Distinguishing rosacea from sensitive skin by reflectance confocal microscopy

Abstract

Background: The updated standard classification and pathophysiology of rosacea have provided clear and meaningful evaluation parameters; however, differentiating rosacea from sensitive skin (SS) remained an obstacle for dermatologists around the world, especially in China. Herein, we aimed to find a better characteristic to distinguish rosacea from SS by using reflectance confocal microscopy (RCM). Method: Forty rosacea patients and 143 healthy subjects were recruited in this study. Firstly, a SS questionnaire and a lactic acid sting test were conducted among healthy subjects. Next, two major groups were divided out, including a SS group (40 subjects) and a normal skin control group (NS, 60 subjects). The cutaneous structures of face and fossa cubitalia were imaged by RCM. Results: We found that more parakeratosis, honeycomb pattern, spongiform edema, and dermal papillae (P < .05) in rosacea patients than that of the NS group, whereas there were no significant differences, were found in rosacea patients and the SS group. Strikingly, we found that rosacea patients have a larger depth of honeycomb pattern than that of SS subjects (P < .05). But, the epidermal thickness of rosacea did not differ from that of SS groups. There was also no significant difference of epidermal thickness and honeycomb structure depth between rosacea patients and NS group. Conclusion: From the RCM images of parakeratosis, honeycomb pattern, spongiform edema, and dermal papillae, we found that RCM might be a faithful tool to distinguish rosacea from NS group. The depth of honeycomb structure of SS was more superficial than rosacea patients, whereas no significant difference between rosacea patients and NS group. RCM may provide a new method for evaluating the development of rosacea although it failed to distinguish rosacea and SS effectively.

The Challenges in Investigating the Pathogenesis of Sensitive Skin by Noninvasive Measurements: A Systematic Review

“… 60 Three studies focused on using the structure of epidermal lesions determined by RCM to assess sensitive skin. 37 , 61 , 62 Notably, SS and NSS subjects differed in honeycomb structure depth or structure. In one study, the honeycomb structure was shallower in SS than in NSS subjects, 61 while in the other two studies, patients with lactic acid stingers had irregular honeycomb structures on the face.…”

“…In one study, the honeycomb structure was shallower in SS than in NSS subjects, 61 while in the other two studies, patients with lactic acid stingers had irregular honeycomb structures on the face. 37 , 62 …”

Skin Care and Colour Cosmetics in Patients with Sensitive Skin

“…While sensitive skin was first shown to be the same entity as or a subgroup of rosacea in a previous study (30), it can now be distinguished from rosacea through diagnostic methods (e.g., reflectance confocal microscopy) (30). In our study, sensitive skin was frequently observed in the patients with rosacea, but the prevalence rates of allergic contact and photocontact dermatitis were also high in the patients with sensitive skin, probably due to the use of makeup and skin care products or skin care habits (31).…”

Rosacea and seborrheic dermatitis differentially respond to lactic acid sting and capsaicin tests in Chinese women

“…Previous studies demonstrated that the prevalence of sensitive skin symptoms is higher in subjects with rosacea, 22 while LAST and CAT are commonly used to determine whether individuals have sensitive skin. 23,24 In agreement with previous studies, 25,26 we demonstrated here that the positive rates of both LAST and CAT were significantly higher in subjects with rosacea than in normal controls.…”