From the Guidelines
If facial redness persists despite cortisone treatment, you should consult a dermatologist for proper diagnosis and alternative treatment, as this condition could be rosacea, which doesn't typically respond well to cortisone and may actually worsen with prolonged steroid use. The cause of persistent facial erythema unresponsive to corticosteroid treatment can be attributed to various factors, including rosacea, a chronic inflammatory disease of the skin predominantly affecting the centrofacial region, as discussed in the study by 1. Other possibilities include seborrheic dermatitis, lupus, allergic reactions, or contact dermatitis.
Diagnosis and Treatment
A dermatologist might recommend specific treatments like topical metronidazole, azelaic acid, or ivermectin for rosacea, or may suggest oral antibiotics like doxycycline 40-100mg daily, as outlined in the treatment algorithm by 1. It's essential to note that the treatment approach should be phenotype-led, considering the individual patient's experience and the severity of the condition.
Management and Prevention
While waiting for a dermatologist appointment, it's crucial to avoid triggers such as spicy foods, alcohol, extreme temperatures, and harsh skincare products. Using gentle, fragrance-free cleansers and applying a broad-spectrum sunscreen daily can help manage the condition. The study by 1 highlights the risks associated with prolonged topical corticosteroid use, including skin atrophy, striae, folliculitis, telangiectasia, and purpura, emphasizing the need for alternative treatments.
Key Considerations
- Persistent facial redness that doesn't respond to standard treatments requires professional evaluation.
- Continued use of cortisone can lead to skin thinning, increased blood vessel visibility, and rebound inflammation when stopped, as warned by 1 and 1.
- A phenotype-based approach to diagnosis and treatment, as recommended by 1 and 1, can help address rosacea and its treatment in a manner consistent with the patient's individual experience.
From the Research
Causes of Persistent Facial Erythema
- Persistent facial erythema is a common symptom of rosacea, a chronic cutaneous disorder affecting the face 2, 3, 4, 5, 6
- The exact cause of persistent facial erythema in rosacea is not fully understood, but it is thought to be related to abnormalities in the cutaneous vasculature and the role of alpha-adrenoreceptors 5
- Triggers such as flushing, environmental stimuli, and physiological factors can exacerbate facial erythema in rosacea patients 4, 6
Treatment Resistance to Corticosteroids
- Corticosteroids are not typically used as a first-line treatment for rosacea, and their use can actually exacerbate the condition in some cases 2, 4
- Topical and oral antibiotics, as well as other medications such as azelaic acid, metronidazole, and sulfacetamide/sulfur, are commonly used to treat rosacea 2, 4, 6
- In cases where facial erythema is persistent and unresponsive to traditional treatments, alternative therapies such as intense pulsed light, pulsed dye laser, and botulinum toxin injections may be considered 3, 6
Alternative Therapies for Persistent Facial Erythema
- Intense pulsed light and pulsed dye laser have been shown to be effective in reducing facial erythema and telangiectasias in rosacea patients 3, 6
- Topical brimonidine tartrate 0.5% has been shown to reduce persistent facial erythema in rosacea patients 6
- Intradermal botulinum toxin injections have also been used to treat erythema and flushing in rosacea patients 6