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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. 22 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 23