Download Rescue from Redness: Options for Rapid Improvement of Erythema

Clinical Focus: Rosacea
By Dina Anderson, MD
Rescue from Redness: Options
for Rapid Improvement of Erythema
Pharmaceutical interventions and procedures allow for successful long-term
management of rosacea, but what can patients do for quick redness reduction?
D
ermatologists and their patients
today have more options for
rosacea management than ever
before. Despite the availability of
both topical and systemic therapies
and/or procedures that can provide
effective long-term control, some
patients present to their dermatologist
desperate for a “quick fix” to reduce
erythema in the short-term, usually
because of an upcoming social or
business function. When confronted
with patients seeking to safely and
quickly minimize erythema, dermatologists can suggest some affordable,
effective options.
Rapid Redness Reduction
Antioxidants. Antioxidant ingredients
incorporated into various topical formulations may offer anti-inflammatory and redness-reducing effects. Green
tea polyphenols (such as found in the
Replenix line, Topix) have been popu-
NEW In Your Practice
Without a Lift. Botulinum toxin A (BTA) has been used successfully on facial muscles for
wrinkle reduction on the upper portion of the face for years, but researchers recently
tried to gauge its face lifting effect via intradermal injection in the mid-to-lower face
(Int J of Dermatol, 47:1287 - 1294). Researchers enlisted nine volunteers to undergo
intradermal injections of a total dose of 20-25 units of botulinum toxin into one-half
of the face and normal saline into the other half as control. Clinical photographs were
taken every four weeks for 16 weeks. Skin biopsies were taken before treatment and
eight weeks after injection. Photographic documentation did not show significant
face-lifting effect. But there was statistically significant wrinkle reduction on the BTA
sides compared to pretreatment. While the face-lifting effect of intradermal injection
with BTA was not conclusive, the agent showed moderate but signification wrinklesmoothing effect on the lower face without obvious side effects.
Scar Tissue. For patients whose acne scars cause considerable psychosocial distress, a
novel technique called ablative fractional resurfacing (AFR)—it combines CO2 ablation
with fractional photothermolysis—may provide relief, suggests a new study (Lasers
Surg. Med. 40:381-386). Post-treatment side effects were mild to moderate and transient and resolved rapidly. There was no delayed onset hypo-pigmentation or permanent scarring. All patients had quantifiable objective improvement in the depths of
acneiform scars ranging from 43 to 79.9 percent. The mean level of improvement in the
appearance of moderate to severe acne scars was 66.8 percent.
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Practical Dermatology
lar with patients, and there has been
recent interest in coffeeberry extract
(RevaleSkin, Stiefel) for its calming
effects. These and a number of other
cosmeceutical products intended for
in-office sale can help reduce redness
rather quickly. Note that some of
these formulations are marketed primarily for other “indications,” such as
overall rejuvenation or even skin
lightening, rather than for “calming”
or erythema-reducing effects.
Cosmeceutical products will provide
more noticeable rejuvenating results
with long-term use, but redness
reduction can often be seen with
fewer applications.
Investigate various offerings to see
which might be a good fit for your
practice.
Topical Corticosteroids.
Dermatologists and a number of
patients know that a slather of a prescription corticosteroid, like Topicort
cream (Taro Pharma), applied twice
over 24 hours helps reduce redness
quickly, especially when it is inflammatory in nature. Give patients only a
sample-size tube; do not provide a prescription in order to avoid over-use of
topical corticosteroids, which can cause
skin atrophy, telangectasias, acneiform
eruptions, rebound flare, and other
long term complications.
OTC Redness Reducers. Several
over-the-counter options available at
any drug store can provide redness
reducing effects for patients seeking
quick relief. One popular product is
Eucerin Anti-Redness (Beiersdorf ),
January 2009
Several over-thecounter options
available at any drug
store can provide
redness reducing
effects for patients
seeking quick relief.
which features licorice extract as its primary ingredient.
Green-tinted anti-redness creams
combine the camouflaging effects of
green cosmetics with the added benefit
of calming ingredients. Some of these
creams are suitable even for use by
men. Green-tinted foundation makeup is also available.
Sulfur Masks. Several manufacturers
offer sulfur masks that are typically
intended for once-weekly application.
Some products are available for office
dispensing, but products are also available on-line or in some drug stores.
Regular use of these masks confers antiinflammatory benefits that may enhance
other therapies a patient may be using.
When masks are applied twice in one
day they can provide a rather dramatic
and rapid reduction in erythema.
OTC “Decongestants.” Afrin
(Schering-Plough HealthCare
Products), the popular and widely used
nasal spray, contains oxymetazoline
hydrochloride, which is described as a
decongestant. While it can help minimize congestion with intranasal delivery, the agent is actually a vasoconstrictor. When the product is applied topically to the skin, it provides rapid
improvement in erythema. Patients
should use this intervention only as a
“rescue” and avoid daily application
until further studies are published. ■
January 2009
Practical Dermatology
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