Many people drink alcohol socially and as a way to relax, and in moderation alcohol can be consumed as part of a balanced lifestyle. General advice for safe alcohol consumption includes avoiding excessive or heavy drinking, limiting consumption to no more than 14 units per week, and spreading out drinking over three or more days to prevent binge drinking.

While there is currently no scientific evidence to suggest that alcohol has a role in the development of AD, as a trigger for flares or making eczema worse, some people report that their eczema symptoms exacerbate after drinking. One of the few studies investigating the link between AD and alcohol found no “consistent association” between alcohol and flares. Unfortunately there is not a lot of research in this area, and therefore the most important thing you can do is to keep track of your symptoms and try to identify any potential triggers.

How does alcohol affect AD?

Alcohol and Histamine

When the body breaks down alcohol, it can trigger the release of histamine, a vital component of the body's immune response. This release is influenced by a toxic by-product of alcohol metabolism called acetaldehyde, which is swiftly converted into safer substances for elimination. The amount of acetaldehyde present is determined by two factors: the quantity of alcohol consumed and the body's ability to metabolise the by-product. Genetic factors heavily influence this process, meaning some individuals may experience an increased buildup of acetaldehyde after drinking alcohol, leading to alcohol intolerance. One consequence of elevated acetaldehyde levels is heightened histamine release, leading to alcohol-related skin rashes and flushing.

Histamines are chemicals that contribute to inflammation and allergic reactions. Many people have experienced a histamine-driven inflammatory response following a nettle sting, food allergy, or insect bite, resulting in symptoms like redness, swelling, and itching. Histamine release triggers these allergy symptoms by causing localised blood vessel dilation, increasing blood flow, and leading to fluid leakage into nearby tissues, allowing immune cells to address local triggers.

Concerning alcohol consumption, increased histamine release in the skin leads to heightened blood flow, resulting in skin warmth and flushing. This is important because temperature plays a significant role in the perception of itchiness, with heat often exacerbating the sensation of itch.

While histamine is implicated in inflammatory skin conditions, it is not considered a major contributor to the inflammation observed during eczema flare-ups. This may explain why there is no robust evidence that alcohol directly worsens eczema, instead the relationship may be that for some alcohol consumption leads to increased histamine release in the skin, leading to flushing, increased skin temperature and worsening of existing itchiness.

Alcohol and the Skin Barrier

There is some evidence which suggests that alcohol can impact the integrity of the skin barrier, which serves as a protective layer to retain moisture and prevent irritants from penetrating the skin. Given that individuals with atopic dermatitis (AD) already have compromised skin barriers, this damage from alcohol may exacerbate pre-existing weaknesses. Consequently, it can allow allergens and irritants to penetrate the skin, leading to inflammation and exacerbating symptoms.

Alcohol and dehydration

Alcoholic beverages act as diuretics, meaning they stimulate increased urine production, which can result in dehydration. This dehydrating effect intensifies with higher alcohol concentrations. While beer generally has a hydrating effect, alcoholic drinks like wine and stronger beverages can lead to a net loss of hydration, where you produce more urine than the volume of water you consume.

One of the central features of atopic dermatitis (AD) is skin dryness, with common triggers for eczema flare-ups including factors that increase skin dryness. Increased dehydration caused by alcohol consumption can worsen this pre-existing skin dryness, further compromising the skin barrier and exacerbating itchiness. Since individuals with AD may already have dehydrated skin, alcohol has the potential to aggravate dryness and exacerbate skin symptoms.

Precautions to take when drinking alcohol

Firstly, people with eczema should aim to avoid excessive drinking whenever possible.

If you suspect that your skin may react abnormally to alcohol, keeping a diary and monitoring your symptoms can be beneficial. Factors worth noting include the amount of alcohol consumed, the rate of consumption, and the type of alcohol consumed. Given the wide variety of alcoholic drinks available, tracking symptoms while consuming only single types can help identify any variability between different beverages. Since histamine release is influenced by the presence of acetaldehyde, drinking slowly or alternating with non-alcoholic drinks may be advantageous and reduce the risk of acetaldehyde build up and histamine release.

To counteract the dehydrating effects of alcohol, drinking water alongside alcohol can effectively lower the overall alcohol concentration in your drink. For example, if you drink water:wine in a 1:1 ratio, you should maintain a net positive (hydrating) fluid balance. The stronger the beverage, the more water:drink ratio you will need to consume to stay hydrated.

Certain medical treatments require abstaining from alcohol consumption, including some immunosuppressants and antibiotics. If you have been prescribed a new medication, it is essential to consult your doctor to ensure it is safe to consume alcohol alongside your treatment.

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