Rosacea is a chronic inflammatory disease commonly seen in the middle of the face, mainly involving the facial vessels and the sebaceous glands of the hair follicles. The epidemiological incidence of the joint investigation of Russia and Germany is 12.3% and 5%, and the United States is 2% to 2.3%. There is no epidemiological investigation of the Chinese population at present. According to reports, 15% to 40% of patients with rosacea have family genetic background. The pathogenesis of acne rosacea is not yet clear. It may be caused by multiple factors induced by chronic inflammation, which is dominated by natural immunity and abnormality of vasomotor function. The main objective clinical manifestations of acne sufferers are paroxysmal flushing or persistent erythema, inflammatory papules, pustules, nasophyte and capillary dilatation in the face, nose or peri. Scorching, drying, and itching are important clinical symptoms of rosacea. According to the type of skin lesions, the American National Rosacea Society Expert Committee (NRSEC) in 2004 proposed the clinical classification standard of acne rosacea, and divided rose acne into red spot capillary dilatation, papule pustule type, increase fertilizer large scale and eye type. In order to further study the characteristics and clinical manifestations of acne rosacea and reduce the missed diagnosis and misdiagnosis of acne rosacea, my team proposed a new type of thinking through the analysis of the clinical characteristics of 586 patients with acne rosacea. Meanwhile, through analyzing the clinical characteristics of 1090 outpatients with rosacea, a new diagnostic standard of 8 was proposed.
Studies have shown that the destruction of skin barrier is one of the causes of aggravated skin lesions of rosacea. Dysfunction of the cuticle barrier leads to the stimulation of some stimulators into epidermis and dermis, aggravating telangiectasia and inflammation. In recent years, more and more studies have found that the damage of skin barrier function is also related to the occurrence of rosacea. The skin barrier caused by inflammation, which causes the formation of vasoactive substances and changes in the vascular endothelial structure, is reflected in the epidermis which causes the occurrence of acne rosacea. Some scholars point out that acne rosacea is more likely to occur in people with dry skin. Researchers have observed 135 patients with acne rosacea, untreated, and found that erythema telangiectasia acne is more likely to appear in dry skin. A decrease in the skin barrier function leading to a decrease in water content in the stratum corneum is one of the mechanisms of rosacea.
The link between rosacea and skin barrier is summarized below
1.Changes of physiological index of skin barrier in acne rosacea
Impaired skin barrier function plays an important role in facial dry, sensitive and other clinical manifestations of rosacea. The skin barrier function of different subtypes of rosacea also varies. The most common subtypes of rosacea are erythematous telangiectasia and papular pustular type. The clinical manifestations of erythema telangiectasia acne are mainly characterized by an excessive flush in the cheek or persistent erythema with facial skin sensitivity, and papular pustular rose acne mostly with facial papular pustules. The detection of the skin barrier function of the above two acne rosacea indicates that the water content of the stratum corneum is obviously decreased, the surface water loss (TEWL) increases, the skin surface P H rises, but the change of sebum content is not obvious, but the proportion of sebum is changed. The above abnormalities are also very obvious in the non skin lesions of the patients with acne vulgaris, but more prominent in the skin lesions, suggesting that there may be abnormal skin barrier function before the appearance of typical skin lesions in acne patients. These abnormalities may be aggravated with the development of the disease.
1.1Changes in the water content of the cuticle
The water content of the stratum corneum is an important indicator of the skin barrier function and can also be used to measure the degree of dryness of the skin. The skin of rosacea patients is sensitive to skin irritation, such as dryness, itching, and so on. Studies show that 66.7% of patients with rosacea have dry skin symptoms, and the water content of the stratum corneum is also significantly reduced. Another study found that papules and pustular rosacea patients had significantly lower water content in the stratum corneum of forehead and cheeks compared with normal controls.
1.2Changes in sebum secretion
The lipids on the skin surface can be classified into sebaceous lipids and intercellular lipids according to their source and composition. The sebaceous glands are secreted from the sebaceous glands directly to the skin surface, and the intercellular lipids are mainly dispersed in the cuticle cells with the growth and metabolism of the cells, and eventually with the disintegration of the cuticle cells to the skin surface. As the main structural part of skin barrier, lipids play an important role in maintaining skin barrier function. Sebum can not only prevent the loss of skin water and electrolyte, but also resist the invasion of harmful substances, have antibacterial activity, and play an important role in maintaining the P H value of skin. It is interesting that there is a conclusion that there is no significant difference between the skin sebum content of the epidermis of the pustular pustular acne patients and the facial sebum in the normal population by measuring the sebum content in the 7 parts of the face of 35 cases of pustular pustular acne and 34 normal controls. However, a study on the composition of sebum, such as N Raghallaigh, suggests that the fatty acid content of sebum in the skin barrier of pustular pustular acne patients has changed. In this study, the content of fatty acids in the facial sebum of 25 cases of pustular pustular acne and 24 normal controls was compared. The results showed that the concentration of myristic acid in the sebum of the pustular pustular acne patients was significantly higher, but the concentration of long chain saturated fatty acids decreased and the lipid composition changed.
1.3 Changes in surface water loss
TEWL reflects the evaporation of water from the skin surface, so it is an important index for evaluating the function of skin barrier. TEWL indicates the loss of water in the stratum corneum, thus reflecting the water permeability barrier of the skin. The higher the TEWL value, the more moisture the skin loses, the worse the barrier function of the cuticle. The TEWL of the face of 75 patients with rosacea and 125 normal controls was measured by Dirshka and so on, suggesting that the TEWL of the nose, cheeks and nose of the patients with rosacea rose significantly.
1.4 Changes in the P H value of the skin
The value of P H on the skin surface is not only a reflection of the organism’s biological activity in the epidermis, but also affects the biological function of the epidermis and even the dermis. It is also an important indicator of the function of the skin barrier. The PH value of normal skin surface is weak acidity, and the PH value of different parts of skin is slightly different. Studies have shown that the P H value of the skin surface increases with the increase of the skin’s drying degree, and the higher the P H value of the skin, the lower the barrier function to the water permeable. Dr. Wu Yan and other studies showed that the surface PH of rosacea patients was higher than that of the normal control group on the surface of PH. N Raghallaigh and other studies on the changes in the skin barrier function of the pustular acne vulgaris have also shown that the PH value of the skin surface of the pustular pustular acne vulgaris is increased.
2.The relationship between the cause of acne rosacea and the skin barrier
The cause of rosacea is complex. At present, many believe that it is caused by multiple factors in the genetic background, and is caused by chronic inflammation, which is dominated by innate immunity and vasomotor dysfunction. Many studies have shown that there are certain links between the pathogenesis of rosacea and the impairment of skin barrier function.
2.1 Inflammatory response and skin barrier
The natural immune response of patients with acne rosacea plays a major role in the formation of the disease. It is mainly reflected in the high response to external environmental stimuli. The antimicrobial peptide (AMPs), especially the cathelicidin antibacterial peptide (CAMP), is highly expressed, and the LL-37 fragment increases, which induces the development of blood vessels neovascularization and inflammation. Studies have shown that epidermal permeability barrier function also regulates skin innate immunity, such as the expression of epidermal antimicrobial peptides. Therefore, on the one hand, inflammation can affect the changes in the skin barrier function of the patients with acne rosacea, causing the face to be susceptible to the external environment and the symptoms of damaged skin barrier, such as flushing and prickling. On the other hand, skin barrier function can also affect the occurrence and development of rosacea inflammation. At the same time, the study showed that after skin barrier was damaged, dermal mast cells infiltration increased significantly, and mast cells were also the key mediators of rosacea inflammation. In recent years, more and more evidence shows that there is a complex and close interaction between the mast cell and the sensory nerve, and the abnormal regulation of the sensory and autonomic nerves is closely related to the high response to external stimuli and the occurrence of early rosacea in the patients with acne.
2.2 Nerve pulse tube change and skin barrier
Patients with rosacea showed significant hyperresponsiveness to endogenous and exogenous stimuli. Sun, high temperature, emotional excitement can trigger the emergence of rosacea patients with paroxysmal flush or erythema, which is closely related to the vasomotor dysfunction and abnormal neurovascular regulation of acne rosacea. Ultraviolet and temperature changes can activate the sensory nerve, and the activation of cutaneous sensory nervous system is closely related to the occurrence and development of early stage of rosacea.
Vascular and lymphatic vessels are related to skin development, homeostasis and wound repair. Recent studies have shown that there is a close relationship between blood vessels and lymphatic vessels and rosacea. Schwab and other studies suggest that in the erythematous telangiectasia and papular pustular acne rosacea, the main manifestations are enlargement, dilatation, increased permeability, increased blood flow, and the formation of blood vessels and lymphatic vessels in some large rosacea. The expansion of blood vessels and the increase of blood flow lead to increased skin loss and stimulate the proliferation and differentiation of keratinocytes.
The role of the cutaneous nervous system in controlling inflammation, immunity and vascular regulation has been demonstrated. Recently, the regulatory mechanism of rosacea has been focused on the cation channels, of which capsaicin receptor (TRPV1) is attracting much attention. The researchers found that TRPV1 was highly expressed in rosacea patients. The inducing factors of rosacea, such as high temperature, alcohol and chemical stimulation, can activate TRPV1, release substance P and calcitonin gene related peptide and other important neuroinflammatory and pain mediators, cause abnormal regulation of nerve and blood vessel, and lead to the occurrence and development of rosacea. Denda reports that the use of TRPV1 inhibitors can accelerate the repair of the skin barrier, suggesting that the activation of TRPV1 in keratinocyte is closely related to the damage to the skin barrier. TRPV1 showed high expression in epidermal keratinocytes and nerve fibers in epidermis and dermis. Jun-Won Yun and so on in mice also proved that blocking the activation of TRPV1 could speed up the repair of skin barrier.
2.3 Microorganism change and skin barrier
There has been much controversy over the relationship between microbial infection and the incidence of rosacea. Some scholars believe that microbial infection plays an important role in the pathogenesis of acne rosacea, but some scholars believe that microbial infection is not directly related to the incidence of acne. Researchers believe that the microbes associated with rosacea are mainly Demodex follicular, Propionibacterium acnes, Staphylococcus epidermidis and Helicobacter pylori. Zhao and other studies suggest that the hair follicle Demodex has a significant statistical correlation with the incidence of rosacea, and the infection of the follicle Demodex is an important risk factor for Rose acne. There is evidence that follicle Demodex in the per unit area of rosacea is significantly higher than that in the normal population, especially in papular pustular type. In the study of Propionibacterium acnes (PA) and Jahns in 82 cases of acne rosacea and 25 healthy people, there was no significant correlation between PA and the incidence of acne. However, other studies have shown that PA can activate Toll receptor 2 (TRL2), and the activation pathway of Toll like receptor is also an important molecular pathway in the pathogenesis of rosacea. Investigation conducted by El Khalawany showed that the detection rate of Helicobacter pylori (HP) in rosacea patients was significantly higher than that in normal subjects. However, there is no clear evidence that Staphylococcus epidermidis is the causative factor of rosacea.
The flora on the skin is an important part of the skin barrier function, and the balance of microorganism is a powerful protective umbrella for the skin. The change of the number of single strains or the imbalance of the whole flora may affect the change of skin barrier. It is pointed out that acidic environment can inhibit the growth of bacteria, yeast or other pathogenic microorganisms. Therefore, when the skin barrier is damaged, the skin P H is higher than the normal value, which causes the microorganism to reproduce or destroy the microecological balance of the skin surface, thus causing skin infection or inflammation and aggravating the damage of the skin barrier.
3.Epidermal permeability barrier and skin immunity and inflammation.
Acne rosacea is susceptible to skin sensitive symptoms on the face, and it is proved by clinical practice that the use of medical care products which have the function of repairing the skin barrier can effectively relieve the skin sensitive symptoms such as drying, prickling and burning of rose acne, and can relieve paroxysmal flush symptoms, which is the basis for the treatment of acne rosacea. The research shows that the external medical skin care products can gradually improve the physiological indexes of the skin barrier of TEWL, the water content of the cuticle and the skin oil, and obviously improve the clinical symptoms such as dry and pruritus.
It has been reported that tranexamic acid as a protease inhibitor can effectively repair damaged skin barrier function. Sun Nan and other 30 cases of acne sufferers by using their own control external use of methicocyclic acid test method, confirmed that methicocyclic acid can inhibit the activity of serine serine protease and antibacterial LL-37 expression to improve the skin barrier function of rosacea.
After comparing the clinical efficacy, I found that the eddy current electric field of 27MHZ has the ability to enhance skin moisturizing ability and repair skin barrier. 27MHZ’s eddy current electric field repair can increase the water content of the cuticle in the skin lesions of acne patients in the short term, reduce TEWL, and quickly improve the clinical symptoms such as dry, pruritus and paroxysmal flush.
Rosacea is a complex skin disease based on skin inflammation and neurovascular changes. Its pathogenesis and clinical symptoms are closely related to external stimuli, and are closely related to the damage of skin barrier function and interact with each other. Most of the patients with acne are accompanied by skin barrier function, and skin barrier function can promote the occurrence and development of rosacea. By repairing skin barrier function, the clinical symptoms of rosacea patients can be significantly improved. To study the role of skin barrier function in the occurrence and development of rosacea, and to provide more evidence and new ideas for the long-term and effective treatment of rosacea.
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