中国玫瑰痤疮临床特征分析和诊断标准再探讨

【摘要】 目的 在分析玫瑰痤疮临床特征的基础上,提出中国玫瑰痤疮诊断标准并验证其敏感性和特异性。方法 纳入2017年12月至2018年7月于中南大学湘雅医院皮肤科门诊初诊的3 350例玫瑰痤疮患者,分析患者表型及临床特征,提出改良版中国玫瑰痤疮诊断标准。全国28个中心对该标准进行临床验证,纳入2 269例玫瑰痤疮和2 408例其他面部皮肤病患者,与2017版美国国家玫瑰痤疮专家委员会（NRSEC）制订的国际诊断标准比较,评估其敏感性和特异性。结果 3 350例玫瑰痤疮患者均存在面中部持续性红斑（100%）。在1 861例主要表现为面颊部红斑的患者中,1 850例（99.4%）在红斑之前或同时出现阵发性潮红;在1 489例主要表现为鼻或口周部红斑的患者中,仅52例（3.5%）发生阵发性潮红; 342例有肥大增生的患者均在肥大增生改变之前发生持续性红斑。基于以上临床特征提出,面颊部可周期性加重的伴有阵发性潮红的持续性红斑,可诊断为玫瑰痤疮;对于表现为鼻、口周部持续性红斑的患者,需合并至少1项选择性表型（阵发性潮红、毛细血管扩张、丘疹脓疱、肥大增生改变或眼部症状）才可诊断为玫瑰痤疮。全国多中心临床验证结果显示,改良版中国玫瑰痤疮诊断标准敏感性为99.6%,接近国际标准100%,特异性为91.9%,而国际标准为73.3%。结论 改良版中国玫瑰痤疮诊断标准具有良好的敏感性和特异性,也更有利于增生肥大型玫瑰痤疮的早期诊断。     

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.     

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.     

微生物在玫瑰痤疮中致病机制的研究进展

玫瑰痤疮是一种好发于面中部的慢性炎症性皮肤病,以面部阵发性潮红、持久性红斑、丘疹脓疱等为主要表现,其病因及发病机制尚不清楚.关于微生物在玫瑰痤疮中的致病作用存在争议.微生物一般通过破坏皮肤屏障、诱发炎症反应、分泌生物活性因子及毒素等方式介导玫瑰痤疮的发生.本文总结国内外近年关于微生物与玫瑰痤疮发病的相关研究,进一步揭示...     

短波理疗仪治疗红斑毛细血管扩张型玫瑰痤疮临床观察

目的:观察短波理疗仪治疗红斑毛细血管扩张型玫瑰痤疮(ETR)的临床疗效。方法:收集70例ETR患者,随机分为2组,其中治疗组40例,对照组30例。2组均每日早晚使用保湿霜,治疗组每隔1周进行1次短波理疗,疗程8周。治疗前、后由皮肤科医生盲态下对患者面部红斑及毛细血管扩张进行评分;患者对阵发性潮红、灼热及干燥症状进行评分。评分标准采用玫瑰痤疮4级评分。皮肤检测仪检测2组治疗前、后皮肤含水量和经皮水流失(TEWL)值。记录疗程中的不良反应。结果:治疗后治疗组患者面部红斑、灼热及干燥程度评分均较治疗前明显改善(P<0.05),治疗组改善优于对照组(P<0.05);对照组患者灼热及干燥程度评分均较治疗前明显改善(P<0.05)。2组毛细血管扩张评分及阵发性潮红评分比较,差异均无统计学意义(P>0.05)。治疗后2组患者皮肤含水量均增加,治疗组增加大于对照组(P<0.05);2组TEWL值均下降,治疗组下降大于对照组(P<0.05)。所有患者均无明显不良反应。结论:短波理疗仪治疗可明显改善ETR患者面部红斑、灼热及干燥症状,且安全性较好。     

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，     

ALA-PDT治疗玫瑰痤疮临床疗效及安全性分析北大核心CSCD

目的:探讨5-氨基酮戊酸光动力疗法(ALA-PDT)治疗玫瑰痤疮疗效及安全性。方法:采用ALA-PDT治疗40例以丘疹脓疱表型为主的玫瑰痤疮患者,5%ALA封包2 h后照红光(635±15 nm),照光剂量80-90 J/cm^(2),间隔10 d治疗1次,共治疗3次。治疗前及末次治疗后1、3、6个月评估病情,通过数码照片、VISIA皮肤图像分析红斑、毛细血管、丘疹脓疱等客观症状改善情况,记录主观症状变化以及不良反应发生情况。结果:40例患者治疗后丘疹脓疱明显减轻,治疗后6个月评估丘疹、脓疱改善有效率为100%,随访期间无明显复发。潮红、持久性红斑和主观刺激症状均有改善(P<0.05),但毛细血管扩张变化差异无统计学意义(P>0.05)。不良反应主要为治疗时疼痛、治疗后红肿和炎症后色素沉着,均为一过性可耐受。结论:ALA-PDT治疗以丘疹脓疱为主的玫瑰痤疮安全、有效,耐受良好,能快速控制丘疹脓疱及炎性红斑,但对单纯以阵发性潮红为主要表现的红斑毛细血管扩张型玫瑰痤疮疗效差。     

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     

女性玫瑰痤疮患者生活质量调查分析

目的:调查玫瑰痤疮对女性患者生活质量的影响。方法:应用皮肤病生活质量指数(DLQI)调查表和Beck抑郁自评量表(BDI)对123例女性玫瑰痤疮患者进行问卷调查,并收集患者人口统计学基本信息,评估疾病亚型与严重程度。结果:DLQI评分为10.46±6.444;BDI评分提示存在严重抑郁症状的占5.69;单因素方差分析结果提示婚姻情况是重要影响因素;相关性分析结果显示DLQI评分、BDI评分、疾病严重程度三者之间呈正相关。结论:玫瑰痤疮对女性患者的生活质量有明显影响。患者易产生抑郁情绪,且这种影响与疾病的严重程度呈正相关,对已婚女性的影响大于未婚女性。因此对于玫瑰痤疮患者的治疗不仅限于药物治疗,同时要及早进行心理疏导。     

羟氯喹联合红光治疗60例玫瑰痤疮临床观察

目的:观察羟氯喹联合红光治疗玫瑰痤疮的疗效及安全性。方法:将60例Ⅰ、Ⅱ型玫瑰痤疮患者随机分为试验组(31例)和对照组(29例),2组均予口服羟氯喹(200 mg,每日2次),共8周,试验组增加红光照射(每周2次)。治疗前、治疗第2、4及8周后,对患者皮损及症状进行评估并记录不良反应。结果:试验组患者持久性红斑(第4及8周)及丘疹和脓疱(第2、4及8周)评分均低于对照组;试验组有效率(83.87%)高于对照组(58.62%),差异均有统计学意义(P0.05)。结论:羟氯喹联合红光治疗Ⅰ、Ⅱ型玫瑰痤疮安全且有效,尤其对持久性红斑、丘疹及脓疱起效更快。     

The enigma of rosacea

This short paper reviews the nature of rosacea emphasizing the possibility of a solar cause. The sites of involvement and the physical signs of rosacea including the flushing, the erythema and the telangiectasia as well as the intermittent episodes of inflammation with swelling and papules may all be explained by UVR induced damage to dermal connective tissue. The dermal damage permits vaso-dilation and vascular pooling.     

Once-daily topical brimonidine tartrate gel 0·5% is a novel treatment for moderate to severe facial erythema of rosacea: results of two multicentre, randomized and vehicle-controlled studies

Background Erythema of rosacea is thought to result from abnormal cutaneous vasomotor activity. Brimonidine tartrate (BT) is a highly selective α₂‐adrenergic receptor agonist with vasoconstrictive activity. Objective To determine the optimal concentration and dose regimen of topical BT gel for the treatment of erythema of rosacea and to evaluate its efficacy and safety. Methods In study A, 122 subjects were randomized to receive a single application of BT 0·07%, 0·18%, 0·5% or vehicle. In study B (4‐week treatment and 4‐week follow‐up), 269 subjects were randomized to receive BT 0·5% once daily, BT 0·18% once daily, vehicle once daily, BT 0·18% twice daily or vehicle twice daily. Evaluations included Clinician’s Erythema Assessment (CEA), Patient’s Self‐Assessment (PSA), Chroma Meter measurements and adverse events. Results In study A, a single application of topical BT gel reduced facial erythema in a dose‐dependent fashion. A significant difference between BT 0·5% and vehicle in Chroma Meter redness value was observed from 30 min to 12 h after application. In study B, BT 0·5% once daily had a statistically superior success profile (defined as a two‐grade improvement on both CEA and PSA over 12 h) compared with vehicle once daily on days 1, 15 and 29 (all P < 0·001). No tachyphylaxis, rebound of erythema or aggravation of other disease signs (telangiectasia, inflammatory lesions) was observed. All regimens were safe and well tolerated with similarly low incidence of adverse events. Conclusions Once‐daily BT gel 0·5% is well tolerated and provides significantly greater efficacy than vehicle gel for the treatment of moderate to severe erythema of rosacea.     

A review of the quality of life following pulsed dye laser treatment for erythemotelangiectatic rosacea

Rosacea is a chronic condition, affecting up to 10% of the population. It has a negative impact on patients’ quality of life (QOL), leading to loss of self-confidence, emotional distress and withdrawal from normal societal interactions. Erythemotelangiectatic (ET) rosacea is a frequent reason for consultation and difficult to treat, as vascular signs such as flushing, erythema and telangiectasia often persist despite medical therapy. Several studies have demonstrated objective improvements in vascular signs following pulsed dye laser (PDL) treatment, but very few have investigated improvement in QOL. We reviewed the current literature to find evidence for the effect of PDL on QOL in ET rosacea.     

Ocular rosacea and treatment of symptomatic Helicobacter pylori infection: a case series

Rosacea is a chronic inflammatory skin disease characterized by recurrent episodes of facial flushing, erythema, papules, pustules, and telangiectasia. More than half of all rosacea patients may have ocular symptoms. Rosacea is associated with certain digestive diseases, such as gastritis, hypochlorhydria, or a number of jejunal mucosal abnormalities, and many patients have Helicobacter pylori infection. The role of Helicobacter pylori has often been a subject of investigation; these studies show conflicting results. Here we present results of the effects of treatment given for H. pylori eradication in seven patients with ocular rosacea that, at the same time, had clinical and serological evidence of H. pylori infection. Six weeks after completion of the treatment, all patients experienced improvement of their rosacea symptoms. Ocular disease responded better than cutaneous rosacea.     

Double-blind, randomized, vehicle-controlled clinical trial of once-daily benzoyl peroxide/clindamycin topical gel in the treatment of patients with moderate to severe rosacea

BACKGROUND: Systemic antibiotics such as tetracycline are well accepted as effective in treating the inflammatory papular/pustular phase of rosacea but may be associated with systemic side-effects. Few controlled data on the use of topical antibiotics in rosacea are available. OBJECTIVE: We evaluated the efficacy and tolerability of a fixed combination of 5% benzoyl peroxide and 1% clindamycin in a topical gel for the treatment of rosacea. Methods This was a 12-week, double-blind, vehicle-controlled, randomized, prospective, parallel-group study in 53 patients with moderate to severe rosacea. RESULTS: The mean percentage reduction in papules and pustules from baseline to the end of treatment was 71.3% in the benzoyl peroxide/clindamycin group (n = 26) and 19.3% in the vehicle group (n = 26; P = 0.0056). A significant (P = 0.0141) difference in favor of benzoyl peroxide/clindamycin was evident by the third week of treatment. Severity scores for erythema, papules/pustules, and flushing/blushing decreased more with benzoyl peroxide/clindamycin than with vehicle. Overall rosacea severity, Physician Global Assessment, and Patient's Global Assessment at the end of treatment were all significantly improved with benzoyl peroxide/clindamycin compared with vehicle (P = 0.0101, 0.0026, and 0.0002, respectively). Application site reactions were reported in four patients (14.8%) in the benzoyl peroxide/clindamycin group. CONCLUSION: A once-daily topical application of a combination of 5% benzoyl peroxide and 1% clindamycin is effective and well tolerated in patients with moderate to severe rosacea.     

A randomized, single-blind, placebo-controlled, split-face study with pimecrolimus cream 1% for papulopustular rosacea

Background Rosacea is a common inflammatory skin disorder for which the pathogenesis is unclear. Currently, there is no cure for rosacea, and it seems that standard therapies have focused mainly on minimizing inflammation. Objectives The aim of this study is to investigate the potential efficacy, tolerability and safety profile of 1% pimecrolimus cream for the treatment of rosacea. Methods Twenty‐five patients with papulopustular rosacea were enrolled to a randomized, single‐blinded, placebo‐controlled, split‐face trial of pimecrolimus cream 1% consisting 4 week treatment and 2 week follow‐up period. The patients were instructed to apply first the ‘left side cream’ labelled placebo cream (Ultrabase cream, Intendis GmbH, Berlin, Germany) to the left hemi‐face then the ‘right side cream’ labelled 1% pimecrolimus cream (Elidel; Novartis Pharma, Nuremberg, Germany) to the right hemi‐face, twice daily. They were informed to apply a standard amount of each cream with the fingertip‐unit and not allowed to use any other agent concomittantly other than sunblock. Clinical evaluation and subjective severity assessment were obtained along with photographic documentation at baseline, first, second, and fourth weeks of the therapy and at the follow‐up visit. Rosacea severity score for each sign of erythema, papules, pustules, oedema, and telengiectesia were graded from 0 to 3. Patients were questioned for the subjective symptoms, overall improvement on appearance and side‐effects. Results Twenty‐four patients completed the study with an exceptional compliance and tolerable safety profile. One patient withdrew from the study due to severe flare‐up reaction affecting both hemi‐faces. The mean baseline total rosacea severity scores were 5.06 + 1.29 for both sides and reduced to 2.5 ± 1.06 vs. 3.25 ± 1.24 on pimecrolimus vs. placebo applied sides without the significance (P = 0.06). There was not any significant difference concerning each rosacea sign scores and total rosacea severity scores except for the significant improvement in erythema score and total rosacea severity score obtained on the pimecrolimus‐applied hemi‐face at 2nd week of therapy (P =0.01 and P = 0.03, respectively). The reduction rates of the mean subjective severity scores at 4th week were 49.77% vs. 38.89% for pimecrolimus vs. placebo, respectively, without a statistical significance (P = 0.15). Subjective symptoms responded well in 54.16% of patients concerning pimecrolimus application compared with 12.50% for the placebo application. The side‐effects were mostly transient local irritations. Conclusion Our data implicated that pimecrolimus cream is not superior to placebo except for its efficacy on erythema. We believe that pimecrolimus cream can be a treatment option for rosacea patients with high erythema score for whom an initial accelerated improvement is needed. We believe further studies with topical pimecrolimus cream on larger study groups with different subtypes and severity of rosacea will clarify the potential effect of pimecrolimus cream for the treatment of rosacea.