What are the treatment options for a patient experiencing flushing and redness of the face after an Electrosurgical Bladder (EBU) procedure?

Management of Facial Flushing and Redness After EBU Procedure

For post-procedural facial flushing and redness, implement immediate gentle skin care with hypoallergenic moisturizers and avoid all irritants, particularly alcohol-containing products, while monitoring for signs of infection or inflammatory complications.

Immediate Post-Procedure Skin Care

Essential Protective Measures

• Apply hypoallergenic moisturizing creams or emollients once daily to smooth the skin and prevent dryness that can worsen erythema 1
• Use mild, pH-neutral (pH 5) non-soap cleansers with tepid water only—avoid hot water which exacerbates facial redness 1, 2
• Pat skin dry gently with clean, smooth towels rather than rubbing to minimize trauma 1
• Strictly avoid all alcohol-containing lotions or preparations on the face, as these significantly worsen dryness and can trigger inflammatory flares 1, 2

Sun Protection Protocol

• Apply hypoallergenic sunscreen daily with at least SPF 30, providing UVA/UVB protection, preferably containing zinc oxide or titanium dioxide 1
• Encourage patients to stay out of direct sun exposure 1
• Recommend protective clothing and wearing a hat for additional sun protection 1

Products and Practices to Avoid

Critical Contraindications

• Never use greasy or occlusive creams as they may facilitate folliculitis development through their occlusive properties 1, 2
• Avoid topical acne medications, particularly retinoids, which may irritate and worsen facial redness due to their drying effects 1
• Do not manipulate or pick at the skin, as this increases infection risk 1
• Avoid hot blow-drying and excessive heat exposure 1

Treatment for Persistent Erythema and Inflammation

Topical Anti-Inflammatory Therapy

• For significant erythema with inflammation, apply hydrocortisone 1% cream or prednicarbate 0.02% cream to affected areas 1, 2
• Limit topical corticosteroid use to 2-4 weeks maximum on the face to avoid skin atrophy, telangiectasia, and tachyphylaxis 1, 2
• Apply treatment no more than twice daily 2

Moisturizer Selection

• Use oil-in-water creams or ointments rather than alcohol-containing lotions or gels 1
• Apply emollients after bathing to damp skin to create a surface lipid film that prevents transepidermal water loss 2
• Consider urea- or polidocanol-containing lotions for additional soothing effects if pruritus is present 1, 2

Monitoring for Complications

Signs Requiring Immediate Intervention

• Watch for secondary bacterial infection indicated by increased crusting, weeping, or pustule formation—Staphylococcus aureus is the most common pathogen requiring oral antibiotics 1, 2
• Look for grouped, punched-out erosions suggesting herpes simplex superinfection, which requires immediate antiviral therapy 1, 2
• Monitor for signs of impetiginization caused by staphylococci or streptococci 1

Advanced Treatment Options for Refractory Cases

Systemic Therapy Considerations

If facial flushing persists beyond initial conservative management, oral beta-blockers (particularly propranolol or carvedilol) have demonstrated large reductions in erythema and flushing with rapid onset of symptom control 3, 4. However, monitor for bradycardia and hypotension as the most common adverse events 3.

Alternative Interventions

• Botulinum toxin A injections (1 unit intracutaneously per square cm) have shown effectiveness for persistent facial flushing, with significant improvement in quality of life scores 5, 6
• Intense pulsed light therapy reduced redness in 83% of patients with facial erythema and flushing in research settings 7

When to Refer to Dermatology

Refer if any of the following occur:

• Diagnostic uncertainty or atypical presentation 2
• Failure to respond after 4 weeks of appropriate first-line therapy 2
• Recurrent severe flares despite optimal supportive care 2
• Need for prolonged topical corticosteroid use beyond 2-4 weeks 2

Common Pitfalls to Avoid

• Undertreatment due to fear of corticosteroid side effects—use appropriate potency for adequate but limited duration, then taper 2
• Applying sunscreen or moisturizers immediately before any subsequent phototherapy procedures, as this creates a bolus effect 2
• Using non-sedating antihistamines, which provide no benefit for post-procedural erythema 2