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     

中外玫瑰痤疮治疗指南与共识解读

玫瑰痤疮是常见的慢性复发性炎症性面部皮肤病,表现为面中央隆凸部为主的阵发性潮红、持久性红斑及面颊、口周或鼻部毛细血管扩张、丘疹或丘脓疱疹,伴或不伴眼部症状以及主观症状如灼热、刺痛、干燥或瘙痒。本病具体发病机制仍不清楚……     

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。     

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。     

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     

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。     

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...     

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。     

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，     

Rosacea in the pediatric population

Rosacea is a condition of vasomotor instability characterized by facial erythema most notable in the central convex areas of the face, including the forehead, cheek, nose, and perioral and periocular skin. Rosacea tends to begin in childhood as common facial flushing, often in response to stress. A diagnosis beyond this initial stage of rosacea is unusual in the pediatric population. If a child is identified with the intermediate stage of rosacea, consisting of papules and pustules, an eye examination should be performed to rule out ocular manifestations. It may be beneficial to recognize children in the early stage of rosacea; however, it is uncertain if prophylactic treatment is necessary.     

他克莫司软膏治疗酒渣鼻临床疗效观察

目的观察外用0.03%他克莫司软膏治疗酒渣鼻的临床疗效和安全性。方法入选的40例酒渣鼻患者均外用0.03%他克莫司软膏,2次/d,共4w。于治疗前及治疗后第1、2、3和4周时各随访1次。结果40例患者中31例完成临床试验。治疗后第1、2、3和4周时治疗红斑有效率分别为32.26%、61.29%、74.19%和83.87%;而丘疹和脓疱的有效率分别为9.68%、22.58%、25.81%和38.71%。0.03%他克莫司软膏对表现为红斑的酒渣鼻患者的疗效优于表现为丘疹和脓疱者。在治疗3～5天时29.03%的患者出现局部刺激反应。结论他克莫司软膏治疗酒渣鼻安全有效,对以红斑为主要临床表现的酒渣鼻患者的疗效较好。     

The clinical importance of demodex folliculorum presenting with nonspecific facial signs and symptoms

Demodex folliculorum (D. folliculorum), found in the pilosebaceous unit, is the most common ectoparasite of humans. Various clinical forms such as pustular folliculitis, papulopustular scalp eruptions, perioral dermatitis, and blepharitis have been defined, although in general, the disease has been classified into three main groups as "pityriasis folliculitis", "rosacea-like demodicidosis", and granulomatous rosacea-like "demodicidosis gravis". Our aim was to test for the presence of D. folliculorum in pathogenic numbers in patients who came to our clinic with non-specific symptoms such as facial itching with or without erythema, seborrheic dermatitis-like or perioral dermatitis-like lesions, papulopustular lesions, and an acneiform clinical appearance without telengiectasia or flushing. Twenty-eight (87.5%) female and 4 male (12.5%), patients and 33 age-and-sex matched healthy subjects enrolled in this study. D. folliculorum was sought in the lesion sites using the non-invasive method known as the Standardised Skin Surface Biopsy (SSSB). The discovery of more than five parasites in an area of 1 cm2, was evaluated as pathogenic. For treatment, 5% permethrine cream was applied twice daily for 15 to 30 days. The clinical symptoms of the patients were classified into clinical groups and evaluated as facial itching in 2 (6.3%), nonspecific erythema and itching in 21 (65.6%), erythema and pityriasiform squamous lesions in 3 (9.4%), acneiform in 3 (9.4%), papulopustular lesions in 1 (3.1%), granulomatous rosacea-like in 1 (3.1%), and perioral dermatitis-like symptoms in 1 (3.3%), D. folliculorum density was determined as 5>D/cm2 in all clinical lesions. A significant clinical healing and density of D. folliculorum at <=5 D/cm2 was determined in all but two patients after treatment. We consider that D. folliculorum presentation with different symptoms and signs than classical forms is not rare. For this reason, we suggest that it is useful to test for D. folliculorum in patients with non-classical presentations like facial itching, itching accompanied by non-specific erythema, itching and non-specific pityriasiform squamous lesions, and acneiform lesions.     

Combined effects of silymarin and methylsulfonylmethane in the management of rosacea: clinical and instrumental evaluation

Objective   This study aims to evaluate a topical treatment based on silymarin/methylsulfonilmethane (S-MSM) to improve erythematous-telangiectactic rosacea.
Methods    Forty-six patients affected by stage I–III rosacea entered this double-blind, placebo-controlled study. Subjects were treated for 1 month. Clinical and instrumental evaluations were done at baseline, after 10 and 20 days, and at the end of the study. Itching, stinging, erythema, and papules were investigated clinically as well as hydration and erythema instrumentally with capacitance and color measurements.
Results    A statistically significant improvement was observed in many clinical and instrumental parameters investigated ( P <  0.001). In particular, improvement of skin redness, papules, itching, hydration, and skin color occurred.
Conclusions    The combination of silymarin and S-MSM can be useful in managing symptoms and condition of rosacea skin, especially in the rosacea subtype 1 erythemato-telangiectatic phase. The action can be considered multicentric and multiphase because of the direct modulating action on cytokines and angiokines normally involved and up-regulated in the case of such skin condition.     

Treatment of rosacea with doxycycline monohydrate

Rosacea is one of the most commonly occurring inflammatory dermatoses treated by dermatologists today. Estimates suggest that at least 13 million Americans have recognized rosacea, and the clinical experience of most practitioners would add considerably more to that number. Rosacea is an inflammatory condition of the skin, classically presenting with a history of flushing and/or blushing along with the clinical findings of erythema, edema, telangiectasia, papules, pustules, and nodules of the face. Severity and distribution vary considerably. A patient may have only a few scattered papules and pustules of the central third of the face or there may be numerous inflammatory, painful, tender, large nodules. In some cases, only the face may be affected. In other cases, there may be lesions of the scalp, neck, and/or torso. Although the exact etiology is unknown, rosacea is thought by most experts to be an inflammatory process incited by vascular instability with subsequent leakage of fluid and inflammatory mediators into the dermis.     

Prognosis of 234 rosacea patients according to clinical subtype: The significance of central facial erythema in the prognosis of rosacea

Rosacea has a wide spectrum of clinical features, which include persistent facial redness, flushing, telangiectasia, inflammatory papules/pustules, hypertrophy and/or ocular features. The prognosis of rosacea according to clinical subtype has not been evaluated. We analyzed the prognosis of rosacea in 234 patients, which included 120 patients with mixed subtype, 75 with the erythematotelangiectatic rosacea subtype and 39 with the papulopustular rosacea (PPR) subtype. The prognosis of rosacea was classified as: (i) no improvement; (ii) partial remission; and (iii) complete remission. The frequencies of complete remission, time to complete remission and 1‐year complete remission rate were compared between subtypes. Follow‐up periods ranged 2–72 months (median follow‐up, 17.5). Aggravation of the disease was found in 50.4% of patients during follow up. Partial or complete remission was noted in 61.5% and 20.9% of patients, respectively. The median time to complete remission was 56.0 months. The prognosis of disease was more favorable for patients with the PPR subtype than for patients with other subtypes with respect to the frequency of complete remission, median time to complete remission and the 2‐year complete remission rate. In conclusion, papulopustular rosacea without remarkable centrofacial erythema showed a more favorable prognosis than other subtypes. Erythematotelangiectatic lesions in rosacea patients present a challenge for the treatment of rosacea.