I’m a former mental health and addictions nurse who’s also been sober for almost four years. I’m committed to providing education around the effects of alcohol because, to be frank, this knowledge is rather sparse in the general public.
Many people have questions about alcohol, but the information is limited, or it’s too hard to understand, or it isn’t available at all.
Yet, we have more and more people drinking at increasingly unsafe levels. And often, they have no idea what they’re doing to their bodies. Also, people may wonder what’s happening when they drink too much, but they may be too embarrassed to ask. For instance, many people wonder why alcohol causes a flushed or red face in some heavy drinkers?
For me, I used to get a red puffy face when I drank too much. I never understood why that happened, and the information was pretty scarce. Once I got sober and started doing more research, I realized more about what was happening to me.
There are three main reasons why alcohol causes flushing in the face. I’ll try to explain in the easiest way possible using my knowledge and the research I’ve pulled together.
1. Alcohol flush reaction
This is a rare cause of redness in the face after consuming alcohol. You can think of it as an allergic reaction of sorts, except it’s a bit more complicated than that.
In some people, alcohol causes an accumulation of acetaldehyde during the breakdown of alcohol in the blood. This buildup causes flushing and red splotches all over the face and body. It’s also associated with nausea, headache, and rapid heartbeat.
It’s most definitely not a pleasant experience. The good news is, those with this reaction are much less likely to get addicted to alcohol and sometimes don’t like to drink at all.
Alcohol, and the sugar in the alcohol, causes wide-spread inflammation. Although this inflammation affects every part of the body, it’s often most noticeable in the face.
It turns out that this was what caused my facial flushing. I tend to react to sugar and toxins a little more severely than other people. To be honest, I’m glad for it, because the discomfort of inflammation helped me inch closer to sobriety.
Alcohol causes small blood vessels to dilate in response to inflammation. The vessels most affected are the tiny peripheral vessels in the face, hands, and feet. This explains why they often get swollen, red, and sometimes itchy when drinking copious amounts of alcohol.
Unfortunately, when a person drinks excessively for many years, this inflammation can start damaging other areas of the body like the kidneys, liver, heart, and larger blood vessels. Some people are more prone to inflammation than others. But yes, anyone who drinks well beyond the safe amount will have some aspect of dangerous inflammation.
3. Portal hypertension
The last and most serious reason why alcohol causes a flushed face is due to portal hypertension.
And actually, the facial redness of portal hypertension is not caused by flushing; rather, it’s caused by permanently swollen and damaged blood vessels in the face. These vessels are nicknamed “spider veins,” but the scientific word is spider angiomas.
If you were to look up close, you would see many small purplish blood vessels that are visible through the skin. You should know that “spider veins” from portal hypertension are also found in the mouth, throat, esophagus, and stomach. And you should also know that the “spider veins” that happen as a result of portal hypertension are not a good sign. In fact, portal hypertension, in the presence of excessive alcohol intake, may indicate advanced severe liver damage.
Portal hypertension happens when the liver is so damaged that it pushes blood out of the liver, causing increased pressure in the portal vein. This causes blood to be detoured to those smaller vessels, as I mentioned before. These vessels are at high risk of rupture, which can cause severe bleeding or sudden heart attacks.
Due to its seriousness, if a person has "spider veins" on the face and is a heavy drinker, it’s imperative to consult a doctor to see if portal hypertension is the cause.
As you can see, there’s more than one reason why alcohol causes a flushed face. Some are mild, while others are more serious. But it’s worth knowing all these reasons so you can take control of your health and make decisions about how much you drink.
If you’re someone who gets an alcohol flush reaction, the discomfort of it alone may be enough to stop you from drinking at all.
However, those who get mildly inflamed from drinking may continue drinking even though it causes some problems. Just know that mild inflammation can turn dangerous if left unchecked.
Lastly, portal hypertension may be a cause of facial redness due to increased blood pooling in the small vessels of the body. This condition can be life-threatening if excessive drinking continues. Always get a check-up if you suspect you have “spider veins” on your face due to portal hypertension.
We live in a society where excessive alcohol consumption is glorified while the education around its effects is limited. As a nurse who is also in recovery, I feel strongly about helping others learn more about the impact of alcohol.
As I’ve always said, we’re all autonomous in our decisions, but having knowledge really helps.
Below are the references I used to write this article.
Alcohol Flush Reaction
How Does the Liver Work?
Alcohol, inflammation, and gut-liver-brain interactions in tissue damage and disease development
Relationship between facial flushing and blood acetaldehyde levels after alcohol intake
Portal hypertensive gastric mucosa: an endoscopic study.