Perrigouard C, Peltre B, Cribier B
Clinique dermatologique, faculté de médecine, université de Strasbourg, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France.
Ann Dermatol Venereol. 2013 Jan;140(1):21-9. doi: 10.1016/j.annder.2012.10.592. Epub 2012 Dec 21.
Rosacea has a number of pathophysiological components, chief of which are vascular abnormalities and inflammation. The morphology of the dilated vessels in rosacea may indicate an increase in the number and size of lymphatic vessels. We carried out a histological and an immunohistological study to quantify these abnormalities in rosacea and compared them with those seen in lupus erythematosus.
We reviewed all cases of rosacea analysed over a 4-year period. Ultimately, we only included 86 cases in which the diagnosis could be confirmed by a dermatologist based upon histopathological correlation and follow-up. All biopsies were reviewed for histopathological features, and 25 of these were compared with 25 facial biopsies in documented cases of lupus erythematosus, using standard staining followed by immunohistochemical analysis with anti-CD3, CD4, CD8 and CD20 (lymphocytic) antibodies, anti-CD68 (histiocytic) antibodies, anti-CD31 (endothelial cell) antibodies and anti-D2-40 (podoplanin, a marker for lymphatic endothelial cells) antibodies.
In 88% of cases of rosacea, large superficial dermal vessels of geometrical or bizarre configuration were noted, and turgescent cells and dermal edema were frequently seen. Over 75% of cases involved Demodex, including erythemato-telangiectatic subtypes. The rosacea included a mean 15 vessels/mm(2), eight of which expressed D2-40; six were greater than 30μm in diameter (mean: 103μm; maximum: 400μm), with only two of these being D2-40+. The lupus erythematosus biopsies exhibited a mean 15 vessels/mm(2), nine of which expressed D2-40; four measured over 30μm in diameter (mean: 59μm; maximum: 100μm), of which two were D2-40+. The vessels measuring over 100μm were only seen in rosacea, and notable actinic elastosis was associated in 80% of these cases. No Demodex was seen in the lupus cases. The lymphocytic infiltration consisted mainly of CD4+ T cells in both groups, but was chiefly sub-epidermal in lupus, occasionally masking the small vessels of the superficial dermis.
Rosacea is characterised by large, dilated, anfractuous capillaries, which are both larger and more numerous than in lupus, although there is no difference in dermal vascular density between the two diseases. Contrary to what their form may suggest, these dilated vessels are not lymphatic. D2-40+ vessels (lymphatic), which are flatter, are found in both lupus and rosacea. The association of large telangiectasias with actinic elastosis may indicate a causative role of exposure to UV radiation. These vessels likely exhibit increased permeability, resulting in dermal edema. Inflammation is consistently present, even in the early forms, strongly suggesting a dual inflammatory and vascular mechanism.
酒渣鼻有多种病理生理成分，其中主要的是血管异常和炎症。酒渣鼻扩张血管的形态可能表明淋巴管数量和大小增加。我们进行了一项组织学和免疫组织学研究，以量化酒渣鼻的这些异常，并将其与红斑狼疮中的异常进行比较。
我们回顾了4年期间分析的所有酒渣鼻病例。最终，我们仅纳入了86例经皮肤科医生根据组织病理学相关性和随访确诊的病例。对所有活检组织进行组织病理学特征检查，并将其中25例与25例红斑狼疮记录病例的面部活检组织进行比较，采用标准染色，然后用抗CD3、CD4、CD8和CD20（淋巴细胞）抗体、抗CD68（组织细胞）抗体、抗CD31（内皮细胞）抗体和抗D2-40（足板蛋白，淋巴管内皮细胞标志物）抗体进行免疫组织化学分析。
在88%的酒渣鼻病例中，可见几何形状或奇异形态的大的浅表真皮血管，且常可见肿胀细胞和真皮水肿。超过75%的病例有毛囊蠕形螨，包括红斑毛细血管扩张型亚型。酒渣鼻平均每平方毫米有15条血管，其中8条表达D2-40；6条直径大于30μm（平均：103μm；最大：400μm），其中只有2条为D2-40阳性。红斑狼疮活检组织平均每平方毫米有15条血管，其中9条表达D2-40；4条直径超过30μm（平均：59μm；最大：100μm），其中2条为D2-40阳性。直径超过100μm的血管仅见于酒渣鼻，且在80%的这些病例中伴有明显的光化性弹力纤维病。红斑狼疮病例中未见毛囊蠕形螨。两组的淋巴细胞浸润均主要由CD4 + T细胞组成，但在红斑狼疮中主要位于表皮下，偶尔会掩盖浅表真皮的小血管。
酒渣鼻的特征是大的、扩张的、蜿蜒曲折的毛细血管，其数量和大小均超过红斑狼疮，尽管两种疾病的真皮血管密度没有差异。与它们的形态可能暗示的情况相反，这些扩张的血管不是淋巴管。扁平的D2-40阳性血管（淋巴管）在红斑狼疮和酒渣鼻中均有发现。大的毛细血管扩张与光化性弹力纤维病的关联可能表明紫外线辐射暴露的致病作用。这些血管可能表现出通透性增加，导致真皮水肿。即使在早期形式中，炎症也始终存在，强烈提示存在双重炎症和血管机制。
