What Does the Research Say?
Only a limited amount of research has examined the relationship between alcohol and acne and at this point we cannot say definitively if drinking causes or worsens acne, or for that matter if drinking has no effect or even helps clear acne.
Two studies have reported that drinking may be associated with an increased prevalence of acne, but both studies were observational and relied on self-reported survey responses and thus the data must be interpreted with
The first study, published in International Journal of Dermatology in 2011, examined 1236 subjects with acne and reported that drinking was a strong risk factor for acne, and that this link was stronger in males than in females.1
The second study, published in Acta Dermato-Venereologica in 2012, included a total of 17,345 participants, 1399 of whom had acne, and showed that adolescent (under 25 years old) drinkers were more likely than non-drinkers to have acne. Interestingly, any amount of drinking increased the risk of having acne regardless of whether it was moderate (defined as 1 to 3 drinks per week) or heavy (defined as 4 or more drinks per week). In adults, the difference in acne prevalence was not significant between groups.2 “In adolescents, the prevalence of acne was 41.2% in heavy drinkers, 41.4% in mild to moderate drinkers, and 28.8% in non-drinkers, showing a significantly higher prevalence in drinkers. In adults (over 25 years old), the prevalence of acne was 5.5% in heavy drinkers, 5.8% in mild to moderate drinkers, and 5.5% in non-drinkers.”2
A final study, published in 2014, came to a different conclusion that alcohol consumption was not linked with acne, however, since the data from the study was not reported, it is difficult to evaluate the quality or significance of the results.3
How Might Alcohol Cause or Worsen Acne?
Researchers have proposed several hypotheses regarding how alcohol might cause or worsen acne and suggested that changes in hormones, bacteria, and/or inflammation may be to blame. Again, these hypotheses should be met with skepticism since we do not have quality data from randomized studies from which to draw any conclusions.
Hormones are an important factor in acne development, particularly male hormones called androgens, which are present in both males and females. Higher levels of androgens tend to lead to acne. Four studies of both men and women showed testosterone and estrogen levels higher after alcohol consumption.4-7 Testosterone levels appear to be increased in men both after acute4 and habitual drinking.7 Interestingly, although men who drink habitually have higher testosterone levels than non-drinkers, they also have lower sperm count, suggesting that although their testosterone levels may be higher, they may have an impaired ability to respond to testosterone.7 One other study showed the opposite—decreased testosterone in physically active male soldiers who are regular drinkers.8 Although it is not completely clear why there is a discrepancy in these studies, all of the studies that showed an increase in testosterone after drinking used Caucasian participants, while the study showing a decrease in testosterone was conducted in Indian soldiers. Since people of Asian descent are known to metabolize alcohol differently than Caucasians,9 it is possible that this variation accounts for different results in testosterone levels.
In women, drinking appears to increase estrogen levels, and the amount of alcohol women consume is directly related to the increase in estrogen levels.5-6 Higher levels of estrogen normally correllate with fewer acne symptoms.
Although these studies point to a possible association between drinking and hormone levels, we do not have enough evidence at this time to draw a causative link between alcohol, hormone levels, and acne. More research is required on both men and women and in various ethnicities.
Bacteria. After drinking, some alcohol can be secreted through our sweat. Researchers have proposed that the alcohol secreted in sweat could possibly act as a fuel for acne bacteria.10 P. acnes, the bacteria most often associated with acne, can metabolize alcohol and use it as a fuel source. Researchers hypothesize that a byproduct of this metabolism called acetaldehydes may exacerbate acne.10 Again, this is by no means factual. It is simply an initial hypothesis.
Alcohol may also aggravate acne by suppressing the immune system. Frequent and long-term alcohol use is known to suppress the immune system, which in turn can allow bacteria to grow and multiply.10-11 It is therefore plausible that alcohol abuse could worsen acne by suppressing the body’s ability to fight bacteria. Again, although all of these hypotheses are interesting, more research is needed to prove whether this really is the case.
Inflammation is another potential, yet still unproven, link between alcohol and acne.12 Chronic use of alcohol causes the body to release more inflammatory molecules called cytokines. Studies have shown that increased levels of cytokines can predispose individuals to develop acne and play an important role in the early stages of acne formation.13
Other Considerations Regarding Alcohol and Acne
Stress. Overuse of any drug, including alcohol, can cause stress. Drinking too much can veer one's life off course, and in severe cases can cause people to lose their jobs, friends, and family. All of these outcomes are stress inducing. We know that stress and acne are related, so this is something to think about.
Missing your daily regimen. Getting drunk can cause people to miss their nightly skin care regimen. Missing even one application of your daily regimen can lead to breakouts.
Irritation. In order to prevent acne, it is important to avoid irritating one's skin. Alcohol acutely affects motor skills. A person is simply not as careful when under the influence of alcohol. This can lead to increased irritation of the skin and potential breakouts as a result.