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Brief Report
December 4, 2019

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

Author Affiliations
  • 1Department of Dermatology, University of California, San Francisco
  • 2Department of Dermatology, University Hospitals Cleveland Medical Center and School of Medicine, Case Western Reserve University, Cleveland, Ohio
  • 3University of California School of Medicine, San Francisco
  • 4Editor, JAMA Dermatology
  • 5Dermatology Service, San Francisco Veterans Affairs Health System, San Francisco, California
JAMA Dermatol. 2020;156(2):182-185. doi:10.1001/jamadermatol.2019.3508
Key Points

Question  Does brimonidine gel, 0.33%, decrease alcohol-induced facial erythema in patients with alcohol flushing syndrome?

Findings  In this randomized, placebo-controlled, double-blind split-face clinical trial of 20 individuals of East Asian descent, brimonidine gel was effective in reducing facial erythema in patients with alcohol flushing syndrome. Brimonidine decreased observed erythema by an average of 2.1 and 1.7 points as evaluated by the clinician and the patient, respectively, on an erythema grading scale of 0 to 4 points.

Meaning  This study demonstrates that brimonidine gel is effective in reducing the alcohol-induced facial erythema of alcohol flushing syndrome.


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 Participants  In 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 Measures  Outcomes 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.

Results  The 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 Relevance  This 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

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