The association between rosacea and a condition of low-tolerance to skincare of the facial skin: a case-control study in China
Abstract
摘要
英文原文
Background: Patients with rosacea often complained of low-tolerance to skincare.
对应中文
背景：玫瑰痤疮患者经常抱怨对皮肤护理的耐受性低。
英文原文
Aim: To examine if the preexisted low-tolerance to skincare is associated with rosacea the occurrence of the Chinese population.
对应中文
目的：研究中国人群中存在的对护肤品的低耐受性是否与玫瑰痤疮的发生有关。
英文原文
Methods: A retrospective case-control survey of 997 rosacea cases and 1,012 skin-healthy controls was carried out in China. Low-tolerance to skincare was evaluated based on the history of facial skin allergic reactions related to skincare in the past five years before the onset of rosacea. A comparative analysis was performed between the case and control groups by the chi-square test and the logistic regression analysis.
对应中文
方法：对997例玫瑰痤疮患者和1012例皮肤健康对照进行回顾性病例对照调查。根据玫瑰痤疮发病前五年与护肤品相关的面部皮肤过敏反应的病史，评估对护肤品的低耐受性。通过卡方检验和逻辑回归分析对病例组和对照组进行比较分析。
英文原文
Results: History of facial skin allergic reaction due to skin care products (OR=5.110, 95%CI=3.893-6.706) and skin care in beauty salons (OR=3.002, 95%CI=1.506-5.981) both presented a positive correlations with the occurrence of rosacea. Facial masks and cosmetics were two of the most common products causing facial allergic reaction. The OR values increased with the increased frequency of allergic reactions related to facial mask and cosmetics. In addition, the history of facial skin allergic reaction had a significantly associated with the severity of self-reported symptoms of rosacea including dryness, burning, stinging and itching.
对应中文
结果：皮肤护理产品引起的面部皮肤过敏反应史（OR=5.110，95%CI=3.893-6.706）和美容院的皮肤护理史（OR=3.002，95%CI=1.506-5.981）均与玫瑰痤疮的发生呈正相关。面膜和美妆产品是引起面部过敏反应最常见的两种产品。OR值随着与面膜和美妆产品相关的过敏反应的频率增加而增加。此外，面部皮肤过敏反应史与自我报告的玫瑰痤疮症状（包括干燥、灼烧、刺痛和瘙痒）的严重程度显著相关。
英文原文
Conclusions: The condition of low-tolerance of the facial skin to skincare was closely associated with the occurrence of rosacea.
对应中文
结论：面部皮肤对护肤品耐受性低的情况与玫瑰痤疮的发生密切相关。
INTRODUCTION
介绍
英文原文
Rosacea is a common chronic inflammatory facial skin disease which is characterized by transient/persistent centrofacial erythema, telangiectasias, inflammatory papules and pustules, and phymatous changes. Additional to these visible features, patients often suffered self-report symptoms like burning, stinging, dryness and so on.
对应中文
玫瑰痤疮是一种常见的面部慢性炎症性皮肤病，以一过性/持续性面部中心性红斑、毛细血管扩张、炎性丘疹和脓疱及肿块性改变为主要特征。除了这些明显的特征外，患者还经常出现自我报告的症状，如灼热、刺痛、干燥等。
英文原文
The pathogenesis of rosacea is still unclear. Existing studies have shown that the main factors involved in the pathogenesis of rosacea include the immune system, microbes and the cathelicidin axis, neurovascular processes and neurogenic inflammation, and genetics. Furthermore, an accumulating amount of direct and indirect evidence suggests that the destruction of the skin barrier may play an essential role in the pathogenesis of rosacea, which could explain the widely accepted character of the high sensitivity of the facial skin in patients with rosacea. Such patients often complained that they could easily to develop allergic symptoms, even just because applying some skincare products or cosmetics. Interestingly, there were quite a few patients claiming that this situation occurred as early as before the diagnosis of rosacea. Although the allergic symptoms could be fully and quickly alleviated after stopping the exposure, they were easy to reoccur when trying a new product. The recurrent skincare-related skin allergic reactions indicates a condition of low-tolerance to skincare. Some scholars have proposed that there was a stage of “pre-rosacea” before the diagnosis of rosacea, which mainly manifested as facial skin hypersensitivity to multi substances, but there is no epidemiologic evidence could support this point. In view of the fact that skincare products or cosmetics were common substances that the facial skin would be exposed to, we inferred that individuals with the condition of low-tolerance to skincare might have increased risk to develop rosacea. To investigate this potential relationship, we conducted this large-scale case-control study in the Chinese population. Strictly speaking, skin allergy should be referred to as allergic contact dermatitis (ACD), which is defined as a delayed-type hypersensitivity response to contact allergens with symptoms of erythema, edema, itching, or burning. As ACD shares similar clinical signs and symptoms with irritant contact dermatitis (ICD), it is difficult distinguish them without a patch testing. Therefore in this study, skincare-related skin allergic reactions were defined as the allergic symptoms caused directly by skin care products or behaviors including but not limited to allergic or irritant contact dermatitis diagnosed by a physician.
对应中文
玫瑰痤疮的发病机制仍不清楚。现有研究表明，参与玫瑰痤疮发病机制的主要因素包括免疫系统、微生物和中枢轴、神经血管过程和神经源性炎症，以及遗传。此外，越来越多的直接和间接证据表明，皮肤屏障的破坏可能在玫瑰痤疮的发病机制中起着至关重要的作用，这可以解释玫瑰痤疮患者的面部皮肤高度敏感这一被广泛接受的特点。这些患者经常抱怨说，他们很容易出现过敏症状，甚至只是因为使用一些护肤品或美妆产品。有趣的是，有相当多的病人声称这种情况早在诊断玫瑰痤疮之前就已经发生。虽然在停止接触后，过敏症状可以完全迅速缓解，但在尝试新产品时，过敏症状很容易再次出现。反复出现的与护肤品有关的皮肤过敏反应表明了对护肤品的低耐受性状况。有学者提出，在诊断玫瑰痤疮之前有一个 “玫瑰痤疮前期 “的阶段，主要表现为面部皮肤对多种物质过敏，但目前没有流行病学证据可以支持这一观点。鉴于护肤品或美妆产品是面部皮肤会接触到的常见物质，我们推断，对护肤品耐受性低的人可能会增加患玫瑰痤疮的风险。为了研究这种潜在的关系，我们在中国人群中进行了这项大规模的病例对照研究。严格来说，皮肤过敏应该被称为过敏性接触性皮炎（ACD），它被定义为对接触性过敏原的延迟型超敏反应，症状为红斑、水肿、瘙痒或灼热。由于ACD与刺激性接触性皮炎（ICD）有着相似的临床症状和体征，如果不进行斑贴试验，很难将它们区分开来。因此在本研究中，护肤品相关的皮肤过敏反应被定义为由护肤品或行为直接引起的过敏症状，包括但不限于由医生诊断的过敏性或刺激性接触性皮炎。
DISCUSSION
讨论
英文原文
In this study, we identified a close relationship between the skincare-related allergic reaction of the facial skin and the development of rosacea, indicating that the condition of low-tolerance to skincare of the facial skin had a relatively high possibility to progress to rosacea. Our findings can guide clinicians to help patients to improve the patients’ tolerance of the facial skin and prevent it from further developing into rosacea.
对应中文
在这项研究中，我们确定了面部皮肤的皮肤护理相关过敏反应与玫瑰痤疮的发生之间的密切关系，表明面部皮肤对皮肤护理的低耐受性条件有相对较高的发展为玫瑰痤疮的可能性。我们的研究结果可以指导临床医生帮助患者提高面部皮肤的耐受性，防止其进一步发展为玫瑰痤疮。
英文原文
Because of the barrier dysfunction, the facial skin of the patients with rosacea often has a relative lower irritant threshold (IT) or lower tolerance to irritation than that of healthy controls does under the same condition the healthy skin, which means that skin allergic/irritant reactions could occur easily in patients with rosacea. The common triggers of the facial skin were skin care products or cosmetics. Which also can be observed in the frontal fibrosing alopecia. In previous studies, there was a statistical association between alopecia and use of facial sunscreens or antiageing creams. It has been recognized skin care products were potential exacerbants of rosacea. However, a very limited number of studies have investigated if the preexisted low-tolerance to skin care products can increase the risk of the occurrence of rosacea. Our results showed that rosacea patients were more likely to have a history of facial skin allergic reaction due to skincare and tthat the OR value increased with the increase of frequency, implying a very high possibility of evolving into rosacea if a patient suffered recurrent allergic reactions due to skincare. The results provided support to the viewpoint proposed by some scholars that there was a part of “pre-rosacea” before the diagnosis of rosacea, which mainly manifested as facial skin hypersensitivity to multi substances. Confirmation of the linkage between low-tolerance of the facial skin and rosacea may indicate the significance of early diagnosis and prevention of rosacea for individuals with a primary complaint of repeated facial skin allergy/irritation.
对应中文
由于屏障功能障碍，玫瑰痤疮患者的面部皮肤往往比健康对照组在相同条件下的健康皮肤具有相对较低的刺激阈值（IT）或对刺激的耐受性较低，这意味着皮肤过敏/刺激反应可能在玫瑰痤疮患者身上容易发生。面部皮肤的常见诱因是护肤品或美妆产品。这也可以在额叶纤维化脱发症中观察到：在以前的研究中，脱发与使用面部防晒霜或抗衰老霜之间存在着统计学关联。人们已经认识到护肤品是玫瑰痤疮的潜在加重剂。然而，只有非常有限的研究调查了预先存在的对护肤品的低容忍度是否会增加玫瑰痤疮发生的风险。我们的结果显示，玫瑰痤疮患者更有可能有因护肤品引起的面部皮肤过敏反应史，而且OR值随着频率的增加而增加，这意味着如果患者因护肤品而反复出现过敏反应，则演变成玫瑰痤疮的可能性非常大。该结果为一些学者提出的观点提供了支持，即在诊断玫瑰痤疮之前有一部分 “前玫瑰痤疮期”，主要表现为面部皮肤对多种物质的过度敏感。确认面部皮肤的低耐受性与玫瑰痤疮之间的联系，可能表明对以面部皮肤反复过敏/刺激为主要诉求的人来说，早期诊断和预防玫瑰痤疮的意义。
DISCUSSION
讨论
英文原文
Among the possible exposed substances, skin care products were the most common category for the facial skin. Previous studies have discussed a variety of emerging allergens declared the American Contact Dermatitis Society (ACDS) as the allergens of the year, including surfactants, fragrances, preservative and propylene glycol, which were widely used ingredients of skin care products or cosmetics. Based on our results, a variety of skincare products or behaviors might cause facial allergic reactions, specifically, the use of facial mask and makeup products and skincare services in beauty salons were the behaviors involving involving the highest risk of facial allergy/irritation development in China. In addition to inducing an irritant or allergic reaction, some specific sensitizing components could also directly activate the critical inflammatory reactions related to rosacea. For example, the common sensitizing ingredients cinnamaldehyde may trigger inflammatory responses by stimulating TRPA1 (transient receptor potential ankyrin 1), which is an important mediator of rosacea.
对应中文
在面部皮肤可能接触的物质中，护肤品是最常见的类别。先前的研究已经讨论了美国接触性皮炎协会宣布的各种新出现的过敏原（ACDS）作为“年度过敏原”，包括表面活性剂、香料、防腐剂和丙二醇，它们是护肤品或化妆品的广泛使用成分。根据我们的研究结果，各种护肤品或行为可能会引起面部过敏反应，具体而言，美容院提供的面膜、美妆产品以及护肤服务是涉及中国面部过敏/刺激发展的最高风险的行为。除了诱发刺激性或过敏反应外，某些特定致敏成分还可直接激活与玫瑰痤疮相关的关键炎症反应。例如，常见的致敏成分肉桂醛可能通过刺激TRPA1来触发炎症反应，TRPA1是玫瑰痤疮的重要介质。
英文原文
The frequent occurrence of skin allergic/irritant reactions might be mainly attributed to the skin barrier dysfunction mainly, which was developed long before the occurrence of rosacea. On the other hand, potentially-shared immune pathways have been demonstrated for subsets of allergic reaction and rosacea, including Th1 and/or Th17, and the participation of mast cell. Recurrence allergic reactions may lead to a synergistic immune response and exacerbate the barrier dysfunction, which further trigger the onset of rosacea. During this process, barrier dysfunction was an important part, thus it’s easy to understand patients with a history of skin allergy are more likely to suffer much severer self-reported symptoms of rosacea like burning, stinging and dryness, which are also the intrinsic symptoms of skin allergy/irritation. Further studies are needed to explore the effects of skin allergy/irritation on the pathogenesis of rosacea.
对应中文
皮肤过敏/刺激反应的频繁发生可能主要归因于皮肤屏障功能障碍，这种功能障碍早在玫瑰痤疮发生之前就发展起来了。另一方，很多证据都已经证明了过敏反应和玫瑰痤疮亚类潜在的共同免疫途径，包括Th1和/或Th17、以及肥大细胞的参与等。反复过敏反应可能导致协同免疫反应，加重屏障功能障碍，进一步触发玫瑰痤疮的发病。在这个过程中，屏障功能障碍是一个重要的组成部分，因此很容易理解有皮肤过敏史的患者更有可能遭受更严重的玫瑰痤疮症状，如灼热、刺痛和干燥，这些也是皮肤过敏/刺激的内在症状。皮肤过敏/刺激在玫瑰痤疮发病机制中的作用有待进一步研究。
英文原文
Our study was a retrospective case-control investigation, so the recall bias was inevitable and the causal association was weak. Therefore, the outcomes of the condition of low-tolerance to skincare in the control group should be followed up. Secondly, we did not do perform a patch test to distinguish skin allergy from skin irritation, and the self-reported condition was not objective enough. In addition, facial allergy caused by food allergens, inhaled allergens and other contact allergens were not evaluated, as their incidences were enough to be neglected. Last, the history of skin allergy of the whole body was not inquired because of the centrofacial predilection site of rosacea.
对应中文
本研究为回顾性病例对照研究，回忆偏差不可避免、因果联系较弱。因此，对照组对皮肤护理耐受性低的情况应进行随访。其次，我们没有做斑贴试验来区分皮肤过敏和皮肤刺激，而且自我报告的情况不够客观。此外，食物过敏原、吸入性过敏原和其他接触性过敏原引起的面部过敏没有进行评估，因为它们的发病率足以被忽略。最后，没有询问全身皮肤过敏史，因为玫瑰痤疮位于面部中心部位。
英文原文
In conclusion, the condition of low-tolerance of the facial skin to skincare products or behaviors closely related to the development of rosacea. There is a key role for the Demodex mite in this inflammatory process, from the onset of the disease, even when no clinical signs of inflammation are visible. In this inflammatory process, the Demodex mite is Opportunistic infection, and its proliferation as a marker of rosacea. A previous history of intolerance to several skincare or cosmetic products in a patient should act as an alert the of the possibility of rosacea development. For individuals who show a low-tolerance to skin care products, cautions should be taken while trying new facial care products or anti-allergic skincare services. What the sufferers are recommended to do is to accept professional treatment to and enhance the tolerance of skin under the help of dermatologists.
对应中文
综上所述，面部皮肤对护肤品或行为的低耐受性与玫瑰痤疮的发生发展密切相关；蠕形螨在这一炎症过程中起着关键作用，从疾病开始，即使在临床上看不到炎症迹象的情况下也是如此。在这一炎症过程中，蠕形螨是机会性感染，其增殖作为玫瑰痤疮的标志。患者以前对几种护肤品或化妆品不耐受的病史应作为玫瑰痤疮发展的可能性的警示。对于对护肤品耐受性低的个人，在尝试新的面部护理产品或抗过敏护肤品时应谨慎行事。建议患者在皮肤科医生的帮助下接受专业治疗，增强皮肤的耐受性。
REFERENCES
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Deng Z, Yan S, Li J, Yao Y, Li G, Hong Z, Huang Y. The association between rosacea and the condition of low tolerance to skincare of the facial skin: a case-control study in China. J Cosmet Dermatol. 2021 Apr 26. doi: 10.1111/jocd.14178. Epub ahead of print.