Rosacea pathogenesis, common triggers, and dietary role: The cause, the trigger, and the positive effects of different foods
Abstract
摘要
英文原文
Rosacea is a common chronic inflammatory cutaneous disorder, primarily manifesting on the cheeks, nose, chin, and forehead with a classic relapsing-remitting course that affects mostly fair skin types (Fitzpatrick I and II). The pathogenesis remains unclear, but the complex interplay between environmental and genetic factors may augment the innate immune response and neurovascular dysregulation. Different nutrients may play a role in the pathogenesis of rosacea. Many dietary triggers, including hot beverages, alcohol, spicy foods, caffeine, vanilla, cinnamon, niacin, marinated meats, and dairy products, have been postulated for this disease; however, there is a lack of well-designed and controlled studies evaluating the causal relationship between rosacea and dietary factors. We have explored the available evidence and hypotheses based on trigger-food categories of rosacea, the role of the skin-gut microbiome axis, and potentially benefiting dietary factors such as probiotics, prebiotics, and high-fiber diets.
对应中文
玫瑰痤疮是一种常见的慢性炎症性皮肤病，主要表现在脸颊、鼻子、下巴和额头，典型的复发-缓解过程主要影响白皙的皮肤类型(Fitzpatrick I型和II型)。发病机制尚不清楚，但环境因素和遗传因素之间复杂的相互作用可能会增强先天免疫反应和神经血管失调。不同的营养素可能在玫瑰痤疮的发病机制中起作用。许多饮食诱因，包括热饮料、酒精、辛辣食物、咖啡因、香草、肉桂、烟酸、腌制肉类和乳制品，都被认为是这种疾病的诱因；然而，缺乏良好设计和对照的研究来评估玫瑰痤疮和饮食因素之间的因果关系。我们根据玫瑰痤疮的触发食物类别、皮肤-肠道微生物群轴的作用，以及益生菌、益生元和高纤维饮食等潜在的饮食因素，探索了现有的证据和假设。
Background
背景
英文原文
Rosacea is a common chronic inflammatory cutaneous disorder, primarily manifesting on the cheeks, nose, chin, and forehead with a classic relapsing-remitting course.
对应中文
玫瑰痤疮是一种常见的慢性炎症性皮肤病，主要表现在面颊、鼻子、下巴和前额，具有典型的复发-缓解过程。
英文原文
Rosacea affects approximately 5% of the adult population with onset usually after the third decade of life. The typical patient is a middle-aged woman with fair skin type and Northern European or Celtic ancestry.The primary clinical hallmarks are flushing, persistent facial erythema, telangiectasias, inflammatory papules, and pustules. Secondary features include burning or stinging, dry appearance, scaling, edema of the face, and phymatous changes.Ocular involvement can be found in more than 50% of patients and may present as dryness, irritation, blepharitis, conjunctivitis, or keratitis. Rosacea subtypes include erythematotelangiectatic rosacea, papulopustular rosacea, phymatous rosacea, and ocular rosacea.There may be overlap among the subtypes. A patient may have simultaneous occurrence of more than one subtype, and one subtype may progress to another, although this idea remains controversial. The exact pathogenesis and pathophysiology of rosacea remain incompletely characterzed; however, it is widely accepted that genetic and environmental factors such as diet can trigger initiation and worsening of this condition mainly through dysregulation of the immune system leading to proinflammatory cytokine production and antimicrobial peptides, including cathelicidin, kallikrein 5, and LL-37.
对应中文
玫瑰痤疮影响大约5%的成年人，通常在30岁后发病。典型的患者是中年女性、皮肤白皙、有北欧或凯尔特血统。主要临床特征为潮红、持续性面部红斑、毛细血管扩张、炎性丘疹和脓疱。次要特征包括烧灼或刺痛、外观干燥、脱屑、面部水肿和肿块样改变。超过50%的患者眼部受累，可能表现为干燥、刺激、眼睑炎、结膜炎或角膜炎。玫瑰痤疮亚型包括红斑性玫瑰痤疮、丘疹脓疱性玫瑰痤疮、瘤性玫瑰痤疮和眼部玫瑰痤疮。子类型之间可能存在重叠。一名患者可能同时出现多个亚型，一个亚型可能发展为另一个亚型，尽管这一观点仍有争议。玫瑰痤疮的确切发病机制和病理生理学尚不完全清楚；然而，人们普遍认为，遗传和环境因素（如饮食）主要通过免疫系统失调导致促炎细胞因子和抗菌肽的产生，包括抗菌肽、激肽释放酶5、LL-37，从而触发该疾病的发生和恶化。
Dietary role and common food triggers
饮食作用和常见的食物诱因
英文原文
The influence of nutrition on dermatologic disorders has been postulated and explored. Different nutrients may play a role in the pathogenesis of rosacea.Many dietary triggers for rosacea have been postulated, including hot beverages, alcohol, spicy foods, caffeine, vanilla, cinnamon, niacin, marinated meats, and dairy product.Identifying and avoiding dietary trigger factors may help someone avoid flare-ups; however, there is a lack of well-designed and controlled studies evaluating the relationship between rosacea and dietary factors. We explore the available evidence based on trigger categories below.
对应中文
营养对皮肤病的影响已经被假设和探索，不同的营养素可能在玫瑰痤疮的发病机制中起作用。玫瑰痤疮的诱因很多，包括热饮料、酒精、辛辣食物、咖啡因、香草、肉桂、烟酸、腌肉和乳制品。识别和避免饮食触发因素可能有助于避免突发事件；然而，缺乏设计良好的对照研究来评估玫瑰痤疮与饮食因素之间的关系。我们将根据以下触发类别探讨可用证据。
Heat
热
英文原文
Hot beverages and foods could be a common trigger for rosacea patients. Heat causes direct vasodilation and stimulates the transient receptor potential vanilloid member 1 (TRPV1) cation channels implicated in flushing, stinging sensation, and sensitive skin.Repeated and prolonged exposure to heat can directly induce vasodilation, which leads to initiation or exacerbation of rosacea.Based on this mechanism, patients may potentially benefit from avoiding consumption of hot drinks.
对应中文
热饮料和食物可能是玫瑰痤疮患者的常见诱因。热可引起直接的血管扩张，并刺激瞬时受体电位香草酸(TRPV1)阳离子通道，该阳离子通道与潮红、刺痛感和敏感皮肤有关。反复和长期暴露在高温下可直接导致血管扩张，从而导致玫瑰痤疮的发生或加重。基于这一机制，患者可能从避免饮用热饮料中获益。
Caffeine
咖啡因
英文原文
The relationship between the risk of rosacea and caffeine intake (coffee, tea, or soda) is poorly understood. Caffeine decreases vasodilation through its sympathomimetic induction on renin-angiotensin aldosterone system and has antioxidant and immunosuppressant effects that can potentially reduce the aberrancy of the altered immune system in rosacea.A study on a large cohort of women (4,945 cases) from the Nurses’ Health Study II demonstrated that increased caffeine intake from coffee but no other sources was inversely associated with the risk of incident rosacea, not supporting limiting caffeine intake as a means to prevent rosacea.
对应中文
人们对玫瑰痤疮风险和咖啡因摄入量（咖啡、茶或汽水）之间的关系知之甚少。咖啡因通过对肾素-血管紧张素醛固酮系统的交感神经诱导来减少血管扩张，并具有抗氧化和免疫抑制作用，潜在地可以减少中改变的免疫系统的畸变。《护士健康研究II》中一项针对大量女性（4945例）的研究表明，从咖啡中增加咖啡因摄入（但没有其他来源）与玫瑰痤疮发病风险呈负相关，结果并不支持采用限制咖啡因摄入作为玫瑰痤疮预防手段。
Alcohol
酒精
英文原文
Alcohol induces peripheral vasodilation, promotes inflammation and oxidative stress, modulates the immune system, and is also associated with alterations in the gut microbiome.Its breakdown products, acetaldehyde and acetic acid, cause a histamine release that can trigger and exacerbate the transient flushing and edema.Although a common trigger of the transient flushing, the association between alcohol intake and rosacea development and severity remains controversial and debatable.White wine and liquor intake were significantly associated with a higher risk of rosacea in women. Alcohol consumption was significantly associated with an increased risk of rosacea in a dosedependent manner.Continuing to drink alcoholic beverages may accelerate disease progression and contribute to treatment resistance.Patients with rosacea may consider avoiding alcoholic beverages to potentially improve their rosacea symptoms.
对应中文
酒精导致外周血管扩张，促进炎症和氧化应激，调节免疫系统，还与肠道微生物群的改变有关。其分解产物乙醛和乙酸会引起组胺释放，从而触发和加剧一过性潮红和水肿。虽然酒精摄入是一过性潮红的常见诱因，但酒精摄入与玫瑰痤疮的发展和严重程度之间的联系仍然存在争议和争议。饮用白葡萄酒和白酒与女性患玫瑰痤疮的风险显著相关。饮酒与玫瑰痤疮风险增加呈剂量依赖关系。继续饮用酒精饮料可能会加速疾病进展，并导致治疗抵抗。玫瑰痤疮患者可考虑避免酒精饮料，以潜在改善症状。
Capsaicin
辣椒素
英文原文
Capsaicin is an organic compound found in large amounts in the fruits of several pepper variants (red chili, cayenne, and jalapeño) and is responsible for the spicy taste of these plants.Non-spicy peppers (green, bell, cherry, paprika, etc.) contain a certain amount of capsaicin, up to 25% of that present in spicy variants. Although widely used for its analgesic properties attributed to capsaicin’s ability to bind to TRPV1 receptors in the thalamus and sensory neurons, binding of the same receptor in the keratinocytes and dermal nerve endings seems to be the mechanism that triggers rosacea signs. Activation of TRPV1 channels induces the release of substance P and calcitonin gene-related peptide (CGRP) at the neuron endings.These agents may dilate cutaneous blood vessels and lead to an increase in metabolic activity resulting in heat generation; however, a group has failed to prove a role for spicy food in rosacea. Further studies are warranted to investigate the real-life impact of spicy food on rosacea and explore whether available evidence is translatable.
对应中文
辣椒素是一种有机化合物，在几种辣椒变种（红辣椒、辣椒和墨西哥辣椒）的果实中大量存在，是造成这些植物辛辣味道的原因。不辣的辣椒（绿椒、柿子椒、樱桃椒、红辣椒等）含有一定量的辣椒素，而辣的辣椒素含量高达25%。尽管由于辣椒素能与丘脑和感觉神经元中的TRPV1受体结合而被广泛应用，但与角化细胞和真皮神经末梢中的TRPV1受体结合似乎是引发玫瑰痤疮症状的机制。TRPV1通道的激活可诱导神经元末梢释放P物质和降钙素基因相关肽(CGRP)。这些药物可能扩张皮肤血管，导致代谢活动增加，从而产生热量；然而，研究小组未能证明辛辣食物在玫瑰痤疮中的作用。进一步的研究需要调查辛辣食物对玫瑰痤疮的实际影响，并探索现有的证据是否可靠。
Cinnamaldehyde
肉桂醛
英文原文
Cinnamaldehyde (CMN) is the compound derived by aromatic cinnamon plants that gives cinnamon its flavor and odor. It is found in several unrelated foods like vegetables (tomatoes, carrots, lettuce, spinach, celery, and cucumbers), chocolate, fruits (apples, oranges, and citruses) and as a food supplement. CMN can be found in many commercial cinnamon-containing foods (cereals, puddings, apple sauces, fruit juices, cookies, breads, etc.) available on the market.CMN is a potent activator of thermosensitive receptors, transient receptor potential ankyrin 1 (TRPA1),which is the main pathway that is attributed to its clinical effects of worsening rosacea symptoms. Cinnamon-containing foods may possibly aggravate rosacea, and avoidance may be considered.
对应中文
肉桂醛（CMN）是芳香肉桂植物衍生的化合物，赋予肉桂的味道和气味。它存在于几种不相关的食物中，如蔬菜（西红柿、胡萝卜、生菜、菠菜、芹菜和黄瓜）、巧克力、水果（苹果、橙子和柑橘），并作为一种食物补充。CMN可以在市场上许多含有肉桂的商业食品（谷物、布丁、苹果酱、果汁、饼干、面包等）中找到。CMN是一种有效的热敏受体，瞬时受体电位 (TRPA1）的激活剂，这是其临床上玫瑰痤疮症状恶化的主要途径。含肉桂的食物可能加重玫瑰痤疮，应尽量避免食用。
Formaldehyde
甲醛
英文原文
Formaldehyde is naturally found in low amounts in many foods like fruits (apples, grapes, plums, and bananas), vegetables (cauliflower, spinach, onions, and shiitake mushrooms), meats (pork, smoked ham, beef, and poultry),seafood (fish ball, cod, Bombay-duck, and crustaceans), coffee, tofu, and wet noodles.Formaldehyde is water soluble, so food that is washed and cooked thoroughly aids in its removal. There is a lack of literature regarding formaldehyde mechanism in the pathophysiology of rosacea. A few case reports confirm that exposure to formaldehyde not necessarily coming from food sources may account for a trigger of rosacea flare-ups.TRPA1 receptors mediate formalininduced pain and may also be the mechanism responsible for the inflammatory response in rosacea.Formaldehyde can also directly irritate nociceptors in sensory neurons, resulting in stinging. Whether formaldehyde or eliminating formaldehyde from foods or beverages makes any differ- ence in rosacea is open to conjecture, and more evidence is needed.
对应中文
甲醛在许多食物中自然含量较低，如水果（苹果、葡萄、李子和香蕉）、蔬菜（花椰菜、菠菜、洋葱和香菇）、肉类（猪肉、熏火腿、牛肉和家禽）、海鲜（鱼丸、鳕鱼、龙头鱼和甲壳动物）、咖啡、豆腐和湿面条。甲醛是水溶性的，所以彻底清洗和煮熟的食物有助于去除甲醛。关于玫瑰痤疮病理生理学中甲醛的作用机制，目前尚缺乏相关文献。一些病例报告证实，接触不一定来自食物来源的甲醛可能是引发玫瑰痤疮发作的原因。TRPA1受体介导甲醛诱发的疼痛、同时也可能是玫瑰痤疮炎症反应的机制。甲醛还可以直接刺激感觉神经元中的伤害感受器，导致刺痛。无论是甲醛还是从食品或饮料中去除甲醛对玫瑰痤疮有什么影响还有待猜测，还需要更多的证据。
Histamin
组胺
英文原文
Histamine causes cutaneous vessel dilatation, and histamine receptors H2R and H3R have been found to be upregulated in rosacea skin and contribute to skin hypersensitivity, edema, and facial flushing.In addition to its role in the inflammatory process, histamine plays a key role in immune regulation, which might contribute to the underlying mechanism of histamine as a rosacea trigger.Common histamine-rich foods include fruits (avocado, bananas, papaya, and pineapples), dried fruits (apricots, dates, raisins, and figs), vegetables (tomatoes, spinach, and eggplants), nuts (cashews, walnuts, and peanuts), chocolate, cow’s milk, fermented foods, and smoked fish. Histamine-rich foods must be carefully taken in patients that report histamine intolerance. Roughly 1% of the general population accumulates excessive histamine from food due to the low activity of diamine oxidase, the main enzyme involved in the metabolism of ingested histamine.Dermatologic sequelae of excessive histamine may include rosacea in addition to urticaria, atopic dermatitis, other dermatides, and acne.Despite the idea that avoiding histamine-rich foods in rosacea might be beneficial, it remains arguable, and more definitive evidence is needed.
对应中文
组胺引起皮肤血管扩张，目前已发现组胺受体H2R和H3R在玫瑰痤疮患者皮肤内上调，导致皮肤过敏、水肿和面部潮红。除了在炎症过程中发挥作用，组胺在免疫调节中发挥关键作用，这可能有助于组胺作为玫瑰痤疮触发器的潜在机制。常见的富含组胺的食物包括水果(牛油果、香蕉、木瓜和菠萝)、干果(杏子、枣、葡萄干和无花果)、蔬菜(西红柿、菠菜和茄子)、坚果(腰果、核桃和花生)、巧克力、牛奶、发酵食品和熏鱼。报告组胺不耐受的病人必须小心食用富含组胺的食物。由于二胺氧化酶(参与摄取组胺代谢的主要酶)活性低下，大约1%的人从食物中积累过量的组胺。过量组胺的皮肤后遗症除荨麻疹、特应性皮炎、其他皮炎和痤疮外，还可能包括玫瑰痤疮。尽管在玫瑰痤疮中避免富含组胺的食物可能是有益的，但这仍然是有争议的，需要更明确的证据。
Skin-gut microbiome axis and the evidence of probiotics, prebiotics, fiber, and other nutrients
皮肤-肠道微生物群轴和益生菌、益生元、纤维和其他营养素的证据
英文原文
The cutaneous microbiome profile may contribute to various skin disorders, including rosacea. Demodex folliculorum,and Staphylococcus epidermidis (Staphylococcus albus) are present in excess in rosacea skin. Some studies have associated skin colonization with Demodex, S. epidermidis, Bacillus oleronius (a bacterium carried by Demodex mites), and Bartonella quintana with the development of rosacea.
对应中文
皮肤微生物群特征可能导致各种皮肤病，包括玫瑰痤疮。毛囊蠕形螨和表皮葡萄球菌(白色葡萄球菌)在玫瑰痤疮皮肤中过量存在。一些研究已经将蠕形螨、表皮葡萄球菌、油状芽孢杆菌(一种由蠕形螨携带的细菌)和五日热巴尔通体与玫瑰痤疮的发展联系起来。
英文原文
The intestinal microbiome is home to approximately 300 to 500 bacterial species with individual fluctuations attributed to factors such as age, genetics, the host immune system, diet, medications, stress, and surgical procedures.Type, quality, and food origin shape the gut microbial ecology and microbiome–host interactions that may affect host health. Gut microbiota plays a major role in immune response and helps reduce local inflammation in the gastrointestinal tract. Recent studies have attempted to draw a link between gut microbiome and common dermatologic conditions such as atopic dermatitis, rosacea, and hidradenitis suppurativa. Disruption of the normal symbiotic ecosystem of intestinal microbes is associated with proinflammatory conditions.
对应中文
肠道微生物群是大约300到500种细菌的家园，其个体波动归因于年龄、基因、宿主免疫系统、饮食、药物、压力和手术程序等因素。类型、质量和食物来源形成肠道微生物生态和微生物群落-宿主相互作用，可能影响宿主健康。肠道菌群在免疫反应中起着重要作用，并有助于减少胃肠道局部炎症。最近的研究试图在肠道微生物群与常见的皮肤病如特应性皮炎、玫瑰痤疮和化脓性汗腺炎之间建立联系。肠道微生物正常共生生态系统的破坏与促炎症状态有关。
英文原文
Gut dysbiosis may be closely associated with rosacea. Prior to the era of skin microbiome analysis, gastrointestinal disturbances such as indigestion, malabsorption, and constipation have been associated with higher rosacea rates.Recently, more studies have suggested a potential connection between rosacea and gastrointestinal diseases.
对应中文
肠道菌群失调可能与玫瑰痤疮密切相关。在皮肤微生物组分析时代之前，消化不良、吸收不良和便秘等胃肠疾病与玫瑰痤疮发病率较高有关。最近，更多的研究表明玫瑰痤疮与胃肠道疾病之间存在潜在的联系。
英文原文
Helicobacter pylori prevalence has been found to be significantly higher in patients with rosacea, and its eradication has led to significant clinical improvement of skin symptoms.Metronidazole and clarithromycin have proven beneficial in treating both acne rosacea and peptic ulcer disease, the causative agent of which is H. pylori.It has been suggested that patients with rosacea should be tested for H. pylori infection, and patients who are H. pylori-positive should be treated for eradication of H. pylori to enhance the treatment of rosacea; moreover, small intestine bacterial overgrowth prevalence is found significantly higher in rosacea patients. Reduction in cutaneous lesions has been reported after eradication of small intestine bacterial overgrowth.Despite the existing literature, the pathogenic link between rosacea and gastrointestinal disorders remains unknown,and future studies are needed to investigate the possible common pathophysiological processes between these clinical entities.
对应中文
幽门螺杆菌在玫瑰痤疮患者中的患病率显著升高，根除幽门螺杆菌后，临床皮肤症状明显改善。甲硝唑和克拉霉素已被证实对痤疮、玫瑰痤疮和消化性溃疡都有疗效。消化性溃疡的病原体是幽门螺杆菌。建议玫瑰痤疮患者应进行幽门螺旋杆菌感染检测，幽门螺旋杆菌阳性患者应进行幽门螺旋杆菌根除治疗，以加强对玫瑰痤疮的治疗；此外，在玫瑰痤疮患者中，小肠细菌过度生长的患病率明显较高。在根除小肠细菌过度生长后皮肤病变减少已被报道。尽管已有文献，玫瑰痤疮和胃肠道疾病之间的致病联系仍不清楚，未来的研究需要调查这些临床实体之间可能共同的病理生理过程。
Probiotics
益生菌
英文原文
Probiotics are defined as live microorganisms that, when administered in adequate amounts, confer a health benefit to the host.Certain strains of Lactobacillus and Bifidobacteria can influence immunologic pathways through different mechanisms.Probiotic bacteria have a potential therapeutic benefit for patients with neurogenic skin inflammation such as rosacea.Lactobacillus paracasei, given as an oral probiotic, inhibits substance Pinduced skin inflammation and improves the skin barrier function, reducing the skin sensitivity in the study participants.A single case report of scalp and ocular rosacea was treated successfully with low dose doxycycline and oral probiotic therapy.Although cutaneous dysbiosis in the rosacea skin microbiome is widely recognized, novel therapeutic potential of topical probiotics for the management of rosacea needs to be further explored.
对应中文
益生菌被定义为活的微生物，当给予足够的量时有益于宿主的健康。某些乳酸菌和双歧杆菌可以通过不同的机制影响免疫途径。益生菌对玫瑰痤疮等神经源性皮肤炎患者具有潜在的治疗益处。副干酪乳杆菌作为口服益生菌，可以抑制物质诱导的皮肤炎症，并改善皮肤屏障功能，降低研究参与者的皮肤敏感度。一例头皮和眼部玫瑰痤疮的病例报告采用小剂量强力霉素和口服益生菌治疗成功。尽管玫瑰痤疮皮肤微生物群中的皮肤生态失调已被广泛认识，但局部益生菌治疗玫瑰痤疮的新治疗潜力仍需进一步探索。
High-fiber diet and prebiotics
高纤维膳食和益生元
英文原文
Dietary fibers are edible carbohydrate polymers that are resistant to the endogenous digestive enzymes and thus are neither hydrolyzed nor absorbed in the small intestine.Some of these compounds are considered “prebiotics,” defined as a nondigestible food ingredient that beneficially affects the gut microbiota by selectively stimulating the growth and/or activity of beneficial gut bacteria, thereby improving host gastrointestinal tract health.Consumption of a fiberrich diet promotes a healthy gut microbiome; however, in the absence of clinical data and a substantial knowledge gap, it is difficult to define what constitutes a healthy microbiome.Fibers derived from fruits and vegetables increase the diversity of the gut microbiome and promote the antiinflammatory effects locally and at distant sites such as the skin. Although not well established, the addition of a prebiotics to the diet may have substantial benefit in rosacea patients.As a general rule, patients should be advised to consume a high-fiber diet.
对应中文
膳食纤维是一种可食用碳水化合物聚合物，对内源性消化酶有抵抗力，因此不会在小肠中被水解或吸收。其中一些化合物被认为是“益生元”，定义为一种非可消化食品成分，通过选择性地刺激有益肠道细菌的生长和/或活性，从而改善宿主胃肠道健康，从而有益于肠道微生物区系。食用纤维蛋白饮食可促进肠道微生物群的健康；然而，由于缺乏临床数据和巨大的知识缺口，很难定义健康微生物组的构成。来自水果和蔬菜的纤维增加了肠道微生物的多样性，并促进局部和远处部位（如皮肤）的抗炎作用。虽然尚未完全确定，但在饮食中添加益生元可能对玫瑰痤疮患者有很大益处。一般来说，应建议患者食用高纤维饮食。
Other dietary nutrients
其他营养素
英文原文
Zinc is a crucial trace mineral that has fundamental roles in DNA synthesis, cell division, and protein synthesis. Skin contains the third highest abundance of zinc in the body. The highest concentration is localized in the epidermis, where it is essential for the differentiation, proliferation, and survival of keratinocytes.Due to its known antioxidant and antiinflammatory properties in reducing skin inflammation, zinc has a potential benefit in rosacea patients. Zinc sulfate supplement has been shown to be a safe and effective option in the treatment of rosacea,although the group did not observe any significant improvement in rosacea severity with oral zinc supplements.Good food sources of zinc include meat, shellfish and/or oyster, dairy products, legumes, eggs, and whole grains. Additional studies are required to determine the role of oral zinc in this setting.
对应中文
锌是一种重要的微量元素，在DNA合成、细胞分裂和蛋白质合成中起着重要作用。皮肤的锌含量在人体中排名第三。最高浓度位于表皮，对角质形成细胞的分化、增殖和存活至关重要。由于锌具有已知的抗氧化和抗炎特性，可以减轻皮肤炎症，因此锌对玫瑰痤疮患者有潜在的益处。补充硫酸锌已被证明是治疗玫瑰痤疮的一种安全有效的选择，尽管该小组没有观察到口服补锌对玫瑰痤疮的严重程度有任何显著的改善。锌的良好食物来源包括肉类、贝类和/或牡蛎、乳制品、豆类、鸡蛋和全谷物。需要更多的研究来确定口服锌在这一环境中的作用。
英文原文
Selenium, another trace element, has gained attention due to the antioxidant properties of preventing oxidative stress, cell membrane destabilization, and DNA damage. It also prevents the effects of UVB radiation and induced apoptosis.Dietary sources of selenium include Brazil nuts, fish, and meats (beef, pork, turkey, and chicken), seafood (tuna and salmon), whole grains, and garlic. To date, no studies have examined its effect as a supplement in rosacea patients.
对应中文
硒，另一种微量元素，由于其抗氧化特性，如防止氧化应激、细胞膜失稳和DNA损伤而受到关注。它还可以防止UVB辐射的影响和诱导的细胞凋亡。硒的饮食来源包括巴西坚果、鱼类和肉类（牛肉、猪肉、火鸡和鸡肉）、海鲜（金枪鱼和鲑鱼）、全谷物和大蒜。到目前为止，还没有研究检测其作为玫瑰痤疮患者补充剂的效果。
英文原文
Omega-3 fatty acids are polyunsaturated fatty acids (PU- FAs) that are essential for proper functioning of cell membranes and homeostasis and are widely discussed for their cardiovascular benefits. The impact of dietary PUFAs on the immune system has focused on omega-3 PUFAs α-linolenic acid and its potent substrates, eicosatetraenoic acid, and docosahexaenoic acid.Although widely discussed for their ability to inhibit the expression of several proinflammatory cytokines, there are no uniform scientific guidelines on the ideal omega-3 PUFA intake.
对应中文
ω-3脂肪酸是一种多不饱和脂肪酸(PU- FAs)，对细胞膜的正常功能和体内平衡至关重要，并因其对心血管的益处而被广泛讨论。膳食中不饱和脂肪酸对免疫系统的影响主要集中在ω-3不饱和脂肪酸α-亚麻酸及其有效底物二十碳四烯酸和二十二碳六烯酸。尽管广泛讨论了它们抑制几种促炎细胞因子表达的能力，但对于理想的ω-3脂肪酸摄入量尚无统一的科学指南。
Conclusions
结论
英文原文
Studies and reports over the past several decades have explored and postulated on the association and pathogenic mechanisms of common dietary triggers in rosacea. An appropriate diet can be recommended for patients with rosacea based on the available evidence. Avoiding common triggers (hot beverages, caffeine, alcohol, spicy food, cinnamon, and niacin) and promoting healthy nutrients (probiotics and prebiotics) and supplements that can potentially shift the gut microbiome profile toward a supporting skin microbiota may reduce the clinical picture of rosacea, although the available evidence is not definitive, and more rigorous studies are needed. We believe this information should be part of the discussion between the dermatologist and the patient with rosacea; however, to support the current existing evidence on common dietary triggers and further explore other promising revenues of dietary supplements or topical probiotics, additional investigations are needed.
对应中文
在过去的几十年里，研究和报道探索和假设了玫瑰痤疮中常见的饮食诱因的相关性和致病机制。根据现有的证据，可以为玫瑰痤疮患者推荐适当的饮食，避免常见的诱因（热饮、咖啡因、酒精、辛辣食物、肉桂和烟酸）和促进健康的营养素（益生菌和益生元）；另外，将肠道微生物群转变为支持皮肤微生物群的补充剂可能会降低玫瑰痤疮的临床症状，但是现有的证据并不明确、但还需要更严格的研究。我们相信这些信息应该成为皮肤科医生和玫瑰痤疮患者讨论的一部分；然而，为了支持目前关于常见饮食诱因的现有证据，并进一步探索膳食补充剂或局部益生菌的其他有可能的益处，还需要进行额外的调查。
REFERENCES
1. Alia E, Feng H. Rosacea pathogenesis, common triggers, and dietary role: The cause, the trigger, and the positive effects of different foods. Clin Dermatol. 2021.