| Background: Rosacea is a common chronic inflammatory disease,mainly affecting the central area of the face(forehead,cheeks,nose,and chin)and eyes,and the pathogenesis is not completely clear.The diagnosis and classification methods of rosacea have evolved from using subtypes to using phenotypes.At present,there is still a lack of large-scale sample studies on phenotype distribution,aggravating factors,comorbidities,and treatment in China.Objective: In order to improve overall understanding of rosacea and provide reference suggestions for treatment,the study investigates the clinical features,demodex test results,aggravating factors and comorbidities of rosacea and summarizes treatment experience.Methods: From May 30,2016 to June 1,2020,the clinical data of 2038 patients with rosacea diagnosed in the dermatology outpatient department of our hospital for the first time is retrospectively analyzed.The clinical data mainly includes the patient’s gender,age,clinical features,demodex examination results,aggravating factors,complications and treatment.The collected data are statistically analyzed using SPSS 25.0 software.Result:1.Demographic statistics: A total of 2038 patients with rosacea are included,including 415 males(20.36%)and 1623 females(79.64%).The number of female patients is significantly more than the number of male patients(the ratio of female to male was 0.26:1,P < 0.001),and the number of female patients is predominant in all age groups.The mean age is 36.47±12.55 years old,and the mean age of female patients is significantly younger than that of male patients(36.04±11.93 years old for female patients and 38.19±14.61 years old for male patients,P = 0.006).The high incidence age group of rosacea is 20-49 years old,accounting for 76.99% of the total.2.Clinical features:(1)Phenotype distribution In the diagnostic features,persistent erythema accounts for 93.08% and phymatous changes account for 6.38%.The main features are as follows: flush 76.05%,papules or pustules 58.98%,telangiectasia 44.36%,ocular manifestations 12.94%.The secondary features are as follows: burning 75.66%,dryness or tightness 69.04%,pruritus 43.97%,stingling39.55%,swelling 17.86%.The incidence of secondary characteristics in females is higher than that in males.1.96% of patients are accompanied by skin lesions other than the face(neck,chest,ear,scalp,shoulder and other parts),of which the neck accounted for the largest proportion(77.27%).In hypertrophic changes,the incidence of cheek mass is significantly lower than that of nasal mass.34.15% of the patients have skin lesions involving the nose and basically have persistent erythema,while a few patients(17.29%)have hypertrophic changes.12.94% of the patients have ocular manifestations,which include dry or itching(84 85%),tingling(51.89%),foreign body sensation(28.79%),tears(16.67%),photophobia(12.88%).(2)Subtype distribution The most common subtype is Erythema telangiectasia rosacea(ETR)(61.97%),followed by Papular pustular rosacea(PPR)(53.24%)and Ocular rosacea(OR)(12.94%),and the rarest subtype is Pachyntic hypertrophic rosacea(PHR)(6.38%).ETR,PPR,OR are all dominated by females;In PHR,the proportion of males is significantly higher than that of females(97 males and 33 females,P<0.001).In addition,there are some special types of rosacea,and steroid-induced rosacea accounts for 8.15%.Outbreak rosacea accounts for 2.30%,most of which are females(82.98%).(3)Severity The most common severity is mild(49.46%),followed by moderate(37.98%),and severe(12.56%).(4)Demodex test results The positive rate of a single demodex test is 41.53%.The positive rate of demodex of PPR(60.18%)is higher than that of ETR(35.40%).(5)Aggravating factors 42.05% of the patients have aggravating factors.The common aggravating factors are sun exposure(87.48%),temperature change(73.16%),emotional changes(48.07%),improper skin care(38.74%),and diet factor(32.20%).(6)Comorbidities The most common skin comorbidities are acne(n=375)and seborrheic dermatitis(n=166).Systemic comorbidities involve multiple systemic diseases,such as constipation,sleep disorders,hyperlipidemia,gastroenteritis,chronic cholecystitis,hyperemia,migraine,irregular menstruation,diabetes,thyroid dysfunction,depression,coronary atherosclerotic heart disease.3.Treatment: 0.75% Metronidazole gel(86.85%)is the most commonly used topical drug,and doxycycline(58.37%)is the most commonly used oral drug.For mild patients,the treatment effect of local treatment is similar to local treatment combined systemic treatment(P=0.063).For moderate and severe patients,the treatment effect of local combined systemic treatment is significantly better than local treatment(P<0.001).Conclusion:1.Rosacea mainly affects young and middle-aged females.2.The common features of rosacea are persistent erythema,flushing,papules or pustules,burning,dryness or tightness.Some patients have two or more subtypes at the same time.The most common subtype is ETR,followed by PPR.PHR is rare and mostly male.Mild rosacea is more common than moderate and severe rosacea.The positive rate of demodex in PPR is higher than that in ETR.Sunlight and temperature change are the most common aggravating factors.Acne and seborrheic dermatitis are the most common comorbidities of skin diseases.Patients may have systemic comorbidities.3.For most mild patients,local treatment can be used.In addition,considering that rosacea is a chronic inflammatory skin disease with a high recurrence rate,it is recommended that moderate to severe patients can use local treatment after their skin lesions improved. |
