Distinguishing rosacea from sensitive skin by reflectance confocal microscopy
Abstract
摘要
英文原文
Background: The updated standard classification and pathophysiology of rosacea have provided clear and meaningful evaluation parameters; however, differentiating rosacea from sensitive skin (SS) remained an obstacle for dermatologists around the world, especially in China. Herein, we aimed to find a better characteristic to distinguish rosacea from SS by using reflectance confocal microscopy (RCM).
对应中文
背景：玫瑰痤疮的最新分类标准和病理生理学提供了明确而有意义的评估参数；然而，区分玫瑰痤疮和敏感性皮肤（SS）仍然是世界各地皮肤科医生的一个难题，尤其是在中国。在此，我们的目的是采用反射共聚焦显微镜（RCM）从中发现更好的鉴别SS与玫瑰痤疮的特征。
英文原文
Method: Forty rosacea patients and 143 healthy subjects were recruited in this study. Firstly, a SS questionnaire and a lactic acid sting test were conducted among healthy subjects. Next, two major groups were divided out, including a SS group (40 subjects) and a normal skin control group (NS, 60 subjects). The cutaneous structures of face and fossa cubitalia were imaged by RCM.
对应中文
方法：40例玫瑰痤疮患者和143名健康受试者被纳入本研究。首先，对健康受试者进行SS问卷调查和乳酸刺痛试验。接下来，分为两个主要组，包括敏感性皮肤组（SS组，40名受试者）和正常皮肤对照组（NS组，60名受试者）；每位受试者的面部和肘窝的皮肤结构均采用RCM成像。
英文原文
Results: We found that more parakeratosis, honeycomb pattern, spongiform edema, and dermal papillae (P<0.05) in rosacea patients than that of the NS group, whereas there were no significant differences, were found in rosacea patients and the SS group. Strikingly, we found that rosacea patients have a larger depth of honeycomb pattern than that of SS subjects (P<0.05). But, the epidermal thickness of rosacea did not differ from that of SS groups. There was also no significant difference of epidermal thickness and honeycomb structure depth between rosacea patients and NS group.
对应中文
结果：我们发现玫瑰痤疮患者的角化不全，蜂窝状结构、海绵状水肿和真皮乳头都比NS组多（P<0.05），而玫瑰痤疮患者和SS组之间没有显著差异。引人注目的是，我们发现玫瑰痤疮患者蜂窝状结构的深度比SS受试者大（P<0.05）。但是，玫瑰痤疮患者的表皮厚度与SS组没有差异。玫瑰痤疮患者与NS组的表皮厚度和蜂窝状结构深度也无显著差异。
英文原文
Conclusion: From the RCM images of parakeratosis, honeycomb pattern, spongiform edema, and dermal papillae, we found that RCM might be a faithful tool to distinguish rosacea from NS group. The depth of honeycomb structure of SS was more superficial than rosacea patients, whereas no significant difference between rosacea patients and NS group. RCM may provide a new method for evaluating the development of rosacea although it failed to distinguish rosacea and SS effectively.
对应中文
结论：从角化不全、蜂窝状结构、海绵状水肿和真皮乳头的RCM图像中，我们发现RCM可能是区分NS组和玫瑰痤疮的可靠工具。SS组蜂窝状结构的深度较玫瑰痤疮组浅，而玫瑰痤疮组与NS组无显著性差异。RCM虽不能有效区分玫瑰痤疮和SS，但可为评价玫瑰痤疮的发生发展提供一种新的方法。
INTRODUCTION
介绍
英文原文
Rosacea is a common chronic congestive inflammatory skin disease which predominantly affects the centrofacial region (cheeks, chin, nose, and central forehead).Initially, the National Rosacea Society’s Expert Committee described four subtypes of rosacea: erythematotelangiectatic, papulopustular, phymatous, and ocular.Recently, the standard classification of rosacea was changed from subtype-based to phenotype-based diagnosis.The typical features of rosacea were continuum of inflammation, flushing, and fixed centrofacial erythema.However, the standardization and quantification of rosa- cea measurements were challengeable for variable clinical signs.In addition, skin biopsy of rosacea was usually nonspecific; therefore, it is hard to diagnose this elusive condition. By far, clinical features represent the indispensably gold standard of diagnosis.Non-invasive, reliable, and objective measurement tools for rosacea assessment are needed to figure out the mystery.
对应中文
玫瑰痤疮是一种常见的慢性充血性炎症性皮肤病，主要影响面部中央区域（脸颊、下颌、鼻和前额中央）。最初，国家玫瑰痤疮协会的专家委员会描述了玫瑰痤疮的四种亚型：红斑毛细血管扩张型、丘疹脓疱型、赘生型和眼型。最近，玫瑰痤疮的标准分类从基于亚型的诊断转变为基于表型的诊断。玫瑰痤疮的典型特征是持续的炎症、潮红和固定的中心面红斑。然而，玫瑰痤疮测量的标准化和量化对于不同的临床体征是有挑战性的。此外，玫瑰痤疮的皮肤活检通常是非特异性的；因此，很难诊断这种难以捉摸的情况。到目前为止，临床特征代表了不可或缺的诊断黄金标准。无创、可靠、客观的玫瑰痤疮评估工具是揭开谜团的必要工具。
英文原文
Flushing is a common manifestation shared by rosacea and SS, which is an extremely common skin condition but not a disease.The incidence of SS is about 50% and little across countries,whereas the prevalence of rosacea is only 5.46% in the general population.Furthermore, treatments of these two conditions are extremely different. Although some specific cosmetics are useful under both conditions of SS and rosacea, some treatments often cause opposite effects. In most cases, oral medicines used in rosacea, such as tetracyclines, metronidazole, and others have limited effects, or even cause worse outcome for SS. Therefore, it is urgent to find effective, non-invasive, reliable, and sensitive measurement tools to distinguish rosacea and SS.UV such.
对应中文
发红是玫瑰痤疮和SS的共同表现。SS是一种极为常见的皮肤病，但同玫瑰痤疮不是一种疾病。SS的发病率约为50%、各国之间的发病率差异很低，而玫瑰痤疮在普通人群中的患病率仅为5.46%。此外，这两种疾病的治疗方法极为不同、虽然一些特殊的化妆品在SS和玫瑰痤疮两种情况下都很有用，但一些治疗方法往往会产生相反的效果。在大多数情况下，治疗玫瑰痤疮的口服药物，如四环素、甲硝唑和其他药物的作用有限，甚至会导致SS的不良后果。因此，迫切需要寻找有效、无创、可靠、灵敏的测量工具来鉴别玫瑰痤疮和SS。
英文原文
In vivo, RCM is a non-invasive and direct imaging technique that has shown prospect in aiding diagnosis of many skin conditions. It is often used for identifying pigmented lesions, differentiating benign and malignant tumors and determining non-melanocytic skin tumors.For a long time, the Demodex mites, microscopic parasites which normally inhabit human facial sebaceous follicles, are always considered to be causative factors of rosacea.But there has been long raised a question: Which one comes first, Demodex or rosacea? Thus, other objective and reliable measurement tools are needed to solve the controversy. Recently, the utilization of RCM in diagnosis and therapeutic monitoring of rosacea has been reported.By using RCM evaluation, our group also reported that “epidermal honeycomb structure” and “spongiform edema” could be effective in diagnosis of SS.Herein, we aimed to explore whether RCM could be applied in evaluation the rosacea and SS in practice.
对应中文
在体内，RCM是一种非侵入性的直接成像技术，在许多皮肤疾病的辅助诊断中显示出良好的前景。它通常用于鉴别色素性病变、鉴别良恶性肿瘤以及确定非黑色素细胞皮肤肿瘤。长期以来，蠕形螨、一种通常栖息于人类面部皮脂腺滤泡的微小寄生虫，通常被认为是玫瑰痤疮的致病因素。但一直以来人们都有一个疑问：蠕形螨和玫瑰痤疮，哪一种先出现？因此，需要其他客观可靠的测量工具来解决争议。最近有文献报道了RCM在玫瑰痤疮诊断和治疗监测中的应用。通过RCM评估，我们的研究小组发现“表皮蜂窝结构”和“海绵状水肿”可有效诊断SS；而本研究的目的是探讨RCM是否可以在实践中应用于玫瑰痤疮和SS的区分和评估。
DISCUSSION
讨论
英文原文
Rosacea is a chronic inflammatory condition affecting the central face. Although the diagnosis, classification, and assessment of rosacea have been recently updated, there are no effectively noninvasive and objective skin measurement methods for assessment of this condition.Skin sensitivity of rosacea patients is higher than that of normal people.Rosacea and SS share some common influencing factors, pathogenesis, and clinical manifestations. Thus, rosacea is often mistakenly diagnosed as SS.However, they are definitely different diseases in nature. The wrong diagnosis would bring the wrong treatment strategies, which cause more serious consequences. A previous study from our group demonstrated that the typically damaged structures observed in SS by using RCM, including parakeratosis, disarranged honeycomb pattern, and reduced honeycomb pattern depth.In this study, we aimed to investigate whether RCM could be used as a non-invasive reliable and objective method to assess and monitor rosacea.Some researchers have revealed the potential role of Demodex mites in rosacea; however, we are inclined to support that Demodex mites are a manifestation of rosacea rather than a necessary diagnostic factor. By using RCM, we demonstrated that there are much more parakeratosis, honeycomb pattern, spongiform edema, and dermal papillae present in rosacea patients than those of controls. Moreover, rosacea patients have much thicker honeycomb structure depth than SS subjects. Unlike other measurement strategies, cell structures of rosacea from RCM detection are more objective and reliable. Our results of structures obtained from RCM displayed the differences between the rosacea, sensitive skin (SS), and normal skin. Further investigation on the differences of structures from RCM will lead us to better understanding the similarities and differences between rosacea and SS.
对应中文
玫瑰痤疮是一种影响中央面部的慢性炎症性疾病。虽然最近对玫瑰痤疮的诊断、分类和评估进行了指南更新，但目前还没有有效的非侵入性的和客观的皮肤测量方法来评估玫瑰痤疮。玫瑰痤疮患者的皮肤敏感度高于正常人，而玫瑰痤疮和SS又有一些共同的影响因素、发病机制和临床表现。因此，玫瑰痤疮经常被误诊为SS。然而，它们在本质上绝对是不同的疾病，错误的诊断会带来错误的治疗策略、造成更严重的后果。在这项研究中，我们的目的是研究RCM是否可以作为一种无创、可靠和客观的方法来评估和监测玫瑰痤疮。一些研究人员已经揭示了蠕形螨在玫瑰痤疮中的潜在作用；然而，我们倾向于支持蠕形螨是玫瑰痤疮的一种表现，而不是一种必要的诊断因素。通过使用RCM，我们证明玫瑰痤疮患者比对照组存在更多的角化不全、蜂窝状、海绵状水肿和毛乳头。此外，玫瑰痤疮患者的蜂窝状结构深度比SS患者要厚得多。与其他检测策略不同，RCM检测的玫瑰痤疮细胞结构更加客观可靠。我们从RCM获得的结构结果显示了玫瑰痤疮、敏感性皮肤（SS）和正常皮肤之间的差异。进一步研究玫瑰痤疮和SS在结构上的差异，将有助于我们更好地理解玫瑰痤疮和SS之间的异同。
英文原文
There are also some flaws in this study. We have anticipated to distinguish rosacea and SS by using RCM. However, with the excep- tion of a bigger honeycomb structure depth, rosacea has no significant difference with that of SS. It could not be ruled out that small sample size of rosacea has more abnormal qualitative data than SS when comparing with normal controls. We will figure out this question in the future study.
对应中文
本研究也存在一些缺陷。我们期望通过RCM来区分玫瑰痤疮和SS。但除蜂窝状结构深度较大外，玫瑰痤疮与SS无显著差异。与正常对照组相比，不排除小样本玫瑰痤疮比SS有更多的异常定性数据。我们将在未来的研究中解决这个问题。
CONCLUSION
结论
英文原文
In summary, this study provides the cellular-level structures of rosacea by RCM imaging and confirms the importance of the protection function of the epidermis structure. The results are valuable in providing the reference for the diagnosis and treatment of rosacea. Further investigations on the differences of structures from RCM will lead us to better understanding the similarities and differences in their pathophysiology between rosacea and SS.MA et Al.
对应中文
综上所述，本研究通过RCM成像提供了玫瑰痤疮的细胞水平结构，证实了表皮结构保护功能的重要性。研究结果对玫瑰痤疮的诊断和治疗具有一定的参考价值；对RCM结构差异的进一步研究将有助于我们更好地理解玫瑰痤疮和SS在病理生理学上的异同。
REFERENCES
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Ma, Y., Li, L., Chen, J., Chen, T., & Yuan, C. (2020). Distinguishing rosacea from sensitive skin by reflectance confocal microscopy.Skin Research and Technology, 26, 671 – 674.