1090例玫瑰痤疮患者临床特征分析及玫瑰痤疮新诊断标准探讨

目的 在分析大样本玫瑰痤疮患者临床特征的基础上提出新的诊断标准.方法 纳入中南大学湘雅医院皮肤科门诊初诊的1 090例玫瑰痤疮患者,收集基本资料、临床症状和自觉症状等,根据描述性分析结果,总结玫瑰痤疮临床特点,探讨新的玫瑰痤疮诊断标准.以1 200例以面部红斑为主要临床特点的门诊病例为对象,验证新标准的灵敏度和特异度.结果 1 090例玫瑰痤疮患者,男131例(12.0％)、女959例(88.0％),年龄10～66(33.5±11.1)岁.初始皮损发生在面颊部715例(65.6％),其中712例(99.6％)首发症状为阵发性潮红,689例(96％)伴有干燥、灼热、瘙痒等皮肤敏感症状;初始皮损发生在口周部208例(19.1％),其中204例(98.1％)首发症状为持久性红斑;皮损首发于鼻部167例(15.3％),其中163例(97.6％)首发症状为持久性红斑;伴有眼部症状311例(28.5％),伴有面部以外(颈部、耳后等)症状24例(2.2％).由此拟定新的玫瑰痤疮诊断标准,必备条件:面颊/口周/鼻部阵发性潮红或持久性红斑;次要条件:①灼热、刺痛、干燥或瘙痒等皮肤敏感症状;②毛细血管扩张;③丘疹或脓疱;④肥大增生改变;⑤眼部症状.符合必备条件和1条及以上的次要条件,即可诊断为玫瑰痤疮.将新的诊断标准在1 200例以面部红斑为主要临床特点的面部皮炎患者中进行验证,其灵敏度为99.3％,特异度为95.8％.结论 提出了一个具有较好敏感性和特异性的玫瑰痤疮诊断标准,值得在临床工作中应用.     

玫瑰痤疮患者阵发性潮红的临床特征分析及对生活质量的影响

【摘要】 目的 探讨玫瑰痤疮患者阵发性潮红的临床特点及对生活质量的影响。方法 采用前瞻性研究，收集2017年8月至2019年8月湘雅医院皮肤科门诊玫瑰痤疮患者728例，采用阵发性潮红国际标准化量表（FSQ）、持久性红斑医生评分量表（CEA）、患者自评量表（PSA）和视觉模拟评分法（VAS）收集资料，分析阵发性潮红的发作特点、严重程度、对生活的困扰度及其与持久性红斑评分的相关性等。统计分析采用χ2检验和Spearman相关分析。结果 728例患者中，阵发性潮红最常出现的部位为颊部（682例，93.7%）及颧部（617例，84.8%）；持续时间5 min至2 h的患者比例最高（484例，66.5%）；317例（43.6%）受刺激后潮红发作，233例（32.0%）潮红每天发作且1天内多次发作。503例（69.1%）患者潮红的总体评分在中度以上；412例（56.6%）认为潮红可对睡眠造成不同程度的影响，其中59例（8.1%）认为影响可达重度及以上；662例（90.9%）认为潮红对生活有不同程度的影响，其中304例（41.8%）认为影响程度在重度及以上。潮红总体评分和其对生活的困扰评分均与医生评价的持久性红斑严重程度（CEA评分）呈低度正相关（rs = 0.166、0.151，均P＜0.05），与患者自评的红斑严重程度（PSA评分）具有显著相关性（rs = 0.518、0.500，均P＜0.05）。结论 玫瑰痤疮患者的阵发性潮红具有典型的发作部位，发作持续时间较长，频率高，影响患者生活质量，需得到临床医生的重视。     

421例玫瑰痤疮患者临床特征分析

目的 分析玫瑰痤疮患者的临床表现,提高对玫瑰痤疮临床特征的认识.方法 回顾性分析421例玫瑰痤疮患者,统计分析其性别、年龄、皮损部位、皮损表现及自觉症状得分.结果 421例玫瑰痤疮患者中男58例,女363例,男女比例为1:6.25,男女各年龄段均可发病.玫瑰痤疮患者最常见的皮损表现为阵发性潮红(93.8％,395/421)、持久性红斑(84.3％,355/421)及炎性丘疹(68.9％,290/421),且多同时出现≥2种皮损表现(83.1％),阵发性潮红及持久性红斑最常同时出现.患者最常累及部位为颊部(87.2％,367/421),鼻部(76.5％,322/421)及口周(63.7％,268/421),多同时累及≥3个部位(67.2％),且颊部、鼻部及口周为最常同时累及的部位.自觉症状中最常见的3大症状为灼热感(73.6％,310/421)、干燥感(69.6％,293/421)及瘙痒感(66.0％,278/421).结论 颊部、鼻部或口周部的阵发性潮红及持久性红斑为玫瑰痤疮的主要症状,炎性丘疹、脓疱、鼻赘、毛细血管扩张及灼热、干燥、瘙痒感为玫瑰痤疮的重要临床表现.     

中国玫瑰痤疮诊疗指南（2021版）

【摘要】 玫瑰痤疮是一种好发于面中部的慢性炎症性皮肤病,主要表现为面中部反复潮红、红斑。近年来,对本病的诊治有了新的认识,为此,组织部分专家在《中国玫瑰痤疮诊疗专家共识（2016）》的基础上制定本指南,新版指南提出了分部位诊断标准,希望能进一步规范我国玫瑰痤疮的诊断与治疗。     

盐酸米诺环素联合复方甘草酸苷治疗玫瑰痤疮疗效评价

<正>玫瑰痤疮是一种累及面部皮肤血管和毛囊皮脂腺单位的慢性炎症性皮肤病,该病早期可表现为面部阵发性潮红或持久性红斑,继而出现丘疹、脓疱,病久可产生以鼻赘为特征的肥大增生性改变。临床上分为红斑毛细血管扩张型、丘疹脓疱型、鼻赘型和眼型     

小剂量异维A酸与多西环素治疗中重度丘疹脓疱性玫瑰痤疮的临床对照研究

<正>玫瑰痤疮是一种具有社会心理影响的面部慢性炎症性皮肤病，具体发病机制仍不明确^[1]。其主要临床特征包括面中部好发的阵发性潮红、持续性红斑、丘疹脓疱及毛细血管扩张，常伴有不适症状^[2]。在玫瑰痤疮的不同表型中，丘疹脓疱性玫瑰痤疮典型的表现是圆顶状的红色丘疹，针头大的浅表脓疱，也可能会出现结节^[2]。本病对患者容貌有较大影响并影响患者的生活质量^[3]。抗生素是丘疹脓疱性玫瑰痤疮的一线系统治疗，     

玫瑰痤疮面部潮红与红斑新认识

【摘要】 持续型面中部红斑与潮红是玫瑰痤疮最常见的临床表现,但对其病理机制了解甚少,并缺乏高证据等级临床研究支持。本文结合国内外研究进展及临床经验,强调将面部潮红与红斑作为独立的临床表型进行研究探讨的必要性,认为精神压力、焦虑和/或抑郁可能是其发病的使动环节。由精神因素出发,探索玫瑰痤疮面部潮红及红斑相关神经炎症与皮肤免疫及血管的关系具有潜在的临床意义。     

玫瑰痤疮的诊断及鉴别诊断

<正>玫瑰痤疮(rosacea),又称酒糟鼻,是一种常见累及面部皮肤的慢性炎症性皮肤病。表现为以面中央部为主的原发的阵发性潮红或持久性红斑伴毛细血管扩张、炎症性丘疹和脓疱疹,鼻部或面颊、口周增生肥大和纤维化,睑缘炎等一种或多种客观体征,可有灼热、刺痛、干燥或瘙痒等主观症状~([1])。可发生于各年龄阶段,但以白种人,中年女性好发。玫瑰痤疮     

聚多卡醇治疗红斑毛细血管扩张型玫瑰痤疮12例疗效观察

目的探讨聚多卡醇治疗红斑毛细血管扩张型玫瑰痤疮的临床疗效和安全性。方法采用局部注射聚多卡醇治疗12例红斑毛细血管扩张型玫瑰痤疮患者,并观察临床疗效。结果 12例患者均达痊愈标准,治疗后局部无再出血、渗出、破溃、色素沉着及瘢痕。随访6个月,未见复发。结论聚多卡醇局部注射治疗红斑毛细血管扩张型玫瑰痤疮疗效显著,美容效果好,具有很好的临床应用前景。     

A型肉毒毒素皮内注射治疗玫瑰痤疮持久性红斑及潮红专家共识

A型肉毒毒素是一种神经毒素, 广泛用于皮肤美容。有证据表明, 皮内注射A型肉毒毒素能改善玫瑰痤疮患者面部皮肤潮红及持续性红斑, 但对治疗浓度、剂量、操作方法、疗程、治疗间隔等均存在差异。中华医学会皮肤性病学分会玫瑰痤疮研究中心、中国医师协会皮肤科分会玫瑰痤疮专业组在玫瑰痤疮诊疗指南的基础上, 参考新近文献并结合诸多专家临床应用经验撰写本共识, 为A型肉毒毒素皮内注射治疗玫瑰痤疮提供更科学、规范的参考依据。     

A case of granulomatous rosacea: sorting granulomatous rosacea from other granulomatous diseases that affect the face

Granulomatous rosacea is a variant of rosacea that may present similar to other granulomatous diseases. We present the case of a 45-year-old woman with a 2-year history of facial erythema with multiple papules and pustules on the cheeks, chin, and glabella. The patient responded to minocycline, resulting in healing 6 months without residual scarring. This patient's clinical and histological presentation and treatment outcome are to our assessment consistent with granulomatous rosacea. However, other clinically and histologically related entities will be discussed. These entities include, but are not limited to, perioral dermatitis, granulomatous periorificial dermatitis, lupus miliaris disseminatus faciei, facial afro-caribbean eruption syndrome, and sarcoidosis.     

Clinical evaluation of 30 patients with localized nasal rosacea

The clinical features of localized nasal rosacea have not been described in detail. This study was designed to analyze the subtypes and severity of localized nasal rosacea. Our present study included 30 patients with localized nasal rosacea. The erythematotelangiectatic subtype (13/30, 43.3%) was the most common type, followed by the phymatous subtype (9/30, 30%). The duration of rosacea was shorter and the severity of localized nasal rosacea was lower in the erythematotelangiectatic subtype cases compared with the patients with mixed or phymatous subtypes. Almost all of the papulopustular eruptions or phymatous lesions were associated with erythematotelangiectatic lesions. These findings suggest that the erythematotelangiectatic subtype may be considered the initial phase of localized nasal rosacea.     

Neurogenic rosacea in Korea

Rosacea with severe neurological symptoms such as burning and stinging is often not treated effectively by conventional therapies. The aim of this study was to investigate the clinical characteristics of Korean rosacea patients with prominent neurological symptoms. The demographic features, medical history, clinical manifestations and treatment modalities of 17 neurogenic rosacea patients who had prominent neurological symptoms and 106 erythematotelangiectatic rosacea (ETR) patients as a control group were investigated. All 17 neurogenic rosacea patients had severe persistent erythema with burning/stinging sensation limited to both cheeks. Among these patients, 94.1% were female (16/17). Heat stimuli (58.8%, 10/17) and stress (52.9%, 9/17) were major aggravating factors. Fourteen of 17 patients (82.3%) improved after receiving anticonvulsants and antidepressants. In conclusion, rosacea patients with severe neurological symptoms show distinct clinical manifestations and should be classified separately, and a different therapeutic approach is necessary for them.     

Clinical presentations and classification of rosacea

Rosacea is a chronic skin disease affecting up to 10% of the population in some European countries. Rosacea manifests as various combinations of characteristic signs and symptoms in a centrofacial distribution. At present, there is no consensus about the definition or classification of the clinical patterns of rosacea. Initially, four stages were differentiated (pre-rosacea then stages I through III), with several variants (e.g., persistent erythema and edema, rosacea conglobata, and rosacea fulminans). The National Rosacea Society (NRS) in the USA has classified rosacea into four subtypes (erythematotelangiectatic, papulopustular, phymatous, and ocular) and one variant (lupoid or granulomatous rosacea). This classification scheme does not mention progression from one type to another and makes no reference to pathophysiological considerations. It uses major and minor diagnostic criteria based on the physical findings and symptoms. The NRS has also developed criteria for grading disease severity. The classification of rosacea into stages or subtypes, without considering the possibility of progression from one to another, will probably remain controversial until additional knowledge on the pathophysiology of rosacea is obtained.     

Treatment of rosacea with intense pulsed light: significant improvement and long-lasting results

Background  Rosacea is a common skin condition but the treatments currently available are not satisfactory.
Objectives  To assess the efficacy of intense pulsed light (IPL) for treatment of stage I rosacea (flushing, erythema and telangiectasia).
Methods  Thirty-four patients were treated, 25 women and nine men, mean age 47 years. The treatment employed was IPL 515–1200 nm, with a 560 nm cut-off filter. The fluence range was 24–32 J cm⁻². Four treatments were administered on the face at 3-week intervals. Erythema values were measured at baseline and at the end of the treatment period on the cheeks and chin. Digital photographs were assessed by a consultant dermatologist on a 10-point visual analogue scale (VAS). Patients' assessments were also made using a 10-point VAS. Outcome measures were repeated 6 months after treatment.
Results  After four treatments the mean reduction of the erythema values was 39% on the cheeks ( P  <   0·001) and 22% on the chin ( P  <   0·001). This was confirmed by photographic assessment where erythema improved by 46% and telangiectasia by 55% ( P  <   0·001). The severity of rosacea was reduced on average by 3·5 points on the 10-point VAS. Patients' and physicians' assessments of the overall improvement of rosacea were similar: more than 50% improvement was noticed in 73% and 83% of patients, respectively ( P  <   0·001). The results were sustained at 6 months. Side-effects were minimal and self-limiting.
Conclusions  IPL significantly reduces erythema and telangiectasia of rosacea and this is sustained for at least 6 months.     

Granulomatous rosacea

Rosacea is classified into four clinical subtypes, namely erythematotelangiectatic, papulopustular, phymatous, and ocular. There is also a granulomatous variant, which is recognized in the rosacea spectrum. The objective of this study is to take a closer look at the different histopathologic patterns and cellular compositions seen in granulomatous rosacea and their correlation to the clinical presentation. Facial biopsies from patients previously identified with a clinical diagnosis consistent with rosacea, and who demonstrated a granulomatous infiltrate upon histopathologic examination, were reviewed and the results were correlated to the clinical presentation. Four distinct histopathologic granulomatous patterns were identified, namely nodular, perifollicular, diffuse, and a combined perifollicular and nodular patterns. The clinical presentation varied greatly among patients and failed to correlate to the microscopic findings. The varied clinical features seen in our study favors the theory that granulomatous rosacea is not a clinical subtype of rosacea per se, but a distinct histological variant, which can be found in most of its clinical spectrum.