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.     

Rosacea in black South Africans with skin phototypes V and VI

Rosacea is a chronic facial dermatosis considered to affect primarily white patients with light phototype skin, and is poorly documented in black patients. The aim of this study was to document the clinical features of rosacea in patients with phototypes V and VI. An 8‐year retrospective chart review of patients with a clinical and histological diagnosis of rosacea or acne rosacea was undertaken. Of 6700 patients, 15 (0.2%) had rosacea. All were of African descent with skin phototype V or VI. Mean age was 47 years, and female : male ratio was 14 : 1. Of the 15 patients, 5 (33%) were positive for human immunodeficiency virus; 5 (33%) had used topical steroids to treat the roseacea; 6 (40%) had phototype V and presented with erythema, telangiectasia and erythematous papules, while 9 (60%) had phototype VI skin and presented with skin‐coloured papules; and 10 (67%) had histology showing granulomatous rosacea, while 5 (33%) declined a facial skin biopsy. A high index of suspicion is required to diagnose rosacea in black patients as the classic signs of erythema and telangiectasia are difficult to discern.     

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.     

Rosacea and the gastrointestinal system

Rosacea is a common skin condition characterised by erythema, papules and pustules. Increasing evidence suggests that the gut–skin axis is implicated in the pathogenesis of rosacea. Sufficient evidence exists to support the notion that the gut microbiome plays a role in the inflammatory cutaneous response and there appear to be associations with small intestinal bacterial overgrowth and Helicobacter pylori infection. A dysbiotic microbiome and an innate immune system dysregulation contribute to the pathophysiology of rosacea, and further exploration of their roles is warranted. Greater understanding of this condition and the effect of the gut–skin axis could allow for more efficacious and timely treatment. This article reviews our current findings and understanding in the skin and gut relationship in rosacea.     

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.     

Specific gel-cream as adjuvant to oral isotretinoin improved hydration and prevented TEWL increase – a double-blind, randomized, placebo-controlled study

Background  Hydrating and emollient products are often recommended to patients under isotretinoin therapy to control the most frequent mucocutaneous side effects and to improve adherence to treatment.
Aims  To assess, using noninvasive biophysical tests, the clinical and instrumental effectiveness of a hydrating gel-cream compared with placebo as an adjuvant to isotretinoin for treatment of facial skin in patients with inflammatory acne.
Methods  Prospective, double-blind, randomized study, using MULTI SKIN MC750, on the adjuvant effect of a hydrating gel-cream for acne (active product) vs. a gel-cream without active substances (placebo). Follow-up lasted 3 months.
Results  Sixty-six patients were included. Thirty-four were administered the active product, and 32 placebo. Though the number of lesions fell significantly in both groups, the mean number of papules on day 30 was significantly lower in the active product group. The active product group showed a significant increase in hydration, while the placebo group showed a significant increase in transepidermal water loss (TEWL). Seborrhoea decreased significantly in both groups; there were no differences between them.
Conclusions  Compared with placebo, the specific gel-cream with active products as an adjuvant to oral isotretinoin improved hydration, prevented TEWL increase, and reduced inflammatory acne lesions after 30 days.     

Comparative study of some treatment modalities of rosacea

Background   Rosacea is a disease of complex pathogenesis and variable response to various therapeutic methods.
Aim of the work   To evaluate and compare the efficacy, safety and side effects of some topical lines of treatment of rosacea.
Patients and methods   The study included 24 patients (23 females and 1 male) with rosacea on the face. They were classified into three groups – each including eight patients (16 face sides) – and treated with one of three topical agents (azelaic acid 20% cream, metronidazole 0.75% cream or permethrin 5% cream) on one side of the face and another one on the other side twice daily for 15 weeks.
Results   There was a significant improvement of lesions after 15 weeks of topical treatment with the three agents. Azelaic acid cream was significantly more effective on inflammatory lesions but not erythema than the other two creams. Side effects – mostly transient – were observed with topical creams with no significant difference. They included itching, burning sensation, oedema and scales. Patients who used azelaic acid 20% cream were more satisfied than with other modalities.
Conclusion   Azelaic acid 20% cream provides an effective and safe alternative to metronidazole 0.75% cream or permethrin 5% cream with the added benefit of increased patient satisfaction.     

Ocular signs, symptoms and tear function tests of papulopustular rosacea patients receiving azithromycin

Background  Tetracycline derivatives provide moderate benefit in the treatment of ocular rosacea. Recently, azithromycin has been found to be an effective alternative in the treatment of cutaneous papulopustular rosacea.
Objective  We planned a study to evaluate the effects of azithromycin on ocular symptoms, signs and tear function tests of papulopustular rosacea patients.
Methods  An open-labelled study was performed in a population of 20 papulopustular rosacea patients.
Results  Eighteen subjects completed the trial. Significant improvement was seen in ocular symptoms, eyelid findings and conjunctival hyperaemia scores ( P  = 0.002, P <  0.0001, and P  = 0.005, respectively). Therapeutic benefit was not observed in ocular surface staining scores. Baseline values of Schirmer test results were within normal limits. No significant side-effects were observed.
Limitations  The study population is limited to dermatology patients who had been referred to the ophthalmology clinic.
Conclusion  Azithromycin may be a new promising therapeutic alternative in ocular rosacea.

Conflicts of interest

None declared.     

Is it possible to characterize objectively sensitive skin?

Background/purpose: Sensitive skin is a subject of intense research work. However, its contours have not been defined and properly investigated so far. The aim of this work was to characterize objectively the consumers of cosmetic products, which referred skin susceptibility to several agents or conditions.
Methods: Twenty-four healthy female volunteers, mean age 38.9±13 years were recruited. The volunteers were fully informed about the study having previously expressed their consent, and were grouped in to I: individuals without any skin sensitivity complaint and II: individuals with self-reported sensitive skin to regular contact with household cleaning products. Sodium lauryl sulphate was used as a 'provocative' agent and it was applied on the back of the volunteers' hands, as an occlusive patch for 24 h. After the patch removal (30 min, 7 and 14 days), the variables erythema, transepidermal water loss, stratum corneum hydration and blood perfusion were measured.
Results: No evidence of a statistical difference was found between the biomechanical behaviour of the skin of the two groups.
Conclusion: The results of our study did not enable us to establish a clear discrimination between sensitive and non-sensitive skin, which once again underlines the subjective nature of this condition.     

Enhancement of visual scoring of skin irritant reactions using cross-polarized light and parallel-polarized light

Background/purpose:  Polarized light has been used as an aid in visualizing various skin conditions, including acne vulgaris, rosacea, photoageing, lentigo simplex, and basal cell carcinoma. The use of parallel-polarized and cross-polarized light was evaluated in mild irritant reactions to determine, if this increases the ability to detect very early stages or low levels of irritation.
Methods:  Low concentrations of sodium lauryl sulfate (0.01% and 0.1%) were patched on human volunteers for 2, 6, and 24 hr, daily for 2–3 days in a modification of the standard patch test. Feminine protection products were evaluated in the behind-the-knee (BTK) test. Erythema reactions were scored by unaided visual assessment and using a polarized light visualization system.
Results:  In the 24-hr patch test, mean erythema assessed with polarized light was consistent with results of unaided visual scoring. Under milder conditions (2- and 6-hr patches), and in the BTK, significant differences from pretreatment levels of erythema were apparent earlier in the series of treatments compared with unaided scoring. In addition, subsurface scoring demonstrated that changes were still present under the skin surface even after unaided visual scoring indicated recovery.
Conclusion:  Low (subclinical) levels of irritation can be detected using enhanced visual scoring, indicating this non-invasive method has the potential to increase the sensitivity of our clinical studies.     

Topical application of 1-methylnicotinamide in the treatment of rosacea: a pilot study

Rosacea is a chronic facial dermatosis with a progressive course, which is characterized by the presence of erythema, papules, pustules, telangiectasias and sebaceous gland hyperplasia. However, the aetiology is still unknown; genetic predisposition, gastrointestinal disorders (Helicobacter pylori), infestations with Demodex folliculorum and environmental stimuli are considered to be involved in the inflammatory process. A metabolite of nicotinamide, 1-methylnicotinamide (MNA(+)), has anti-inflammatory properties, and this is the first study to test the effectiveness of this agent in treating rosacea. In total, 34 patients with rosacea were treated with a gel containing 0.25% MNA(+) as a chloride salt, twice daily for 4 weeks, after which improvement was observed in 26/34 cases. The improvement was good in 9/34 and moderate in 17/34, but no clinical effect was noted in seven subjects. In only one case was skin irritation given as the reason for treatment withdrawal. These results indicate that MNA(+) might be a useful agent for treating rosacea.     

Cleansing, moisturizing, and sun-protection regimens for normal skin, self-perceived sensitive skin, and dermatologist-assessed sensitive skin

ABSTRACT:  Acquiring or maintaining healthy skin requires a multifunctional approach: mild cleansing, moisturizing, and sun protection. The clinical benefits of a daily, healthy facial skin-care regimen comprising a mild cleanser and moisturizer were evaluated on normal skin, self-perceived sensitive skin, and dermatologist-assessed sensitive skin for a period of up to 4 weeks. Subjects with normal, healthy skin were photographed with a calibrated, high-resolution digital camera, and the average improvement in overall health was calculated using image morphing and facial averaging techniques, following a 2-week period of product application. In a second study that included subjects with self-assessed sensitive facial skin, changes in skin hydration, skin dryness, and skin sensitivity (determined by means of a lactic acid sting test and subject self-assessment) were monitored during a 3-week regimen of mild cleansing and moisturizing with products designed for sensitive skin. The third study involved dermatologist-assessed highly sensitive skin patients (mostly rosacea with an atopic background in some cases). These patients underwent a 4-week skin-care regimen involving mild cleansing and moisturizing. In all three studies, significant improvements in skin health/quality were observed by means of expert assessments, instrumental evaluations, and subjective self-assessment.     

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.     

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.     

Skin tolerance, efficacy, and quality of life of patients with red facial skin using a skin care regimen containing Licochalcone A

Background Patients with rosacea and red facial skin often show sensitivity to skin care products which can exacerbate inflammation and subjective irritation. Besides pharmacologic management, special skin care is prudent to avoid cosmetically induced irritation and address cosmetic concerns. Appropriate skin care should provide gentle cleansing, UVA/UVB protection, effective moisturization, and concealing pigments to neutralize the appearance of redness. Aims To evaluate skin compatibility and efficacy of a skin care regimen containing licochalcone A (Lic A), an anti‐irritant from the licorice plant Glycyrrhiza inflata, for subjects with mild to moderate facial redness. Patients/methods Sixty‐two patients with mild to moderate red facial skin used a four‐product skin care regimen for 8 weeks. Clinical assessments of erythema and subjective irritation, cross‐polarized photography, and self‐assessment questionnaires were completed at baseline, and after 4 and 8 weeks of use. A quality of life questionnaire was given at baseline and week 8. Results Clinical evaluations, subject response, and photography confirmed very good tolerability of the regimen and effective neutralization of redness by the pigmented products. Significant improvements in average erythema scores were observed at 4 and 8 weeks (P < 0.05), and an improvement in quality of life was confirmed by the patient questionnaires. Discussion The skin care regimen containing Lic A was found to be compatible with the sensitive facial skin of patients with rosacea and improved the appearance of persistent facial redness. The products were also observed to be compatible with daily metronidazole treatment.     

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.     

Permethrin 5% cream versus metronidazole 0.75% gel for the treatment of papulopustular rosacea. A randomized double-blind placebo-controlled study

BACKGROUND: Permethrin 5% cream used against human ectoparasites suggests that it may be effective in papulopustular rosacea. METHODS: This study included 63 patients diagnosed as having papulopustular rosacea based on the clinical and histological findings. Patients were randomly assigned into permethrin (n = 23), metronidazole (n = 20) and placebo (n = 20) groups. Scores of erythema, telangiectasia, edema and rhinophyma and the numbers of papules, pustules, inflammatory nodules and Demodex folliculorum were determined. Twenty-three patients were given permethrin 5% cream (Zalvor 5% skin cream, 20 patients metronidazole 0.75% gel (Roza gel and 20 patients placebo cream (Basis cream, in packages looking identical to those of metronidazole and permethrin creams, and were recommended to apply them to their faces twice a day. All patients were also given SPF 20 cream for protection against sunlight. Two months of treatment were planned, and the patients were invited to the clinic for fortnightly controls. Scores of erythema, telangiectasia, edema and rhinophyma and the numbers of papules, pustules, inflammatory nodules and D. folliculorum were recorded at each visit. The mean scores of erythema and the mean numbers of papules, pustules and D. folliculorum were determined at baseline and on days 15, 30, 45 and 60. Side effects were also detected. RESULTS: The effect of permethrin 5% cream on D. folliculorum was superior to that of metronidazole 0.75% gel. The effect of permethrin 5% cream on erythema and papules was found to be more effective than placebo and as effective as metronidazole 0.75% gel. However, it had no effect on telangiectasia, rhinophyma and pustules. CONCLUSION: It can be concluded that the application of permethrin 5% cream twice daily for 2 months can be as effective and reliable as metronidazole in the treatment of rosacea and a greater benefit can be gained when it is combined with other systemic and/or topical treatments.     

P45Neomycine sulfate patch tests

Objective:  The purpose of this study is to investigate if patients with neomycin sulfate allergy may develop test responses that are unclassifiable by commonly used assessment scales but which should be considered positive.
Materials:  16 patients who tested positive to neomycin sulfate patch tests are retested with different dose levels and application times. Test areas are assessed visually up to 11 days.
Results:  Three types of reactions were observed. The first type was characterized by erythema and diffuse infiltrate. Some of these had in addition either discrete papules or both papules and vesicles on their surface. The second type of reaction initially developed large perifollicular papules which later developed into coalescent erythema and diffuse infiltrate. The third type of reaction exhibited perifollicular papules only which declined over time. This type was unclassifiable by commonly used assessment scales. All types of reactions were of clinical significance.
Conclusion:  The results support that universal assessment scales for patch‐test responses due to different test agents may be inappropriate for assessment of neomycin sulfate patch tests. The clinician should only consider assessment scales as an aid in the assessment of test responses and be aware that morphology of test responses may differ between test agents and test techniques.     

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。     

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...