[开放获取]    中国玫瑰痤疮诊疗专家共识（2016）

中华皮肤科杂志 ›› 2017, Vol. 50 ›› Issue (3): 156-161.

[开放获取] 中国玫瑰痤疮诊疗专家共识（2016）

中国医师协会皮肤科医师分会美容亚专业…¹,谢红付²

1. 中南大学湘雅医院皮肤科谢红付
2. 中南大学湘雅医院

收稿日期:2016-07-07 修回日期:2016-12-02 发布日期:2017-03-01
通讯作者: 谢红付 E-mail:xiehongfu1964@aliyun.com

Diagnosis and treatment of rosacea in China: an expert consensus statement （2016）

¹,Xie

Received:2016-07-07 Revised:2016-12-02 Published:2017-03-01
Contact: Xie E-mail:xiehongfu1964@aliyun.com

摘要/Abstract

摘要： 玫瑰痤疮是一种好发于面中部、主要累及面部血管及毛囊皮脂腺单位的慢性炎症性疾病［1］，曾称为酒渣鼻。2015年俄罗斯与德国联合流行病学调查显示，患病率分别为12.3%与5.0%［2］，美国为2.0% ~ 2.3%［3］，目前缺乏中国人群玫瑰痤疮患病率的研究。临床主要表现为面部皮肤阵发性潮红以及红斑、丘疹、脓疱、毛细血管扩张等，少部分出现赘生物（常见于鼻部），主要累及20 ~ 50岁的成年人［4?5］，但儿童［6］和老年人同样可以发病。然而，由于过去国内教科书及很多皮肤病专著将“玫瑰痤疮”称为“酒渣鼻”，致使很多医生误认为只有“鼻部发红、肥大”的表现才是“酒渣鼻”……

中国医师协会皮肤科医师分会美容亚专业… 谢红付. [开放获取] 中国玫瑰痤疮诊疗专家共识（2016）[J]. 中华皮肤科杂志, 2017,50(3):156-161. doi:

Xie. Diagnosis and treatment of rosacea in China: an expert consensus statement （2016）[J]. Chinese Journal of Dermatology, 2017, 50(3): 156-161.doi:

参考文献 38

［1］	张建中, 高兴华. 皮肤性病学［M］. 北京: 人民卫生出版社, 2015: 296.
［2］	Tan J, Schöfer H, Araviiskaia E, et al. Prevalence of rosacea in the general population of Germany and Russia ⁃ The RISE study［J］. J Eur Acad Dermatol Venereol, 2016, 30（3）: 428⁃434. DOI: 10.1111/jdv.13556.
［3］	Gupta MA, Gupta AK, Chen SJ, et al. Comorbidity of rosacea and depression: an analysis of the national ambulatory medical care survey and national hospital ambulatory care survey——outpatient department data collected by the U.S. National Center for Health Statistics from 1995 to 2002［J］. Br J Dermatol, 2005, 153（6）: 1176⁃1181. DOI: 10.1111/j.1365⁃2133.2005.06895.x.
［4］	Spoendlin J, Voegel JJ, Jick SS, et al. A study on the epidemiology of rosacea in the U.K［J］. Br J Dermatol, 2012, 167（3）: 598⁃605. DOI: 10.1111/j.1365⁃2133.2012.11037.x.
［5］	李吉, 何琳, 谢红付, 等. 玫瑰痤疮分型再认识［J］. 实用医院临床杂志, 2015, 12（2）: 1⁃2. DOI: 10.3969/j.issn.1672⁃6170. 2015. 02.001.
［6］	Lacz NL, Schwartz RA. Rosacea in the pediatric population［J］. Cutis, 2004, 74（2）: 99⁃103.
［7］	Yamasaki K, Kanada K, Macleod DT, et al. TLR2 is increased in rosacea and stimulates enhanced serine protease production by keratinocytes［J］. J Invest Dermatol, 2011, 131（3）: 688⁃697. DOI: 10.1038/jid.2010.351.
［8］	Antal AS, Dombrowski Y, Koglin S, et al. Impact of vitamin D3 on cutaneous immunity and antimicrobial peptide ［J］. Dermatoendocrinol, 2011, 3（1）: 18⁃22. DOI: 10.4161/derm.3.1. 14616.
［9］	Park K, Elias PM, Oda Y, et al. Regulation of cathelicidin antimicrobial peptide by an endoplasmic reticulum （ER） stress signaling, vitamin D receptor⁃independent pathway［J］. J Biol Chem, 2011, 286（39）: 34121⁃34130. DOI: 10.1074/jbc.M111.250431.
［10］	Meyer⁃Hoffert U, Schröder JM. Epidermal proteases in the pathogenesis of rosacea［J］. J Investig Dermatol Symp Proc, 2011, 15（1）: 16⁃23. DOI: 10.1038/jidsymp.2011.2.
［11］	Yamasaki K, Di NA, Bardan A, et al. Increased serine protease activity and cathelicidin promotes skin inflammation in rosacea［J］. Nat Med, 2007, 13（8）: 975⁃980. DOI: 10.1038/nm1616.
［12］	Kim J, Ochoa MT, Krutzik SR, et al. Activation of toll⁃like receptor 2 in acne triggers inflammatory cytokine responses［J］. J Immunol, 2002, 169（3）: 1535⁃1541. DOI: 10.4049/jimmunol.169. 3.1535.
［13］	Schwab VD, Sulk M, Seeliger S, et al. Neurovascular and neuroimmune aspects in the pathophysiology of rosacea［J］. J Investig Dermatol Symp Proc, 2011, 15（1）: 53⁃62. DOI: 10.1038/jidsymp.2011.6.
［14］	Gomaa AH, Yaar M, Eyada MM, et al. Lymphangiogenesis and angiogenesis in non⁃phymatous rosacea［J］. J Cutan Pathol, 2007, 34（10）: 748⁃753. DOI: 10.1111/j.1600⁃0560.2006.00695.x.
［15］	杨赛, 谢红付, 邓宇瑄, 等. A型性格与玫瑰痤疮的相关性研究［J］. 临床皮肤科杂志, 2014, 43（12）: 707⁃709. DOI: 10.16761/j.cnki.1000⁃4963.2014.12.016.
［16］	袁超, 王学民. 微生物在玫瑰痤疮发病机制中的作用［J］. 中国皮肤性病学杂志, 2015（5）: 521⁃523. DOI: 10.13735/j.cjdv. 1001⁃7089.201402101.
［17］	Bonamigo RR, Leite CS, Wagner M, et al. Rosacea and Helicobacter pylori: interference of systemic antibiotic in the study of possible association［J］. J Eur Acad Dermatol Venereol, 2000, 14（5）: 424⁃425.
［18］	吴艳, 牛悦青, 陈璨, 等. 皮肤屏障与玫瑰痤疮相关性的研究进展［J］. 皮肤病与性病, 2011, 33（2）: 77⁃78. DOI: 10.3969/j.issn.1002⁃1310.2011.02.008.
［19］	Bolognia J, Joseph JL, Julie SV, et al. Dermatology, 3rd ed［M］. Philadelphia: Elsevier Saunders, 2012: 637⁃644.
［20］	Two AM, Wu W, Gallo RL, et al. Rosacea: part II. Topical and systemic therapies in the treatment of rosacea［J］. J Am Acad Dermatol, 2015, 72（5）: 761⁃770; quiz 771⁃772. DOI: 10.1016/j.jaad.2014.08.027.
［21］	Stein L, Kircik L, Fowler J, et al. Efficacy and safety of ivermectin 1 cream in treatment of papulopustular rosacea: results of two randomized, double⁃blind, vehicle⁃controlled pivotal studies［J］. J Drugs Dermatol, 2014, 13（3）: 316⁃323. DOI: 10.3410/f.718301436. 793495893.
［22］	刘英姿, 谢红付, 李吉, 等. 羟氯喹治疗60例轻中度酒渣鼻的有效性及安全性临床观察［J］. 临床皮肤科杂志, 2015, 44（4）: 254⁃258. DOI: 10.16761/j.cnki.1000⁃4963.2015.04.033.
［23］	Hsu CC, Lee JY. Carvedilol for the treatment of refractory facial flushing and persistent erythema of rosacea［J］. Arch Dermatol, 2011, 147（11）: 1258⁃1260. DOI: 10.1001/archdermatol.2011.204.
［24］	Taub AF. Treatment of rosacea with intense pulsed light［J］. J Drugs Dermatol, 2003, 2（3）: 254⁃259.
［25］	Mark KA, Sparacio RM, Voigt A, et al. Objective and quantitative improvement of rosacea⁃associated erythema after intense pulsed light treatment［J］. Dermatol Surg, 2003, 29（6）: 600⁃604. DOI: 10.1046/j.1524⁃4725.2003.29141.x.
［26］	Taub AF, Devita EC. Successful treatment of erythematotelan⁃giectatic rosacea with pulsed light and radiofrequency［J］. J Clin Aesthet Dermatol, 2008, 1（1）: 37⁃40.
［27］	Bernstein EF, Kligman A. Rosacea treatment using the new⁃generation, high⁃energy, 595 nm, long pulse⁃duration pulsed⁃dye laser［J］. Lasers Surg Med, 2008, 40（4）: 233⁃239. DOI: 10.1002/lsm.20621.
［28］	Tan SR, Tope WD. Pulsed dye laser treatment of rosacea improves erythema, symptomatology, and quality of life［J］. J Am Acad Dermatol, 2004, 51（4）: 592⁃599. DOI: 10.1016/j.jaad.2004.04. 010.
［29］	Moreira A, Leite I, Guedes R, et al. Surgical treatment of rhinophyma using carbon dioxide （CO2） laser and pulsed dye laser （PDL）［J］. J Cosmet Laser Ther, 2010, 12（2）: 73⁃76. DOI: 10.3109/14764171003706208.
［30］	Neuhaus IM, Zane LT, Tope WD. Comparative efficacy of nonpurpuragenic pulsed dye laser and intense pulsed light for erythematotelangiectatic rosacea［J］. Dermatol Surg, 2009, 35（6）: 920⁃928. DOI: 10.1111/j.1524⁃4725.2009.01156.x.
［31］	Bassichis BA, Swamy R, Dayan SH. Use of the KTP laser in the treatment of rosacea and solar lentigines［J］. Facial Plast Surg, 2004, 20（1）: 77⁃83. DOI: 10.1055/s⁃2004⁃822963.
［32］	Miller A. Treatment of erythematotelangiectactic rosacea with a KTP YAG laser［J］. J Drugs Dermatol, 2005, 4（6）: 760⁃762.
［33］	Madan V, Ferguson JE, August PJ. Carbon dioxide laser treatment of rhinophyma: a review of 124 patients［J］. Br J Dermatol, 2009, 161（4）: 814⁃818. DOI: 10.1111/j.1365⁃2133.2009.09317.x.
［34］	Zide MF. Surgical removal of rhinophyma［J］. J Oral Maxillofac Surg, 2008, 66（10）: 2168⁃2177. DOI: 10.1016/j.joms.2008.01. 036.
［35］	Tanghetti E, Del RJQ, Thiboutot D, et al. Consensus recom⁃mendations from the American acne & rosacea society on the management of rosacea, part 4: a status report on physical modalities and devices［J］. Cutis, 2014, 93（2）: 71⁃76.
［36］	Tüzün Y, Wolf R, Kutlubay Z, et al. Rosacea and rhinophyma［J］. Clin Dermatol, 2014, 32（1）: 35⁃46. DOI: 10.1016/j.clindermatol. 2013.05.024.
［37］	李铁男, 刘岩. 中晚期酒渣鼻最佳治疗方案的探讨［J］. 中国医学美学美容杂志, 1996, 5（3）: 160⁃162. DOI: 10.15909/j.cnki.cn61⁃1347/r.1996.03.023.
［38］	Metternich FU, Wenzel S, Sagowski C, et al. Surgical treatment of rhinophyma with the ultrasonic scalpel （Ultracision Harmonic Scalpel）［J］. Laryngorhinootologie, 2003, 82（2）: 132⁃137. DOI: 10.1055/s⁃2003⁃37731.