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I've been experiencing a reaction to a few sips of any

Customer Question
Hello there, I've been...
Hello there, I've been experiencing a reaction to a few sips of any alcoholic drink. It doesn't occur every time, but has become more frequent. My forehead gets hot and I feel an increasing warmth until others start to notice the redness. It can spread down my face (blotchy) until it reaches my neck. Sometimes I get a bit of nausea. I'm wondering if a topical antibiotic can cause it - Clindamycin phosphate. I started taking it a few months ago for boils.
JA: How long have you been dealing with this issue? Any other skin concerns?
Customer: I started getting small red bumps (not filled with pus) around my hairline. They are sore and end up scabbing over before going away. I get one or two at a time (always on one side of my neck near the hairline.
JA: Anything else in your medical history you think the doctor should know?
Customer: I've been taking lexapro for anxiety for about a year and a half. And Astelin for several years for sinus congestion
Submitted: 1 month ago.Category: Medical
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Customer reply replied 1 month ago
I added a photo of what the red bumps (boils?) look like on my skin. The alcohol reaction doesn't have bumps - just weird hot blotchy face rash.
Customer reply replied 1 month ago
One more of a particularly bad case of the rash next to hairline
Answered in 37 minutes by:
11/17/2017
Doctor: Dr. Bob, Medical Doctor replied 1 month ago
Dr. Bob
Dr. Bob, Medical Doctor
Category: Medical
Satisfied Customers: 5,524
Experience: 20 Years in Internal Medicine, Neurology and Sports Medicine
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Hello, Deborah. How long have you had this response to alcohol?

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Customer reply replied 1 month ago
It has been on and off for the last year. Now that I think about it, I've had the clindamycin topical for probably about 2 years - using it very sporadically at first, but more frequently lately as the neck rash has been more severe. I never really got an answer as to what the neck rash is. The doctor thought maybe staph. Anyway, I would get flushed cheeks from wine in the past. The first time, I got the weird blotchy red rash was about 2 years ago from red wine. About 1 year ago, beer would make me flush and now it seems to be almost anytime I have alcohol. I don't drink often, but would like to enjoy a drink or two on the weekends.
Doctor: Dr. Bob, Medical Doctor replied 1 month ago

You may very well be one of many women who suffer from what is called the "alcohol flush reaction" due to a deficiency of an enyme (alcohol dehydrogenase) responsible for metabolizing alcohol. Before alcohol reaches the blood stream, it goes through the stomach, where so-called gastric alcohol dehydrogenase (gADH) isozymes break some of it down. Studies have found that women have less of this ADH activity than men do. Because of this, women have a lesser first-pass metabolism and, therefore, for a given dose of alcohol, their blood level is higher than it is for men. This is why women need to be more cautious about drinking alcohol. It is possible that over time your levels of this enzyme have declined or your medications have combined to block its production or action.

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Customer reply replied 1 month ago
I've read about that, but it didn't seem to make sense. I don't have the reaction every time I drink. For instance 2 weeks ok, I had a red sangria drink at lunch with no problem. I went back to the same restaurant a few days ago and order the drink. After 3 sips, my face reacted. Wouldn't that reaction happen every time?
Customer reply replied 1 month ago
I was wondering if you had any insight into the rash you see in the pictures? Doctor said maybe boils, but they never fill with pus or drain. I
Doctor: Dr. Bob, Medical Doctor replied 1 month ago

The response can vary depending on the alcohol content of the drink, the amount you consume, the amount of food you have in your stomach, and possibly the interval since you took your pills. If the alcohol content in your blood reaches a certain threshold, you will get flushing, nausea, etc. At least until your body can get the level back down below your threshold. As for the other rash, it is difficult to say without examining you in person, but they do look inflammatory, probably infectious. If staph, which is a common skin pathogen, it should respond well to penicillins, cephalosporins, even macrolides such as erythromycin. The clindamycin gel may not get it. You may need to use warm compresses and take oral antibiotics.

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Customer reply replied 1 month ago
Thank you for your insights. I will talk to my doctor about getting something else to treat the rash. Have a nice evening.
Doctor: Dr. Bob, Medical Doctor replied 1 month ago

You're welcome. Hope all works out for the best!

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