Fighting Asian flush: Study finds brimonidine gel effective in reducing facial redness

Alcohol flushing syndrome (AFS) affects 20 to 47% of East Asians and is characterised by severe flushing and burning sensation with alcohol consumption.

There are currently no approved treatments for this condition.

The study was published in the journal, JAMA Dermatology​.

Clinical trial​

In the prospective, randomised clinical trial, 20 healthy volunteers of East Asian descent (Chinese, Japanese, Korean etc) with a self-reported history of AFS were recruited.

Participants were randomised to receive a thin layer of brimonidine gel, 0.33%, to either the left or right half of their face. The placebo group received the Neutrogena Hydro Boost Gel Cream, which was applied on the opposite side.

After 30 minutes of gel application, participants were tasked to consume 80-proof vodka (44.36 mL for women, 88.72 mL for men).

Clinician Erythema Assessment (CEA) score, Subject Self-Assessment (SSA) grading score, standardised photographs, and blood alcohol concentration were recorded at 30-minute intervals.

Study results​

The findings reported that there was a significant reduction in alcohol-induced erythema at 60 minutes after drug application, measured by the mean difference in CEA score (p< 0.001) and in SSA score (p<0.001).

This difference persisted at 90 and 120 minutes. Researchers said: “The duration of response persisted to 120 minutes, similar to the time necessary to metabolise alcohol​.”

The gel was able to effectively reduce the effects of AFS even at the peak blood alcohol concentration at 60 minutes (mean, 0.04%; max, 0.07%).

Researchers said brimonidine, like antihistamines, may allow patients with AFS and mild phenotypes to engage in limited alcohol consumption in social settings, to help them reduce the significant psychosocial effect of this condition.

They added many patients with AFS use oral antihistamines to reduce flushing. However, H1 receptor antagonists can have sedating effects and may be dangerous in combination with alcohol, and H2 receptor antagonists increase blood alcohol levels by slowing first pass metabolism.

They said brimonidine is a selective α2-adrenoceptor agonist that induces vasoconstriction. It is approved by the US Food and Drug Administration as a topical gel for rosacea (chronic skin condition that causes redness) but has not been evaluated for AFS.

The researchers also asked participants to rate their likelihood of using the medication again (7.2) and their likelihood of recommending the medication to a friend (7.6) on a scale of 0 to 10.

Use with caution​

One limitation of the study was the small sample size and lack of genetic confirmation of the AFS diagnosis.

Researchers advised that while flushing due to alcohol consumption are typically planned and episodic, as opposed to the chronic nature of erythema in rosacea, “the medication (brimonidine) could be used on a pro re nata basis​.”

They also warned that, “Ethical use of topical brimonidine should be considered in the context of the individual patient and should not be used to promote alcohol abuse. Patients with more severe AFS have systemic symptoms such as headache and nausea; these are not ameliorated by brimonidine​.”

This clinical trial demonstrated that topical brimonidine was effective in decreasing erythema in Asian patients with AFS but researchers suggest larger studies to further assess the long-term efficacy, potential for rebound erythema, and quality of life effect of topical vasoconstrictors in patients with AFS.

Source: JAMA Dermatology

https://doi.org/10.1001/jamadermatol.2019.3508​

“Effect of Topical Brimonidine on Alcohol-Induced Flushing in Asian Individuals: A Randomized Clinical Trial”​

Authors: Wesley Yu, et al.​