doesn’t produce enough of the enzyme ALDH2, which breaks down acetaldehyde in alcohol. 

Without this enzyme, acetaldehyde builds up in the bloodstream as you drink. This causes rapid heartbeat, nausea, and flushing.

People who experience flushing when drinking are not at higher risk of alcohol use disorders. But, they are at higher risk of high blood pressure.

Do Alcohol Use Disorders Increase Rhinophyma Risk?

Terms like “drinker’s nose” are a misnomer. But, there is some evidence that problematic alcohol use can increase a person’s risk of developing rhinophyma.

Barriers to Diagnosis

Alcohol use can harm your memory and executive function. Executive cognitive functions are the “top-level” cognitive processes. These processes command and execute other cognitive processes, like:

• Understanding time
• Manipulating objects in physical space
• Remembering information
• Problem-solving

Recent research indicated heavy drinking can impair executive cognitive functions, even after someone is sober. Moreover, a person can experience impairment even when alcohol use doesn’t rise to the level of dependency.

You need to utilize executive cognitive functions to make and keep doctor’s appointments. You may have to problem-solve by finding out which doctors are relevant, and where you can access effective, affordable care.

Executive cognitive processes enable you to follow up with a referral, if your physician recommends a dermatologist. 

Alcohol use disorders cause impairments that create barriers to getting accurate diagnoses. It may prevent a person from getting their rosacea diagnosed and treated quickly.

As a result, it is more likely to progress to rhinophyma. 

Barriers to Treatment

Chronic alcohol use can increase inflammation and make chronic pain worse. This makes it harder to physically move and go places. A person struggling with chronic alcohol use may cancel doctor’s appointments. 

Beyond that, alcohol use disorders make it harder to treat rosacea. The medicines doctors prescribe to treat rosacea are:

• Doxycycline
• Benzoyl peroxide
• Isotretinoin
• Metronidazole
• Tretinoin

These medications work in different ways. Some are antibiotics that prevent sebum infections. Others shrink the sebaceous glands, which treats hyperplasia. 

Unfortunately, most of these medications cannot be taken with alcohol. In some cases, mixing the drug with alcohol creates dangerous, potentially lethal side effects. In others, alcohol simply counteracts the medication’s effect. 

Alcohol use disorder creates a barrier to effective pharmacological treatment of rosacea. As a result, it increases the risk that rosacea will progress into rhinophyma. 

Stigma Against Rhinophyma Patients

People who suffer from rhinophyma typically face stigma and social rejection. For many, the psychological harm that stems from stigma is even more painful than the physical symptoms. 

Researchers discovered laypeople use negative terms for rhinophyma sufferers more often than neutral or clinical terms. These include “gin blossom,” “potato nose,” and “whiskey nose.”

In popular culture, characters with rhinophyma are almost always villains or antagonists. These negative associations may contribute to the social rejection patients face.

Moreover, individuals with rhinophyma may lack the necessary information to get treatment. For example, a person who doesn’t drink alcohol, yet suffers from “alcoholic nose,” may feel despair that they cannot fix their problem. 

Misinformation and misnomers get in the way of effective treatment. Fortunately, treatment for this condition is available.

How to Treat “Alcoholic Nose”

As rhinophyma is a result of rosacea, the best course of action is to treat rosacea before it progresses. 

Physicians diagnose rosacea with a skin examination. Sometimes rosacea can be misdiagnosed as seborrheic dermatitis, or as an allergic reaction (a rash).

Rule Out Similar Conditions

In some regions, the Leishmania parasite is endemic. It is critical to make sure any skin conditions are not caused by this parasite if you live where it is commonplace. A smear and PCR test determine its presence.

It’s also important to rule out basal cell carcinoma, which can cause similar symptoms. Basal cell carcinoma can co-occur with rhinophyma. It’s best to get an assessment from a dermatologist rather than a general practitioner. 

Typical Rosacea Treatment

Dermatologists typically prescribe medication and skincare therapy to treat rosacea. Skincare therapy can include:

• Daily facial cleansing
• Skin moisturizers
• Sunscreen or sunblock lotion
• Rosacea-friendly skin, makeup, and hair products

Skincare therapy improves the efficacy of rosacea medication. But, pharmaceutical medications are critical to treatment. These medications include topical creams and gels, antibiotics, and drugs that target sebum. 

Diagnosing Rhinophyma

Many of the medications used to treat rosacea also help treat rhinophyma. But, most dermatologists opt to treat rhinophyma with more intensive therapies as well as pharmaceuticals. 

Physicians diagnose rhinophyma specifically using a graded scale. The scale determines the severity of the condition by examining:

• Skin thickness
• Number of lobules
• Presence of nodules
• Degree of nasal hypertrophy

The severity of the condition shapes the course of treatment. There is no cure for rhinophyma. 

Rhinophyma Treatment: Pharmacology

Medication-assisted treatment for rhinophyma typically combines oral and topical drugs. The topical treatments may include soothing or numbing agents, which treat painful skin symptoms (like stinging or burning). 

Oral Medication

The oral medications that help treat rhinophyma are often antibiotics, synthetic vitamin A proteins, and anti-estrogen drugs. Specific medications include:

• Metronidazole
• Doxycycline
• Tamoxifen
• Isotretinoin

Oral isotretinoin reduces inflammation and shrinks your sebaceous glands. Patients must wean off oral isotretinoin before undergoing surgery. 

Antibiotics, like doxycycline, can be effective rosacea treatments. But, their anti-inflammatory effect on rhinophyma is limited.  

Topical

Topical medications can reduce inflammation, treat infections in pores and sebaceous glands, and soothe stinging symptoms. Some topical treatments are incompatible with certain oral medications. 

In many cases, physicians encourage patients to wean off topical medications before pursuing more intensive treatments, like laser-based treatments. The most common topical medications are:

• Metronidazole
• Azelaic acid
• Ivermectin
• Brimonidine gel

Clinicians may pause a pharmaceutical treatment if it negatively impacts the patient’s liver enzyme production. Many surgical and laser procedures cannot be performed safely with these medications in your system. 

Rhinophyma Treatment: Invasive Interventions

When rhinophyma persists, it’s wise to pursue more invasive interventions. Some of these treatments are surgical. Others are non-surgical, but they must be performed in a surgical setting. 

Invasive interventions typically fall into four categories. Researchers are investigating treatments outside those categories, and many show promise.  

Excisional Treatments (Surgical Tissue Removal)

Surgical tissue removal is often the safest of the invasive treatment options. It doesn’t carry any risk of burns, and it gives clinicians a tissue sample to biopsy.

Surgical tissue removal may be full-thickness or partial thickness.

This surgery removes tissues that are damaged or diseased. In some cases, the remaining tissue is reshaped. In others, surgeons must graft donor tissue onto the nose.

Tissue removal can improve breathing by clearing the nasal passageway. It may also remove extra, enlarged sebaceous glands.

Ablative Treatments (Surgical Destruction via Erosion, Vaporization)

Ablative treatments cannot offer clinicians a sample to biopsy. Still, there are benefits to ablative surgery over excisional surgery. 

There is some evidence that ablative treatments prevent recurrence more thoroughly than excisional surgery. And, some patients see less scarring following ablative procedures than they would under excision. 

Most ablative treatments are electrocautery or electrosurgery. Both procedures are “nearly bloodless.” These procedures cauterize blood vessels, which stems the vascular overgrowth that underlies many rhinophyma symptoms.

When a patient carries a higher risk of burns, clinicians may choose “cold ablation.” Cold ablation de-epithelializes tissue rather than vaporizing it.

De-epithelialization thins tissue. It also prevents the epithelium—tissue that lines hollow canals in the body, including nasal passages—from over-growing into the wound. This reduces two risks:

• The risk the body will reject the skin graft
• The risk of moderate-to-severe scarring 

Cold ablation may be the most common invasive intervention for rhinophyma. But, as yet, it is not the standard treatment. Currently, there is no official, gold-standard surgical intervention.  

Laser Treatments

The most successful laser treatment for rhinophyma utilizes a CO² laser. It can cut and vaporize tissue with extreme precision.

This laser can penetrate deeper layers of tissue, as the water in our tissues absorbs most of the laser’s waves. 

Patients who undergo laser treatments require less post-operative care than those who undergo other interventions. But, laser treatments carry some risks. Risks of laser treatment for rhinophyma include:

• Hypopigmentation (skin color lightening)
• Dilated pores
• Millia (small cysts)
• Acne flare-ups

Many of these side-effects can be treated in an outpatient setting. 

Radiofrequency, Ultrasound, Plasma Therapy

These surgeries typically utilize helium and soundwaves to vaporize nodules. The risks are similar to those in the CO² laser treatment.

Unlike laser intervention, radiofrequency and plasma-based therapies are short. They also enable precise targeting. But, as these interventions utilize a high heat, they are not appropriate for patients prone to serious burns. 

Current Treatment Investigations, Clinical Trials 

Researchers are currently running clinical trials to test new rhinophyma treatments. These include:

• Tamoxifen treatments
• Beta-blocker treatments
• Surgical treatment that combines dermabrasion and decortication

Other trials aim to determine the best possible dosage of existing treatments. You can learn about active trials through Center Watch. As clinical trials conclude, we get closer to standardizing treatment.  

Treat Alcohol Disorders, Co-Occurring Conditions Today

Even though “alcoholic nose” is not always alcohol-related, problematic alcohol use erects barriers to treatment. Alcohol use disorders are serious.

The good news is, you don’t have to treat these conditions alone.

Whether you struggle with alcohol dependency, excessive drinking, or recurring alcohol poisoning, evidence-based treatment can help. Medical professionals can help address both the physical and psychological elements of alcohol misuse.

If you’re ready to get treatment, contact us. We’ll help you find a provider near you.