玫瑰痤疮难治性红斑治疗进展

玫瑰痤疮伴发的难治性红斑给患者带来了极大的困扰。目前治疗方法有α-肾上腺素能受体激动剂、β 肾上腺素能受体阻滞剂、肉毒素、激光和光子等。本文就玫瑰痤疮难治性红斑治疗进展进行综述。     

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。     

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。     

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。     

玫瑰痤疮的治疗进展

玫瑰痤疮是常见的慢性炎症性皮肤病,病因尚不清楚.近年来随着对其研究的深入和医疗技术的发展,临床治疗中不断出现新技术和新方法,如应用抗生素、异维A酸、壬二酸、他克莫司,杀虫剂,α肾上腺素受体激动剂,安体舒通等药物治疗及激光治疗,大部分治疗方法已经被研究所证实,并取得了较好的临床疗效,使玫瑰痤疮的治疗有了较大进展,激光为其治疗提供了更为广阔的前景.     

A型肉毒毒素治疗玫瑰痤疮持久性红斑2例并文献复习

患者女性,50岁,面部红斑、丘疹、脓疱伴潮红、灼热、瘙痒3年。诊断：玫瑰痤疮。共给予2次20 U/mL浓度A型肉毒毒素治疗后明显好转（首次：两侧面颊各注射25 U,1周后第2次注射：每侧面颊各10 U）。病例2：患者女性,48岁,面部红斑、丘疹伴潮红、灼热、瘙痒感2年。诊断：玫瑰痤疮。给予1次注射20 U/mL浓度A型肉毒毒素治疗后明显好转（两侧面颊各注射20 U）。     

玫瑰痤疮发病机制的研究进展

玫瑰痤疮的发病机制尚未完全阐明,其治疗缺乏理论依据和针对性.近年来研究发现,玫瑰痤疮患者可能存在易感基因或神经血管调节受体相关的基因突变,在诱发因素(如螨虫、糖皮质激素、紫外线等)的刺激下,一方面表皮抗菌肽异常活化,皮肤屏障功能受损;另一方面神经通过释放神经肽,直接或间接参与皮肤免疫反应、影响血管舒张功能,并最终导致玫瑰痤疮的发生.这些新研究进展为进一步阐明玫瑰痤疮的机制及研究防治措施提供依据.     

玫瑰痤疮与精神神经性疾病相关性研究进展

玫瑰痤疮是一种好发于颜面部的慢性复发性炎症性皮肤病, 现已有大量研究证实其与多种系统性疾病有关, 其中包括精神神经性疾病如焦虑、抑郁、偏头痛、阿尔茨海默病和帕金森病等, 本文综述玫瑰痤疮与精神神经性疾病相关性研究进展及相关机制。     

玫瑰痤疮的病理生理发病机制研究进展

玫瑰痤疮发病机制尚未完全阐明,目前认为遗传因素、皮肤局部免疫失衡、神经免疫功能和神经血管环路紊乱、皮肤屏障功能异常、微生物菌群失调等均参与了玫瑰痤疮的发生发展。本文综述玫瑰痤疮的病理生理发病机制研究进展。     

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.     

幽门螺杆菌与皮肤病相关研究进展

目前,大量临床流行病学的研究认为,幽门螺杆菌与多种皮肤病可能具有相关性.幽门螺杆菌引起皮肤病的病理生理基础可能是其感染后诱导炎症介质及细胞因子释放进而引发的一系列自身免疫反应所致,幽门螺杆菌可能是这些皮肤病的病因也可能是发病的协同因素,然而由于流行病学研究的局限性以及缺乏具有说服力的机制研究,也存有争议.为此,文中概述幽门螺杆菌与多种皮肤病的相关研究,为进一步研究和皮肤病的诊治带来新的思路.     

Demodex folliculorum infestations in common facial dermatoses: acne vulgaris,rosacea, seborrheic dermatitis

BackgroundDemodex mites are found on the skin of many healthy individuals. Demodex mites in high densities are considered to play a pathogenic role.ObjectiveTo investigate the association between Demodex infestation and the three most common facial dermatoses: acne vulgaris, rosacea and seborrheic dermatitis.MethodsThis prospective, observational case-control study included 127 patients (43 with acne vulgaris, 43 with rosacea and 41 with seborrheic dermatitis) and 77 healthy controls. The presence of demodicosis was evaluated by standardized skin surface biopsy in both the patient and control groups.ResultsIn terms of gender and age, no significant difference was found between the patients and controls (p > 0.05). Demodex infestation rates were significantly higher in patients than in controls (p = 0.001). Demodex infestation rates were significantly higher in the rosacea group than acne vulgaris and seborrheic dermatitis groups and controls (p = 0.001; p = 0.024; p = 0.001, respectively). Demodex infestation was found to be significantly higher in the acne vulgaris and seborrheic dermatitis groups than in controls (p = 0.001 and p = 0.001, respectively). No difference was observed between the acne vulgaris and seborrheic dermatitis groups in terms of demodicosis (p = 0.294).Study limitationsSmall sample size is a limitation of the study. The lack of an objective scoring system in the diagnosis of Demodex infestation is another limitation.ConclusionThe findings of the present study emphasize that acne vulgaris, rosacea and seborrheic dermatitis are significantly associated with Demodex infestation. Standardized skin surface biopsy is a practical tool in the determination of Demodex infestation.     

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.     

玫瑰痤疮神经源性炎症及肉毒毒素治疗相关机制的研究进展

【摘要】 局部血管神经功能失调是玫瑰痤疮发病的重要因素,已证实神经源性炎症是神经血管失调的重要环节,而皮内注射肉毒毒素可缓解面部潮红、灼热表现,可能与抑制神经末梢神经肽释放以及抑制肥大细胞脱颗粒有关。本文综述玫瑰痤疮发病机制中神经源性炎症以及肉毒毒素治疗玫瑰痤疮的相关研究进展,以期为玫瑰痤疮神经相关基础研究及临床治疗提供依据。