The first drink of alcohol causes facial flushing and anxiety

Dr. Keith Roach

DEAR DR. ROACH: I am a 76 year old male in excellent health. I have been on no medication except simvastatin for over 15 years. My cholesterol is now below 200. But a problem started about eight months ago. When I’m sitting with friends, I’ll have my first glass of beer. Within a minute, my face turns bright red and I feel a feeling of anxiety. It leaves in a few minutes and does not come back. If I take a sip, it still happens, but not as bad. It happens every time. I mentioned this to my GP in May during my annual medical examination, but he had no answer. He didn’t seem too worried. What do you think of that? Should I be worried? —WD
ANSWER: The medical term for the face turning red, usually accompanied by a feeling of warmth, is called flushing. The face is the most common location, but some people will experience redness in the ears, neck, chest, torso, or arms. The sudden onset you describe makes flushing the diagnosis, rather than any other cause of facial rash, such as lupus or a photosensitivity rash.
Alcohol alone can make many people blush, but since it just started last year, I think there is something else going on. By far, I think the most likely diagnosis is rosacea, which usually occurs in people in their 60s. Alcohol is a strong trigger for flushing in people with rosacea. A careful skin examination would likely prove or disprove my presumed diagnosis, and a dermatologist would be the ideal choice. You might even consider bringing a beer to demonstrate the effect to the doctor.
Although there are some worrisome causes of flushing, such as carcinoid syndrome and pheochromocytoma (both caused by tumors that secrete substances and dilate blood vessels), the association with alcohol makes rosacea the most likely diagnosis.
DEAR DR. ROACH: I’m an 83 year old male with my left knee due for replacement in a month or two. I have been diagnosed with Ehlers-Danlos Syndrome Type 4. Please let me know whether or not you think it is wise to proceed with the operation. —DM
ANSWER: Ehlers-Danlos Syndrome (EDS) is actually a group of genetic connective tissue disorders. What used to be called type 4 EDS is now called the hypermobile subtype of EDS (“hEDS”), and it is the most common form. Diagnosis is made clinically: there are no definitive blood tests, x-ray results, or genetic tests to reliably diagnose hEDS.
Due to hypermobile joints, soft tissue damage can be significant in people with hEDS, and joint replacements are more common. They can still be effective, but ideally they should be performed by a surgeon familiar with hEDS. Although the prosthetic joint is very stable, existing soft tissues and ligaments are at increased risk after replacement surgery, and surgical care should be tailored to your condition.
One of the strongest predictors of a good joint replacement outcome is the physical therapy performed after surgery. It should also be tailored to you, as a person with hEDS.

Dr Roach regrets that he cannot respond to individual letters, but will incorporate them into the column whenever possible. Readers can send questions to [email protected] or mail to 628 Virginia Dr., Orlando, FL 32803.
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