男性酒渣鼻患者血清睾酮及雌二醇的检测

目的探讨血清睾酮及雌二醇的水平在男性酒渣鼻发病中的作用。方法采用放射免疫法对47例男性酒渣鼻患者血清睾酮、雌二醇进行了测定,并以25例正常男性作为对照。结果患者组睾酮、雌二醇与正常对照组比较差异无显著性,但21例伴皮脂溢出症者,睾酮明显高于正常对照组(P<0.05),血清睾酮浓度的升高幅度与酒渣鼻病程及分期无明显的相关性。结论血清睾酮浓度的升高是伴皮脂溢出症的男性酒渣鼻患者的重要原因。     

The Efficacy of Intense Pulsed Light for Treating Erythematotelangiectatic Rosacea Is Related to Severity and Age

Background

Rosacea is a chronic cutaneous disease. Therapeutic modalities should be chosen based on the identified sub-types and clinical features in each patient. Vascular lasers, including intense pulsed light (IPL), are reportedly safe and effective in treating erythematotelangiectatic rosacea (ETR).

Objective

In this study, we assess the comparative efficacy of IPL related to several factors including clinical severity and the age of patients with ETR.

Methods

Patients with ETR were classified into two groups according to the National Rosacea Society Severity Guideline. Severity score and erythema index (EI) were measured using a clinical scorecard and mexameter. For additional evaluation of therapeutic efficacy, investigator and patient global assessments (IGA, PGA) were checked. Efficacy of IPL was analyzed according to severity score, EI, IGA, and PGA related to sex, age, lactic acid stinging test, and severity.

Results

Analyses of the efficacy of IPL according to severity score, EI, IGA, and PGA based on sex, age, lactic acid stinging test, and severity revealed significant differences with age and severity only.

Conclusion

This study supports the efficacy of IPL treatment for patients with ETR. IPL may be more effective in patients with more severe ETR and in younger patients with ETR.     

Case Series of Morbihan Disease (Extreme Eyelid Oedema Associated with Rosacea): Diagnostic and Therapeutic Approaches

Morbihan disease (MD) is a rare form of rosacea that presents with chronic erythema and solid oedema on the upper half of the face. A diagnosis of MD can be made only after eliminating diseases that are similar in terms of clinical and histopathological presentation. The cause of MD remains unclear and no standardised treatment is yet available. MD often tends to be recalcitrant to therapies commonly used to treat rosacea, including systemic corticosteroids, antibiotics, isotretinoin, and topical regimens. Thus, surgical interventions have been attempted but most cases have exhibited unsatisfactory responses. We treated six patients with extreme eyelid lymphoedema without any other cutaneous manifestation. Surgical eyelid reduction was performed in all patients, because ptosis and narrowing of the visual field were the major complaints. Histopathological tests revealed various extents of perivascular and perifollicular inflammation, and dermal oedema. After surgery, patients with severe inflammatory cell infiltration (including mast cells) exhibited a tendency toward recurrence. Other patients with severe dermal oedema exhibited better responses to surgical reduction, and thus no recurrence. We propose that MD should be included in the differential diagnosis of persistent, chronic eyelid oedema even if eyelid oedema is the only manifestation; the histological features may aid in the selection of appropriate therapeutic strategies. We suggest that eyelid reduction surgery can be a useful treatment option for MD patients when there is no massive mast cell infiltration.     

[Translated article] Contact Allergy in Patients With Rosacea

Background and objectiveRosacea is a chronic acneiform skin disorder in which impaired skin barrier function can lead to sensitization to allergens. We aimed to analyze contact allergies in our patients with rosacea.Material and methodsRetrospective cohort study of all patients who underwent patch testing in our skin allergy clinic between May 1991 and May 2019.ResultsA total of 200 patients with rosacea were referred to our clinic for patch testing during the study period; they represented 2.1% of all patch tested patients in the period. Eighty-one percent were women (mean age, 44.7 years). At least 1 positive patch test was recorded for 46.5%; 15% were of current relevance. The most frequent positive reaction was to nickel (26%), followed by cobalt chloride (6.5%), isothiazolinones (6%), p-phenylenediamine (5.5%), fragrance mix II (5%), and thimerosal (3.5%). The most common currently relevant patch test reactions were to isothiazolinones in 10 of the 200 patients (5%); to phenylenediamine, fragrance mix II, and toluensulfonamide formaldehyde resin in 4 patients (2%) each; and to tixocortol and fragrance mix I in 2 patients (1%) each. The allergen groups most often implicated were metals (of current relevance in 12.6%) and drugs (of current relevance in 25.8%). Preservatives and fragrances were the next most common allergen groups, and 70.8% and 43.7% of the positive reactions in these groups, respectively, were of current relevance. Cosmetics were the most frequent source of sensitization, followed by topical medications—notably corticosteroids and antifungal agents.ConclusionsWe emphasize the high prevalence of allergic contact dermatitis in patients with rosacea, a finding which supports patch testing, especially if eruptions worsen when these patients use cosmetics and topical medications.     

A Pilot Study to Evaluate the Efficacy and Safety of Treatment with Botulinum Toxin in Patients with Recalcitrant and Persistent Erythematotelangiectatic Rosacea

BackgroundThere are few pharmacologic options to reduce erythema and flushing in patients with recalcitrant erythematotelangiectatic rosacea (ETR). We previously reported two cases of refractory flushing and erythema of rosacea that were successfully treated with intradermal botulinum toxin injection, and additional research is needed to prove the efficacy and safety of this treatment.ObjectiveTo report the efficacy and safety of botulinum toxin injection as an aid in persistent erythema of rosacea patients.MethodsA total of 20 Korean patients with recalcitrant ETR were enrolled to receive treatment by injection of botulinum toxin. Patients received one treatment of intradermal botulinum toxin injection and were assessed 1, 2, 4, and 8 weeks after treatment. The severity of erythema and telangiectasia was investigated by a non-treating physician, and the Erythema Index (EI) was assessed by mexameter at each visit. Patient satisfaction and any adverse events were also assessed at each visit.Results17 patients completed all follow-up visits and were included in the analysis. Intradermal injection of botulinum toxin significantly reduced erythema severity and EI in ETR patients. Patients reported a satisfaction score of 2.94±0.56 at 8 weeks after treatment. Except for three patients who discontinued the study early due to inconvenience of facial muscle paralysis, 17 patients participating in the final analysis did not report side effects except injection pain at the time of the procedure.ConclusionIntradermal injection of botulinum toxin can be used as an effective and relatively safe adjuvant agent for recalcitrant and persistent erythema of ETR patients.     

A study of the pathogenesis of Rosacea: how angiogenesis and mast cells may participate in a complex multifactorial process

In the present study we evaluated, in involved and clinically uninvolved skin of Rosacea, microvessels density (MVD) and total vascular area (TVA) in addition to multiple morphologic characteristics of microvessels and also mast cells (MCs) number. We examined also the relationship between angiogenesis, MCs number and disease clinicopathological data. The study included 69 patients with Rosacea. A skin biopsy with a 4-mm punch was performed from clinically involved skin in each case. In nine randomly selected patients, facial biopsy specimens were obtained from both involved and clinically uninvolved skin. Histological sections, immunostained for factor VIII, were evaluated by image analysis for the quantification of MVD, TVA and several morphometric parameters related to the vessel size or shape. MCs detection in the dermis was carried out using the chloracetate esterase method (Fast Blue RR) in parafin sections. Serum antibodies against H.pylori were detected. Statistically important differences concerning the factors of angiogenesis between lesional and clinically non-lesional skin were demonstrated. A statistical important correlation was found also between high vascular density, PPR clinical type and the presence of ocular manifestations. MVD or TVA showed no correlation with the degree of solar elastosis or inflammation and with the Demodex density as well. However, high MVD values were found to correlate with granuloma formation in the dermis. MCs number were significantly greater in lesional compared to clinically non-lesional skin. Statistical significance was shown between MCs density and disease duration. However, no correlation between MCs number and blood vessel density was found. Angiogenesis seems to play an important role in the pathogenesis especially of the more severe clinical form of Rosacea. MCs seem to participate in evolution to disease chronicity by contributing to inflammation, angiogenesis and tissue fibrosis.     

Rosacea associated with increased risk of generalized anxiety disorder: a case-control study of prevalence and risk of anxiety in patients with rosacea

BackgroundRosacea may result in emotional distress and anxiety. However, data on the presence of generalized anxiety disorder in rosacea patients are scarce.ObjectiveThe aim of the study was to detect the frequency and level of anxiety and depression in patients with rosacea.MethodsA total of 194 consecutive rosacea patients and 194 age- and sex-matched controls were enrolled. Severity of rosacea was assessed in patients according to the criteria of the National Rosacea Society Ethics Committee. Both patients and controls were evaluated by the Generalized Anxiety Disorder 7-item scale, and severity was measured by the Generalized Anxiety Disorder-Adult.ResultsIndividuals who were diagnosed with an anxiety and/or depressive disorder were more common in patient group (24.7% vs. 7.2%, p < 0,01). Female patients were particularly at risk for having generalized anxiety disorder (OR = 2.8; 95% CI 1.15–7.37; p = 0.02).Study limitationsSingle center study and limited sample size.ConclusionsRosacea patients show greater risk of having anxiety disorders, including generalized anxiety disorder. Female patients, those with lower educational levels, those with phymatous subtype, untreated patients, and patients with prior psychiatric morbidity may be at particular risk for anxiety. It is essential to consider the psychological characteristics of patients to improve their well-being.     

Itch Severity Scale: a self-report instrument for the measurement of pruritus severity

Background Assessing pruritus severity is difficult because of its subjective nature. A questionnaire that takes into account how the symptom is perceived by the patient may provide a more accurate representation of the pruritus. However, recently developed questionnaires do not specifically quantify severity of the symptom. Objectives To develop a self‐report questionnaire to measure pruritus severity and to provide initial evidence of its validity and reliability. Methods We modified a previously developed interview for the characterization and evaluation of pruritus, which was completed along with the RAND‐36 Health Status Inventory and Dermatology Life Quality Index by patients with psoriasis‐associated pruritus. Exploratory factor analysis, studies of internal consistency, and correlation analyses with health‐related quality of life scores were used to help determine which components of the modified pruritus interview to include in the new questionnaire, the Itch Severity Scale (ISS). The ISS was then assessed for construct validity, internal consistency reliability and test–retest reliability. Results Seven of the initial 11 components of the modified pruritus interview were included in the ISS. ISS scores correlated moderately with physical (r = −0·483) and mental (r = −0·492) health composite scores of the RAND‐36 and strongly with Dermatology Life Quality Index scores (r = 0·628), evidence of construct validity. It had an internal consistency reliability of 0·80 and a test–retest reliability of 0·95. Conclusions Based on this preliminary evidence of validity and reliability, this new seven‐item ISS may be useful in comparing pruritus severity among different disease populations or in assessing pruritus treatment effectiveness.     

射频电刀联合中药外敷治疗肥大增生型酒渣鼻的临床疗效观察

目的 观察射频电刀微雕整形修复联合中药治疗肥大增生型酒渣鼻的安全性和有效性.方法 将确诊为肥大增生型酒渣鼻的患者38例,随机分为射频刀A组(13例)、射频刀B组(13例)和普通电刀组(12例).射频刀A组采用射频电刀微雕整形修复+复方紫草油纱,射频刀B组采用射频电刀微雕整形修复+抗生素油纱,普通电刀组采用普通电刀切除增...     

The comparison of Nail Psoriasis Severity Index with a less time-consuming qualitative system

Objective Reliable assessment of severity in nail psoriasis is essential to document treatment responses in clinical trials and routine clinical usage. In this study the correlation between Nail Psoriasis Severity Index (NAPSI) and Cannavo's scoring system was assessed, and inter‐rater correlation of NAPSI scores were evaluated. Materials and Methods Forty‐five patients with nail psoriasis were included. Target nails were selected and graded by the first dermatologist with both scoring systems. The nails were reevaluated by the second dermatologist with NAPSI. Results The two systems were highly correlated (P < 0.001). For NAPSI inter‐rater correlation was also significant (P < 0.001). Conclusion Our results showed that the qualitative and quantitative evaluations of the same rater were similar. Although the qualitative scoring system of Cannavo's is less time consuming than NAPSI, to suggest this system inter‐rater correlations should be evaluated.     

Use of the Self-Administered Eczema Area and Severity Index by parent caregivers: results of a validation study

BACKGROUND: The Eczema Area and Severity Index (EASI) is used by dermatological investigators world-wide to assess eczema disease severity. EASI measures are, however, time-consuming and require trained personnel, thereby limiting its application to large-scale epidemiological studies. Additionally, the use of self-assessed severity indices in dermatology is restricted to adult subjects and conditions, thereby not addressing the needs of paediatric patients. OBJECTIVES: To develop and validate an instrument for a caregiver's self-assessment of the severity of his/her child's atopic dermatitis (AD), the Self-Administered EASI (SA-EASI). METHODS: Trained investigators performed a modified EASI assessment on the same day as an SA-EASI was obtained from 47 caregivers of children with AD. RESULTS: The SA-EASI was found to be a valid measure of the severity of AD. Total, acute and chronic SA-EASI scores predicted total, acute and chronic modified EASI scores (P < 0.0001). SA-EASI body surface area (BSA) scores predicted EASI BSA scores (P < 0.0001). SA-EASI pruritus scores correlated with the acute, chronic and total EASI scores (P = 0.0001). CONCLUSIONS: The SA-EASI may provide caregivers the means to report the severity of their child's skin disease objectively. The high correlation with the EASI score observed in this sample implies that statistical inferences with the SA-EASI will be valid for large populations. In future studies, this will permit analysis of the relationship of skin disease severity to such measures as quality of life, disability, patient satisfaction and the costs of various therapies. Moreover, this SA-EASI instrument may allow older children, over 12 years old, to assess the severity of their AD.     

Nail Dystrophy in Patients with Atopic Dermatitis and Its Association with Disease Severity

BackgroundNail dystrophy arises from various inflammatory dermatologic diseases. However, there have been few reports on the prevalence of nail abnormality in atopic dermatitis (AD) or on the relationship of this condition with the severity of the disease.ObjectiveThis study was intended to determine the prevalence and types of nail abnormalities associated with AD and to evaluate the relation between nail abnormalities and the severity of AD.MethodsAD patients aged 2 to 19 who visited the outpatient clinic were thoroughly examined for nail abnormalities. Demographic information was collected and eczema area and severity index (EASI) score for severity of AD were checked.ResultsA total of 235 AD patients (children and adolescents) were investigated. There were 24 (10.2%) patients with nail abnormalities: transverse groove (Beau''s line) (25.0%), nail pitting (16.7%), koilonychia (16.7%), trachyonychia (12.5%), leukonychia (12.5%), brachyonychia (8.3%), melanonychia (8.3%), onychomadesis (8.3%), onychoschizia (8.3%), and onycholysis (8.3%). There was no statistically significant difference in the total EASI score associated with development of nail abnormalities (p=0.236). However, when the EASI score was confined to the lower extremities, it showed a relation to the prevalence of toe nail dystrophy (odds ratio, 1.115; 95% confidence interval, 1.014~1.316; p=0.030).ConclusionNail abnormalities in AD are thought to be caused mainly by pathologic change in the nail matrix region, and the EASI score confined to lower limbs, might be used as a predictor of toe nail changes in patients with AD.     

窄谱UVB治疗对银屑病外周血Th1/Th2细胞因子的影响

目的:检测窄谱UVB照射治疗银屑病前后患者外周血IFN-γ、IL-2及IL-4、IL-10水平,探讨窄谱UVB达到银屑病改善缓解的可能免疫学机制。方法:对28名静止期银屑病患者行窄谱UVB照射治疗,观察治疗前、治疗后患者外周血γ-IFN、IL-2和IL-4、IL-10水平的变化,并对其水平和皮损严重度作相关分析。结果:银屑病患者外周血IFN-γ、IL-2水平较健康对照者水平升高,分别为(95.17±8.96)pg/mL比(33.72±3.32)pg/mL和(33.54±2.95)pg/mL比(8.61±1.97)pg/mL(P<0.01)。银屑病患者外周血IL-4、IL-10水平较健康对照者水平降低,分别为(20.70±4.43)pg/mL比(25.42±4.12)pg/mL和(17.86±2.31)pg/mL比(20.92±4.83)pg/mL(P<0.01)。经窄谱UVB照射治疗后,Th1型细胞因子由治疗前的高于健康者的高水平下调,而Th2型细胞因子水平治疗前较正常人水平低,治疗后与治疗前改变无明显差异性。Th1型细胞因子水平和银屑病皮损严重程度呈正相关,Th2型细胞因子水平和银屑病皮损严重程度呈负相关。结论:银屑病是以Th1型细胞因子水平升高Th2型细胞因子水平下降为特点的Th1/Th2免疫反应偏移的免疫性疾病,窄谱UVB可能通过抑制Th1免疫反应相对地逆转银屑病的Th1/Th2反应失衡从而达到临床上银屑病的缓解。     

A study examining inter-rater and intrarater reliability of a novel instrument for assessment of psoriasis: the Copenhagen Psoriasis Severity Index

Background There is a perceived need for a better method for clinical assessment of the severity of psoriasis vulgaris. The most frequently used system is the Psoriasis Area and Severity Index (PASI), which has significant disadvantages, including the requirement for assessment of the percentage of skin affected, an inability to separate milder cases, and a lack of linearity. The Copenhagen Psoriasis Severity Index (CoPSI) is a novel approach which comprises assessment of three signs: erythema, plaque thickness and scaling, each on a four‐point scale (0, none; 1, mild; 2, moderate; 3, severe), at each of 10 sites: face, scalp, upper limbs (excluding hands and wrists), hands and wrists, chest and abdomen, back, buttocks and sacral area, genitalia, lower limbs (excluding feet and ankles), feet and ankles. Objectives To evaluate the inter‐rater and intrarater reliability of the CoPSI and to provide comparative data from the PASI and a Physician’s Global Assessment (PGA) used in recent clinical trials on psoriasis vulgaris. Methods On the day before the study, 14 dermatologists (raters) with an interest in psoriasis participated in a detailed training session and discussion (2·5 h) on use of the scales. On the study day, each rater evaluated 16 adults with chronic plaque psoriasis in the morning and again in the afternoon. Raters were randomly assigned to assess subjects using the scales in a specific sequence, either PGA, CoPSI, PASI or PGA, PASI, CoPSI. Each rater used one sequence in the morning and the other in the afternoon. The primary endpoint was the inter‐rater and intrarater reliability as determined by intraclass correlation coefficients (ICCs). Results All three scales demonstrated ‘substantial’ (a priori defined as ICC > 80%) intrarater reliability. The inter‐rater reliability for each of the CoPSI and PASI was also ‘substantial’ and for the PGA was ‘moderate’ (ICC 61%). The CoPSI was better at distinguishing between milder cases. Conclusions The CoPSI and the PASI both provided reproducible psoriasis severity assessments. In terms of both intrarater and inter‐rater reliability values, the CoPSI and the PASI are superior to the PGA. The CoPSI may overcome several of the problems associated with the PASI. In particular, the CoPSI avoids the need to estimate a percentage of skin involved, is able to separate milder cases where the PASI lacks sensitivity, and is also more linear and simpler. The CoPSI also incorporates more meaningful weighting of different anatomical areas.     

Cathelicidin LL-37: An Antimicrobial Peptide with a Role in Inflammatory Skin Disease

Chronic inflammatory skin diseases such as atopic dermatitis, psoriasis or rosacea are very common. Although their exact pathogenesis is not completely understood all three diseases are characterized by dysregulation of cutaneous innate immunity. Cathelicidin LL-37 is an important effector molecule of innate immunity in the skin and atopic dermatitis, psoriasis or rosacea show defects in cathelicidin expression, function or processing. In atopic dermatitis, cathelicidin induction might be disturbed resulting in defective antimicrobial barrier function. In contrast, psoriasis is characterized by overexpression of cathelicidin. However to date it is unclear whether pro- or anti-inflammatory functions of cathelicidin predominate in lesional skin in psoriasis. In rosacea, cathelicidin processing is disturbed resulting in peptide fragments causing inflammation, erythema and telangiectasias. In this review, the current evidence on the role of cathelicidin LL-37 in the pathogenesis of inflammatory skin diseases will be outlined. As cathelicidin LL-37 might also serve as a future treatment target potential novel treatment strategies for those diseases will be discussed.