Face flushes at first drink of alcohol

Dear Dr. Roach: Iama 76-year-old man in excellent health. When sitting with friends, I’ll have my first drink of beer. Within a minute, my face gets bright red, and I get a feeling of anxiety. It goes away in a few minutes and does not return. If I have a sip, it still happens, just not as severe. It happens every time. What do you think about this? Should I worry?

W.D.

Answer: The medical term for the face turning red, usually accompanied by a sensation of warmth, is called flushing. The sudden onset you describe makes flushing the diagnosis, rather than any other causes of facial rash, such as lupus or a photosensitivity rash.

Alcohol alone can cause many people to flush, but since this just started within the last year, I think there is something else going on. By far, I think the most likely diagnosis is rosacea, which usually happens to people in their 60s. Alcohol is a potent trigger for flushing in people with rosacea.

A careful skin exam would be likely to prove or disprove my suspected diagnosis, and a dermatologist would be the ideal choice. You might even consider bringing in a beer to demonstrate the effect to the doctor.

Dear Dr. Roach: Iaman 83-year-old male scheduled to have my left knee replaced in the next month or two. I have been diagnosed with Ehlers-Danlos syndrome, type 4. Please let me know if you think it wise, or not, to go ahead with the operation.

D.M.

Answer: Ehlers-Danlos syndrome (EDS) is actually a group of genetic disorders of connective tissue. What was formerly called type 4 EDS is now called the hypermobile subtype of EDS (“hEDS”), and it is the most common form.

Because of the hypermobile joints, damage to soft tissue can be extensive in people with hEDS, and joint replacements are more common. They still may be effective, but ideally, they should be done by a surgeon familiar with hEDS. Surgical care needs to be adjusted for your condition.

One of the most important predictors of a good result in joint replacement is the physical therapy done after surgery. This also needs to be tailored to you, as a person with hEDS.