Potential role of Demodex mites and bacteria in the induction of rosacea
英文原文
Rosacea is a common dermatological condition that predominantly affects the central regions of the face. Rosacea affects up to 3 % of the world’s population and a number of subtypes are recognized. Rosacea can be treated with a variety of antibiotics (e.g. tetracycline or metronidazole) yet no role for bacteria or microbes in its aetiology has been conclusively established. The density of Demodex mites in the skin of rosacea patients is higher than in controls, suggesting a possible role for these mites in the induction of this condition. In addition, Bacillus oleronius, known to be sensitive to the antibiotics used to treat rosacea, has been isolated from a Demodex mite from a patient with papulopustular rosacea and a potential role for this bacterium in the induction of rosacea has been proposed. Staphylococcus epidermidis has been isolated predominantly from the pustules of rosacea patients but not from unaffected skin and may be transported around the face by Demodex mites. These findings raise the possibility that rosacea is fundamentally a bacterial disease resulting from the over-proliferation of Demodex mites living in skin damaged as a result of adverse weathering, age or the production of sebum with an altered fatty acid content. This review surveys the literature relating to the role of Demodex mites and their associated bacteria in the induction and persistence of rosacea and highlights possible therapeutic options.
对应中文
玫瑰痤疮是一种常见的皮肤病，主要影响面部中央区域。玫瑰痤疮影响着世界上3%的人口，许多亚型已被确认。玫瑰痤疮可以用多种抗生素（如四环素或奥硝唑）治疗，但细菌或微生物在其病因中的作用尚未确定。玫瑰痤疮患者皮肤蠕形螨密度高于对照组，提示这些蠕形螨可能在诱发玫瑰痤疮疾病中起一定作用。此外，从一例丘疹性玫瑰痤疮患者的蠕形螨中分离到对用于治疗玫瑰痤疮的抗生素敏感的芽孢杆菌，并提出了该细菌在诱发玫瑰痤疮中的潜在作用。表皮葡萄球菌主要从玫瑰痤疮患者的脓疱中分离出来，而不是从未受影响的皮肤中分离出来，并可能通过蠕形螨在面部周围传播。这些发现提高了玫瑰痤疮基本上是一种细菌性疾病的可能性，它的发生很可能是生活在皮肤中的蠕形螨过度增殖造成的，因为不利的气候变化、年龄或产生脂肪酸含量改变的皮脂导致皮肤受损。本文综述了蠕形螨及其伴生细菌在玫瑰痤疮的诱导和持续中的作用，并强调了可能的治疗方案。
Rosacea: definition and epidemiology
玫瑰痤疮：定义和流行病学
英文原文
Rosacea is a common chronic inflammatory dermatosis of the face that affects up to 3% of the world’s population. Skin lesions are usually located in the central regions of the face, involving mostly the cheeks, nose and chin. Occasionally, lesions may be found on sunexposed areas such as the neckline, the neck and ears; however, the periocular region often remains lesion-free. The rash is usually symmetrical and may be described according to associated or underlying symptoms of vascular origin (flushing or permanent erythema, telangiectasias or oedema), as well as the presence of papules and pustules, which can develop secondarily. In some patients, hypertrophy of connective tissue and hyperplasia of the sebaceous glands may occur, resulting in the development of phyma. Rosacea usually affects people between the ages of 30 and 50 and is rare in children. Rosacea affects mostly fair-skinned people with Fitzpatrick skin phototypes I and II and is three times more common in women than in men. In men, the disease has a more severe course and men with rosacea have an increased tendency to develop phyma lesions. The standard classification system for rosacea identified four basic stages of the disease: erythematotelangiectatic rosacea (ETR), papulopustular rosacea (PPR), phymatous rosacea, ocular rosacea and one variant rosacea, granulomatous rosacea (GR).
对应中文
玫瑰痤疮是一种常见的面部慢性炎症性皮肤病，影响世界人口的3%。皮肤病变通常位于面部中央区域，主要累及脸颊，鼻子和下巴。有时，在颈部，颈部和耳朵等阳光照射区域可能会发现病变；然而，眼周区域通常保持无病变。皮疹通常是对称的，可以根据血管起源的相关或潜在症状（潮红或永久性红斑，毛细血管扩张或水肿）以及可能继发发展的丘疹和脓疱的存在来描述。有些患者可出现结缔组织肥大和皮脂腺增生，导致肿块的发生。玫瑰痤疮通常影响30到50岁的人，在儿童中很少见。玫瑰痤疮主要影响Fitzpatrick皮肤照片I型和II型的白皮肤人群，女性的玫瑰痤疮发病率是男性的三倍。在男性中，这种疾病的病程更严重，而患有玫瑰痤疮的男性更容易出现肿块病变。玫瑰痤疮的标准分类系统确定了疾病的四个基本阶段：红斑性毛细血管扩张型(ETR)、丘疹脓包型(PPR)、肥大增生型、眼型以及一种变异型玫瑰痤疮-肉芽肿性玫瑰痤疮(GR)。
英文原文
Diagnostic criteria of rosacea include primary features, such as flushing erythema, permanent erythema, papules, pustules and telangiectasias, the presence of which on the convexities of the face justifies the diagnosis of rosacea, and secondary features, such as the feeling of burning or tingling of the skin, oedema, the presence of tarsus, dryness of the skin, ocular symptoms, lesions outside the face and hyperplastic changes, which aid the diagnostic process.
对应中文
玫瑰痤疮的诊断标准包括主要特征，如红斑、永久性红斑、丘疹、脓疱和毛细血管扩张，面部凹凸处存在以上病变，证明玫瑰痤疮的诊断是正确的；次要特征，如皮肤灼热感或刺痛感、水肿、有睑板、皮肤干燥、眼部症状、面部以外病变和增生性改变，有助于诊断。
Aetiopathogenesis
病因病机
英文原文
The aetiopathogenesis of rosacea remains unexplained, as the pathogenic mechanisms that lead to the development of the skin lesions have not yet been fully elucidated. Possible factors responsible for rosacea may include autoimmune dysregulation, vascular disorders, external factors, degeneration of connective tissue elements, functional disorders of the pilosebaceous unit, nutritional and chemical factors and infectious factors. Over a significant period of time, there have been numerous attempts to connect the etiopathogenesis of rosacea with the presence of some micro-organisms on or within the skin, including Demodex mites and bacteria. It is well established that there is a higher density of Demodex mites in the skin of rosacea patients than control patients but the significance of this has been disputed. This review will explore the current understanding of the role of these organisms in the induction of rosacea.
对应中文
玫瑰痤疮的病因和发病机制尚不清楚，因为导致皮肤病变的发病机制尚未完全阐明。玫瑰痤疮的可能因素包括自身免疫失调、血管疾病、外部因素、结缔组织成分退化、毛皮脂腺单位功能紊乱、营养和化学因素以及感染因素。在相当长的一段时间内，人们曾多次尝试将玫瑰痤疮的病因与皮肤上或皮肤内存在的某些微生物联系起来，包括蠕形螨和细菌。众所周知，玫瑰痤疮患者皮肤中蠕形螨的密度高于对照组患者，但其重要性一直存在争议。这篇综述将探讨目前对这些微生物在玫瑰痤疮诱导中的作用的理解。
Demodex mites
蠕形螨
英文原文
There are more than 100 species of Demodex mites (class Arachnida, subclass Acarina) and all are highly specialized, host-specific obligatory commensals of mammals. Various kinds of Demodex mites may infest the skin of the host, depending on the preferred area on the skin. In many cases, mite infestation is asymptomatic and their role remains unclear. The pathogenic role of Demodex mites is well-documented in dogs where Demodex canis causes demodicosis – a serious, potentially fatal disease connected with numerous skin and ocular symptoms.
对应中文
蠕形螨（蛛形纲，螨亚纲）共有100多种，均为高度专门化、宿主特异性的哺乳动物寄生群落。不同种类的蠕形螨可能寄生在宿主的皮肤上，这取决于它们皮肤上的偏好区域。在许多情况下，螨虫感染是无症状的，它们（在人类皮肤寄生）的作用仍然不清楚。（相较人类）犬蠕形螨的致病作用已被充分证明，犬蠕形螨会导致犬蠕形螨病，这是一种严重的、可能致命的疾病，与许多皮肤和眼部症状有关。
英文原文
Human skin may be inhabited by two species of Demodex mites and both have a worm-like shape and are covered by a thin cuticle. The larger species, Demodex folliculorum, is about 0.3–0.4 mm long, has an elongated shape and resides in hair follicles in a cluster consisting of several mites. The smaller species, Demodex brevis, is about 0.2–0.3 mm long, has a spindle shape, shorter legs and resides solitarily in the sebaceous or meibomian glands. As D. brevis inhabits the deep parts of the skin, it is difficult to extract it without tearing of tissue. Due to the fact that the main food sources for mites in all phases of the development are epidermal cells and sebum components, they reside in skin areas particularly rich in sebaceous glands, such as the face-especially the nose, cheeks, forehead and chin. They may also be found in the external auditory canal, on the chest and in the genital area.
对应中文
人类皮肤可能居住着两种蠕形螨，它们都有蠕虫状的形状，并被一层薄薄的角质层覆盖。毛囊蠕形螨体积较大，长约0.3-0.4mm，呈细长状，居住在毛囊中，由几种螨类组成一簇毛囊。皮脂蠕形螨体积较小，长约0.2-0.3mm，呈纺锤形，腿较短，独居于皮脂腺或睑板腺中。由于皮脂蠕形螨栖息在皮肤的深处，如果不撕裂组织，很难将其提取出来。由于螨类在发育的各个阶段的主要食物来源是表皮细胞和皮脂成分，它们居住在皮脂腺特别丰富的皮肤区域，如面部-特别是鼻子、脸颊、额头和下巴。它们也可能存在于外耳道、胸部和生殖器区域。
The ultrastructure of Demodex mites
蠕形螨的超微结构
英文原文
The gnathosoma, comprising the mouth and feeding parts, is located in the anterior portion of the Demodex body, the rest of the body consists of prosoma and opisthosoma. The gnathosoma of D. folliculorum has sharp, stylet-like chelicerae, more developed than those of D. brevis, which are used to cut and take food, and pedipalps, which are used to hold the food. Both species have four pairs of legs in the prosoma. Demodex mites use the chelicerae to cut the epithelial cells of the host skin, secrete lytic enzymes for pre-oral digestion and evacuate liquid cytoplasm components. In the process of destroying the epithelial cells, the epithelial barrier is often disturbed and the mite penetrates into the dermis stimulating Toll-like receptors (TLR) . Proteolytic enzymes (proteases) are among the digestive enzymes secreted by Demodex mites. Concrements of serum immunoglobulin IgD and two inhibitors of serum proteases (a-1-antitrypsin and a-1-antichymotrypsin), which might be a specific defensive reaction of the host against mites, have been detected on the surface of Demodex mites. In atopic dermatitis, proteases produced by house dust mites have been identified as the factor responsible for local skin irritation.
对应中文
颚状体位于蠕形螨身体的前部，由口部和进食部分组成，其余部分由前体细胞和后体细胞组成。毛囊蠕形吸虫的颌口有锋利的口针状的螯节，比用于切割和取食的短须蠕虫和用来盛放食物的足趾要发达得多。两个物种的前肢中都有四对腿。蠕形螨利用螯肢切割宿主皮肤上皮细胞，分泌溶酶用于口腔前消化和排泄细胞质液体成分。在破坏上皮细胞的过程中，上皮屏障常被破坏，螨穿透真皮刺激toll样受体(TLR)。蛋白酶是蠕形螨分泌的消化酶之一。在蠕形螨表面检测到血清免疫球蛋白IgD和血清蛋白酶抑制剂(a-1-抗胰蛋白酶和a-1-抗糜蛋白酶)，可能是宿主对螨特异性防御反应的结果。在特应性皮炎中，由室内尘螨产生的蛋白酶已被确定为局部皮肤刺激的因素。
Demodex life cycle
蠕形螨生命周期
英文原文
In all phases of their life cycle, Demodex mites avoid sunlight. They emerge from the pilosebaceous units at night and migrate across the surface of the skin to find a mating partner, travelling at a speed of about 16 mm/h. The life cycle of Demodex mites consists of five phases of development and lasts from 14 to 18 days. The copulation takes place near the entry of the hair follicle. Afterwards, the gravid female moves to the inside of the sebaceous gland, where she deposits eggs, from which the larvae will emerge about 60 h later. Protonymphs and nymphs are the next phases of the Demodex life cycle.
对应中文
在生命周期的各个阶段，蠕形螨都避免阳光照射。它们在夜间从毛皮脂腺单元中出现，并以16mm/h的速度穿过皮肤表面迁移以寻找伴侣。蠕形螨的生命周期包括五个发展阶段，持续14到18天。交配发生在毛囊入口附近。之后，怀孕的雌性移到皮脂腺内侧，在那里产卵，大约60小时后幼虫将从中出现。原虫和若虫是蠕形螨生命周期的下一个阶段。
英文原文
Due to the fact that Demodex mites are obligate parasites of the pilosebaceous units and highly susceptible to desiccation, they are not capable of surviving for long periods outside the host. Routes of transmission are not fully known but it may occur by direct contact as well as through dust. While the skin of new-borns is free of Demodex folliculorum, colonization of the skin in humans takes place in childhood or early adulthood. Demodex mites are found in representatives of all human races and in all geographical areas.
对应中文
由于蠕形螨是毛囊皮脂腺单位的专性寄生虫，高度易受感染，因此它们无法在宿主之外长期存活。传播途径尚不完全清楚，但可能通过直接接触和灰尘传播。虽然新生儿的皮肤没有毛囊蠕形螨，但蠕形螨定植人类的皮肤发生在儿童或成年早期。蠕形螨存在于所有人类种族和所有地理区域的代表中。
Role of Demodex mites in human skin disease
蠕形螨在人类皮肤病中的作用
英文原文
Demodex mites were originally perceived to be commensals, having a symbiotic relationship with the human host. However the opinion about the role of Demodex in pathogenesis of many diseases, including rosacea has been changing. In some specific conditions in the host system, Demodex mites may become potential pathogens. This may happen when the immunological conditions of the host change and new environmental conditions on the skin facilitate the development of Demodex mites.
对应中文
蠕形螨最初被认为是正常的存在，与人类宿主有共生关系，但关于蠕形螨在包括玫瑰痤疮在内的许多疾病发病机制中的作用的观点正在发生变化。在宿主系统的某些特定条件下，蠕形螨可能成为潜在的病原体。这可能发生在宿主的免疫学条件改变和皮肤上新的环境条件促进蠕形螨的发展时期。
英文原文
There are certain differences in distribution on the skin between the two species of Demodex mites found in the human population. D. folliculorum counts are notably higher but D. brevis inhabits a larger area of the human body. The proportion of D. brevis to D. folliculorum also differs among men (1 : 4, respectively) and women (1 : 10) . D. folliculorum is more often associated with erythema and epithelial desquamation, whereas D. brevis is linked with papulopustular eruption, symmetrical rashes and conditions arising on the background of a pre-existing disease.
对应中文
两种蠕形螨在人群皮肤上的分布有一定的差异。毛囊蠕形螨数量明显较高，但皮脂蠕形螨寄生在人体更大的区域。皮脂蠕形螨与毛囊蠕形螨的比例在男性和女性之间也有所不同(分别为1:4和1:10)。毛囊蠕形螨通常与红斑和上皮脱落有关，而皮脂蠕形螨则与丘疹-脓疱疹、对称性皮疹和已有疾病背景下产生的条件有关。
英文原文
The extent of Demodex colonization in the human population is high (20–80%), reaching 100% in elderly people.Mite density starts to rise in the sixth decade of life and stays at the same level until the eighth decade of life. Mite density is very low in young adults, even though their levels of sebum production, a potential source of food for mites, are very high. Patients with papulopustular rosacea produce sebum with an altered fatty acid profile, suggesting that the nature of the sebum, rather than its quantity, may favour the development of Demodex mites. This finding raises the possibility that non-antibiotic therapies to restore the normal fatty acid composition of sebum may improve skin integrity and inhibit the proliferation of Demodex mites.
对应中文
蠕形螨在人群中的定殖率很高(20-80%)，在老年人中达到100%。螨密度在60岁时开始上升，直到80岁时保持在同一水平。年轻成年人的螨虫密度非常低，尽管他们的皮脂生产水平非常高，皮脂是螨虫的一种潜在食物来源。丘疹脓疱性玫瑰痤疮患者产生的皮脂脂肪酸分布改变表明皮脂的性质而不是其数量，可能有利于蠕形螨的发展。这一发现提高了非抗生素疗法恢复皮脂正常脂肪酸组成可能改善皮肤完整性和抑制蠕形螨增殖的可能性。
英文原文
Due to the fact that Demodex mites are commonly found in healthy individuals and the density of mites is generally low, the presence of mites on the skin is not enough to determine pathogenicity. An increase in mite density on facial skin is observed in perioral dermatitis, caused by long-term use of local steroids or other immunomodulating drugs. Higher numbers of Demodex mites have been noted in patients undergoing immunosuppressive therapy, for example children receiving chemotherapy for leukaemia, patients with HIV-infection or AIDS and chronic dialysis patients.
对应中文
由于蠕形螨在健康人群中普遍存在，且螨类密度普遍较低，皮肤上的螨类不足以确定致病性。在长期使用局部类固醇或其他免疫调节药物引起的口周皮炎中，可以观察到面部皮肤上螨虫密度的增加。在接受免疫抑制治疗的患者中发现了数量较多的蠕形螨，例如接受白血病化疗的儿童、艾滋病毒感染或获得性免疫缺陷综合征患者和慢性透析患者。
英文原文
A positive correlation between high density of Demodex mites and the presence of antigens affecting tissue compatibility, HLA Cw2 and Cw4, has been established. Furthermore, increased numbers of mites have been associated with a higher tendency of leukocytes to undergo apoptosis. Such a genetically conditioned decreased immune performance may result in local immuno-suppression and so facilitate survival and replication of Demodex mites.
对应中文
蠕形螨的高密度与影响组织相容性的抗原HLACW2和CW4的存在呈正相关。此外，螨类数量的增加与白细胞凋亡的趋势更高有关。这种遗传条件下的免疫性能下降可能导致局部免疫抑制，从而促进蠕形螨的生存和复制。
英文原文
Ayres & Anderson first suggested a correlation between the presence of Demodex mites on the skin and development of various skin lesions. They described a disease entity which they named ‘pityriasis folliculorum’ and associated its development with the presence of D. folliculorum mites. Pityriasis folliculorum is characterized by small, follicular, scaling papules, the feeling of skin dryness and pruritus. Lesions in pityriasis folliculorum are usually unilateral, located mainly on the cheeks, but may also reach the eyelids. Ayres & Ayres identified a new disease entity, rosacea-like demodicosis, caused by the presence of abundant D. folliculorum mites and characterized by erythema, dryness and fine follicular scaling. Later research proved pityriasis folliculorum to be a form of demodicosis, and the most frequent one (54 %), but so discrete and unfamiliar that it was often not diagnosed. Demodicosis is characterized by discrete symptoms of erythema, higher densities of Demodex mites per cm2 in comparison to papulopustular rosacea, and is primarily a disease of the elderly or immunocompromised. A compromised immune system is thought to enable such proliferation of Demodex mites in cases of pityriasis folliculorum.
对应中文
Ayres & Anderson首先提出了皮肤上蠕形螨的存在与各种皮损的发展之间的相关性。他们描述了一种名为“毛囊糠疹”的疾病实体，并将其发展与毛囊蠕形螨的存在联系起来。毛囊糠疹的特点是小的、滤泡状的、鳞状丘疹，且患者感觉皮肤干燥和瘙痒。毛囊糠疹的病变通常是单侧的，主要位于脸颊，但也可能到达眼睑。Ayres & Ayres发现了一种新的疾病实体，酒渣样蠕形虫病，由大量毛囊螨的存在引起，特征是红斑、干燥和细滤泡脱落。后来的研究证实，毛囊糠疹是一种蠕形虫病，是最常见的一种(54%)，但由于其离散性和不熟悉性，常常未被诊断。蠕形螨病的特征是红斑的离散症状，与丘疹脓疱性玫瑰痤疮相比，每平方厘米蠕形螨密度更高，主要是老年人或免疫功能低下的疾病。在毛囊糠疹病例中，免疫系统受损被认为是导致蠕形螨增殖的原因。
英文原文
The mean density of Demodex mites on the skin of rosacea patients is 10.8 mites per cm2 in comparison to 0.7 mites per cm2 in healthy people. However, when all types of rosacea are taken into account, statistically larger mite densities per cm2 are found in cases of papulopustular rosacea. Other diseases in which infestation with Demodex mites is believed to be the aetiological factor include blepharitis and, in one case, hair loss described in a 6-year-old boy.
对应中文
玫瑰痤疮患者皮肤蠕形螨平均密度为10.8只/cm²，健康人为0.7只/cm²。然而，当考虑到所有类型的玫瑰痤疮时，在丘疹性角化症的病例中，每平方厘米的线粒体密度在统计学上更大。其他被认为是蠕形螨感染所致的疾病包括睑缘炎和一例6岁男孩中发现的脱发。
英文原文
Histopathological examination of skin specimens obtained from control patients revealed the presence of Demodex mites in 10 % of all facial skin biopsies and in 12 % of all pilosebaceous units. Skin specimens with histological features of folliculitis revealed that D. folliculorum mites were found in 42 % of inflamed and only 10 % of non-inflamed follicles. Overall, 83 % of all affected follicles demonstrated features of inflammation. However, whether D. folliculorum causes folliculitis or simply inhabits inflamed follicles remains unclear. In a study conducted in patients with papulopustular rosacea, the presence of D. folliculorum in follicle secretions was found in 90.2 % of patients and only 11.9 % of control samples. Additionally, histopathological examination of skin obtained from these patients revealed that the presence of Demodex mites was connected with severe perifollicular lymphocytary infiltration.
对应中文
对照组患者皮肤标本的组织病理学检查显示，10%的面部皮肤活检和12%的毛囊皮脂腺单位有蠕形螨的存在。具有毛囊炎组织学特征的皮肤标本显示，在42%的炎症毛囊中发现毛囊蠕形螨，而在10%的非炎症毛囊中发现毛囊蠕形螨。总的来说，83%的受累毛囊表现出炎症特征。然而，毛囊蠕形螨是引起毛囊炎还是仅仅寄生于发炎的毛囊仍不清楚。在一项针对丘疹脓疱型玫瑰痤疮患者的研究中，在90.2%的患者的毛囊分泌物中发现了毛囊蠕形螨，而在对照组中只有11.9%。此外，对这些患者的皮肤进行组织病理学检查发现蠕形螨的存在与严重的滤泡周围淋巴细胞浸润有关。
Role of Demodex mites in human skin disease
蠕形螨在人类皮肤病中的作用
英文原文
It seems that the presence of Demodex mites within the skin is more important than their presence on the skin and dermal symptoms occur when mites residing in hair follicles penetrate into the surrounding tissues. Most probably, when Demodex mites breach the epithelial barrier, their antigens influence the immune system of the host and induce a type IV hypersensitivity reaction. Demodex mites may then be attacked by giant cells giving rise to dermal granulomas, which are most often observed in granulomatous acne rosacea. Granulomas are also found in skin biopsies of patients with papulopustular rosacea and even in patients with erythematous rosacea.
对应中文
似乎皮肤内的蠕形螨的存在比它们在皮肤上的存在更重要，当寄生在毛囊中的螨虫渗透到周围组织时，就会出现真皮症状。最有可能的是，当蠕形螨突破上皮屏障时，它们的抗原会影响宿主的免疫系统，并诱发IV型超敏反应。然后，蠕形螨可能被巨噬细胞攻击产生真皮肉芽肿，这是最常见的肉芽肿型玫瑰痤疮。在丘疹脓疱型玫瑰痤疮患者甚至红斑型玫瑰痤疮患者的皮肤活检中也发现肉芽肿。
英文原文
The causal relationship of Demodex mites in skin lesions has been suspected to occur through several mechanisms. They may mechanically block the follicles, leading to distension and causing intra-follicular hyperkeratosis. The presence of mite’s chitinous external skeleton may act like a foreign body and contribute to the formation of granulomas. The waste products of Demodex mites and/or associated bacteria may activate the elements of innate immune system or stimulate the immune system through the mechanism of delayed hypersensitivity reaction.
对应中文
皮肤损伤中蠕形螨的功能可能是通过多种机制导致皮肤损伤发生。它们可能机械性地阻塞卵泡，导致扩张并导致卵泡内过度角化。蠕形螨几丁质外骨骼的存在可能像异物一样，促进肉芽肿的形成。蠕形螨和/或相关细菌的废弃物可能通过延迟超敏反应的机制激活先天免疫系统成分或刺激免疫系统。
Potential role of Bacillus oleronius in rosacea
油状芽孢杆菌在玫瑰痤疮中的潜在作用
英文原文
Recent examination of patients with blepharitis has provided further evidence on the pathogenic role of B. oleronius. The severity of the disease did not correspond with an increased number of Demodex mites per lash, with the exception of the five most severe cases, where greater numbers of mites were observed. Statistically significant differences in B. oleronius incidence rates were found between patients with severe disease and healthy controls. This might indicate that Demodex mites constitute an independent pathogenic factor of blepharitis and the B. oleronius bacteria, carried by the mites, most probably play a role as a copathogen in the development of more severe forms of blepharitis.
对应中文
最近对眼睑炎患者的检查进一步证实了油性芽孢杆菌的致病作用。该疾病的严重程度与每根睫毛蠕形螨数量的增加并不对应，但五个最严重的病例除外、这几个病例中睫毛处都观察到更多的螨虫。重症患者与健康对照组的油状芽孢杆菌发病率差异有统计学意义。这可能表明蠕形螨是眼睑炎的独立致病因素，其携带的油状芽孢杆菌很可能是较严重睑缘炎的共同致病因素。
Role of Staphylococcus epidermidis in rosacea
表皮葡萄球菌在玫瑰痤疮中的作用
英文原文
Staphylococcus epidermidis has been isolated from the pustules of 9 out of 15 patients with papulopustular rosacea, whereas this bacterium was not detected on unaffected areas of the skin. S. epidermidis was also isolated from the eyelid margins of 4 out of 15 patients with papulopustular rosacea, whereas no pure growth was isolated from the eyelids of ageand sex-matched control subjects. The same study also found that this bacterium was susceptible to antibiotics commonly used to treat rosacea. Facial erythema and increased blood flow in the skin of those with rosacea causes the temperature of the skin to become elevated. Dahl et al. found that S. epidermidis secreted more proteins when cultured at 37 uC than at 30 uC and that isolates from rosacea patients’ skin were consistently b-haemolytic, whereas isolates from control subjects were non-haemolytic. Demodex mites have been shown to transport bacteria around the face so the possibility remains that S. epidermidis, along with other bacteria, are moved to areas which favour their proliferation.
对应中文
从15名丘疹型玫瑰痤疮患者中的9名患者的脓疱中分离出表皮葡萄球菌，而在未感染的皮肤部位未检测到这种细菌。在15例丘疹型玫瑰痤疮患者中有4例从眼睑边缘分离到表皮葡萄球菌，而在年龄和性别匹配的对照组患者眼睑中没有分离到纯生长。同一项研究还发现，这种细菌对通常用于治疗玫瑰痤疮的抗生素很敏感。玫瑰痤疮患者面部红斑和皮肤血流增加会导致皮肤温度升高。Dahl等人发现，表皮葡萄球菌在37℃培养时比在30℃培养时分泌更多的蛋白质，玫瑰痤疮患者皮肤的分离物始终具有溶血性，而对照受试者的分离物则不具有溶血性。已证明蠕形螨可在面部周围传播细菌，因此表皮葡萄球菌与其他细菌一起转移到有利于其增殖的区域的可能性仍然存在。
Conclusion
结论
英文原文
Rosacea is a complex disease entity of disputed aetiology. The literature offers numerous arguments supportive of the theory that rosacea is primarily connected with compromised immunity. According to this theory, on the skin of healthy, immune-competent individuals, the proliferation of Demodex mites is kept under control. In the first stage of rosacea, studied by investigators of the clinical form of pityriasis folliculorum, no inflammation is observed, despite the presence of a large number of Demodex mites. This is probably caused by an unidentified, genetic defect of the innate immunity and/or the localized immunosuppressive influence of the mites. In the later stages of the disease, characterized by developed rosacea, there is an overstimulated reaction of the immune system, which includes elevated levels of serine proteases, kallikrein (KLK5), the presence of abnormal forms of cathelicidins (with lower anti-bacterial potential) and increased expression of Toll-like 2 receptors (TLR 2), which stimulate the calcium-dependent production of kallikrein.
对应中文
玫瑰痤疮是一种病因有争议的复杂疾病。文献提供了大量的论据来支持玫瑰痤疮主要与免疫力下降有关的理论。根据这一理论，在健康、免疫能力强的个体皮肤上，蠕形螨的增殖得到了控制。在研究毛囊糠疹临床形态的研究者研究玫瑰痤疮的第一阶段，尽管存在大量的蠕形螨，但没有观察到炎症。这可能是由先天免疫和/或局部免疫抑制影响的一种未知的遗传缺陷引起的。进一步发展的玫瑰痤疮，在疾病的后期，有一个过度刺激免疫系统的反应，其中包括高浓度的丝氨酸蛋白酶、激肽释放酶(KLK5)、异常存在形式的抗菌肽(抗菌潜力较低)和toll样2受体表达增加(TLR – 2)等，刺激钙依赖激素的产生。
英文原文
Such immunological conditions favour the development of different types of micro-organisms, including Demodex mites. Other characteristic features of rosacea patients, such as increased vascularization and elevated temperature, may further promote the growth of the organisms. Developing Demodex mites may be causative agents of rosacea through various mechanisms: they may mechanically block hair follicles, secrete digestive enzymes, destroy the epithelial barrier or trigger reactions of the immune system.
对应中文
这种免疫条件有利于不同类型微生物的发育，包括蠕形螨。玫瑰痤疮患者的其他特征，如血管生成增加和温度升高，可能进一步促进生物体的生长。蠕形螨的发育可能通过各种机制引起玫瑰痤疮：它们可能机械地阻塞毛囊，分泌消化酶，破坏上皮屏障或触发免疫系统反应。
英文原文
It is believed that B. oleronius forms a symbiotic relationship with Demodex, as it does in the termite. On the skin of humans, this bacterium may occur in the endospore form, which enters the digestive tract of Demodex mites when they consume epithelial cells. The dead mites then decompose inside the hair follicles, where they release significant numbers of bacterial antigens, which have the potential to stimulate a strong immune response. Thus, the intensification of blepharitis and rosacea, especially the papulopustular variant, may not be induced so much by the presence of the mites alone but by the presence of Demodex mites that carry B. oleronius in their digestive tract. Empirically confirmed sensitivity of B. oleronius to different antibiotics, especially doxycycline, might explain the favourable therapeutic effect of the drug in diseases such as rosacea and blepharitis.
对应中文
研究认为，人类皮肤的油状芽孢杆菌与蠕形螨存在共生关系，跟在白蚁中情况一样。在人的皮肤上，这种细菌可能以内芽孢的形式出现，当蠕形螨消耗上皮细胞时，它进入消化道。螨虫死亡后在毛囊内分解，在那里释放大量的细菌抗原，这些抗原有可能刺激强烈的免疫反应。因此，眼睑炎和玫瑰痤疮的加重，尤其是丘疹脓疱变异，可能不是由螨虫的单独存在，而是由在其消化道携带油状芽孢杆菌的蠕形螨的存在引起的。经实验证实，油状芽孢杆菌对多种抗生素尤其是强力霉素敏感，这可能解释了强力霉素对玫瑰痤疮、眼睑炎等疾病有良好的治疗效果。
英文原文
The pathogenic role of Demodex mites, as well as B. oleronius and S. epidermidis, in the induction and persistence of rosacea remains an unresolved issue. The lack of an immunological response to Demodex mites in healthy skin raises the possibility of localized immunosuppression, facilitating the survival of the mite. Hopefully, the results of further research will bring us closer to understanding the role of microbes in the pathogenesis of rosacea and assist in the development of new and more effective therapies for the treatment of this disfiguring disease.
对应中文
和油性芽孢杆菌、表皮葡萄球菌一样，蠕形螨在玫瑰痤疮诱导和持续中的致病作用仍是一个未解决的问题。在健康皮肤中对蠕形螨缺乏免疫应答，增加了局部免疫抑制的可能性，促进了螨虫的生存。希望进一步的研究结果将使我们更深入地了解微生物在玫瑰痤疮发病机制中的作用，并帮助开发新的和更有效的治疗这种畸形疾病的治疗方法。
REFERENCES
1.Jarmuda S, O’Reilly N, Żaba R, Jakubowicz O, Szkaradkiewicz A, Kavanagh K. Potential role of Demodex mites and bacteria in the induction of rosacea. J Med Microbiol. 2012;61(Pt 11):1504-1