What is the treatment for transient erythema?

Treatment of Transient Erythema

For transient erythema, the first-line treatments are topical α-adrenergic agents such as brimonidine 0.33% topical gel or compounded midodrine 0.2%, with oral beta blockers as an alternative option. 1

Understanding Transient Erythema

Transient erythema refers to temporary redness of the skin that comes and goes, often triggered by specific factors. It's important to distinguish transient erythema from other conditions:

• Transient erythema: Temporary redness that appears and resolves quickly
• Persistent erythema: Continuous redness that remains present
• Inflammatory papules/pustules: Raised bumps that may be accompanied by erythema

First-Line Treatment Options

Topical Treatments

• Topical α-adrenergic agents (first choice):
  • Brimonidine tartrate 0.33% - Applied daily, FDA-approved for rosacea 1
  • Compounded midodrine 0.2% - Applied 3 times daily (compounded in Vanicream) 1
  • Oxymetazoline 0.05% - Applied daily 1

Systemic Treatments

• Oral beta blockers - Particularly carvedilol 1
• Doxycycline - Can be considered for transient erythema, particularly if associated with rosacea 1

Treatment Algorithm

1. Start with topical therapy:

   • Begin with brimonidine 0.33% gel or compounded midodrine 0.2% applied to affected areas
   • Trial for at least 4 weeks to assess efficacy 1
   • Monitor for rebound erythema with continued use

2. If topical therapy is insufficient:

   • Consider adding oral beta blockers
   • For rosacea-associated erythema, consider oral doxycycline

3. For refractory cases:

   • Consider physical modalities like pulsed-dye laser (PDL) or intense pulsed light (IPL) 1

Special Considerations

Cautions

• Rebound erythema: Patients should be warned about potential rebound redness with continued use of topical vasoconstrictors 1
• Medication interactions: Be cautious with other medications that may cause vasodilation
• Underlying conditions: Always evaluate for underlying causes of transient erythema (e.g., rosacea, myeloproliferative disorders)

General Measures

• Trigger avoidance: Identify and avoid triggers that precipitate flushing (e.g., spicy foods, alcohol, temperature changes)
• Sun protection: Use SPF 30+ sunscreen daily 1
• Gentle skincare: Use mild cleansers and moisturizers

Specific Scenarios

Rosacea-Associated Transient Erythema

• Brimonidine 0.33% gel is FDA-approved specifically for this indication 1
• Consider combination therapy with other rosacea treatments if papules/pustules are also present

Erythromelalgia-Associated Transient Erythema

• Focus on safe cooling measures (limit ice/water immersion to 10 minutes, 4 times daily) 1
• Consider aspirin 325 mg daily for 1 month trial, especially if associated with myeloproliferative disorders 1

Medication-Induced Transient Erythema

• Identify and discontinue the causative medication if possible 2
• For chemotherapy-induced palmar-plantar erythrodysesthesia, topical treatments may provide symptomatic relief 2

By following this treatment approach and selecting the appropriate medication based on the specific presentation and underlying cause of transient erythema, most patients can achieve significant improvement in their symptoms and quality of life.