Effect of Topical Brimonidine on Alcohol-Induced Flushing in Asian Individuals

Abstract

IMPORTANCE Alcohol flushing syndrome (AFS, also known as Asian glow and Asian flush) affects 20% to 47% of East Asians and causes significant psychosocial distress. There are no approved treatments for this condition.OBJECTIVE To determine whether brimonidine gel, 0.33%, decreases facial erythema in patients with AFS after consumption of alcohol. DESIGN, SETTING, AND PARTICIPANTSIn this randomized clinical trial, 20 healthy volunteers of East Asian descent with a self-reported history of AFS were recruited between April 2018 and March 2019.INTERVENTIONS Participants were randomized to application of brimonidine gel to either the left or right half of their face. Placebo control was applied to the opposite side. After 30 minutes, participants ingested alcohol. MAIN OUTCOMES AND MEASURESOutcomes were specified before data collection. The difference in erythema between the treated and placebo side of each participant's face was measured 60 minutes after drug application (primary outcome) and at 90 and 120 minutes after drug application (secondary outcomes). Participants were asked to rate their likelihood of using the medication again and their likelihood of recommending the medication to a friend on a scale of 0 to 10. RESULTSThe mean (SD) age of the 20 individuals enrolled in the study was 30.5 (8.4) years, and there were 10 women (50%). There was a significant difference in erythema at 60 minutes after drug application as measured by the difference in Clinician Erythema Assessment score (2.1; 95% CI, 1.5-2.71; P < .001) and by the difference in Subject Self-Assessment score (1.7; 95% CI, 1.1-2.3; P < .001). This effect persisted at 90 and 120 minutes. Individuals were likely to use the medication again (7.2; 95% CI, 6.0-8.3) and would also recommend it to a friend (7.6; 95% CI, 6.5-8.6). CONCLUSIONS AND RELEVANCEThis study demonstrates that brimonidine gel is effective in reducing the facial erythema of AFS. Patients with psychosocial distress due to AFS may benefit from treatment with brimonidine.TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03497442

Rosacea: An Overview of Its Etiological Factors, Pathogenesis, Classification and Therapy Options

“…Brimonidine also has additional mast cell-mediated anti-inflammatory properties and acts as a barrier [91,92]. In addition, a study showed that brimonidine was beneficial against alcohol-induced flushing and provided satisfaction in rosacea patients [93]. Both topical drugs could be used with topical, systemic, or instrumental therapies for rosacea.…”