Don’t Just See Red; See Your Head

Leave it to the University of Wisconsin alumnus to put the color red into the spotlight. While my fellow Badger fans and I chant, “Let’s go, Red,” we as dermatologists—and our patients when they look in the mirror—often want the red to go away.

The concept of seeing red usually relates to anger and/or excitement. In bullfighting, the bull charges toward the color red. Sports fans whose colors are red are often immersed in a similar frenzy, independent of the flushing from the spirit (and spirits) involved, and they usually see red if things don’t go their way. There is also the lady in the red dress in The Matrix who had Neo confused; the old mythical tale of the red dragon (Y Ddraig Goch) representing Wales on its national flag to symbolize resilience and the Welsh people; and Dorothy and her famous red shoes that took her back to Kansas. All are timeless.

Of course, the negativity of red, like the old references to communist countries or the upside-down state of an economy, can have a lingering impact and even bias on interpretation of the source of redness … not quite erythema, of course. I would be remiss if I didn’t drag a Rush lyric into the story, as “I see red … hurts my head” was one of my old favorites (from 1984’s “Red Lenses,” off the album Grace Under Pressure).

Seeing red from the clinician’s side can be strikingly imbalanced with what the patients see. A red face, red rash, or red streaks around a wound can often mean untreated or progressive pathology; with acne or rosacea patients, it either adds the element of noncompliance or the aftermath of the worst of days’ flares. Conversely, erythema in the case of topical treatments for actinic keratoses, photodynamic therapy, or responses to laser therapies can often send the message that “things are working” and we should keep going (much to the dismay of the patient who doesn’t want another drop of that misery). The time spent managing outcomes and optimizing patient satisfaction goes out the window when the patient is still red, as that image in the mirror reminds them that they are sick even when their skin might actually be telling us otherwise.  

Of course, while we try to encourage patients to stick with the marathon of the plan, we must also put ourselves in their shoes. “If I’m still seeing red, why am I keeping this madness going?” is a justifiable stance, yet when the dermatologist knows the end of the rainbow isn’t all red, should we not help them finish what they start? When the eye sees only red and not the big picture, should we not take a step back and try to look under the hood at the scene of the crime?

Erythema is a large component of objective measurements of psoriasis, eczema, rosacea, and acne grading in clinical research as well as improvement. Redness, however, is a function of interpretation; when we see red figuratively, think of what the trigger is that makes us go down that path. Whether it’s having outcomes that aren’t favorable, dealing with people who make our blood boil, or even yet another prior authorization, put yourself in the position of those patients who see red and actually are red … so it won’t hurt your head.