Periorbital flushing after alcohol consumption

Abstract

A 32-year-old male previously diagnosed with seborrheic dermatitis with facial involvement who began treatment with tacrolimus cream due to poor response to topical corticosteroids. Two weeks after starting with topical treatment with tacrolimus, the patient reported episodes of periorbital and frontal flushing associated to a burning sensation in the skin of both areas, lasting 15-20 minutes that disappeared spontaneously. The patient related it to moderate consumption of alcoholic beverages: the first time it happened 5-10 minutes after the consumption of wine but other times after the consumption of other alcoholic beverages: gin or whiskey. This is a known side effect that has been described in around 6% of patients who have been treated with calceurin inhibitors. The mechanism that generates this reaction is not known, although there are several pathophysiological hypotheses. It is important to know this possible side effect to avoid the possible performance of unnecessary tests or even iatrogenesis.