Rosacea: An Often Overlooked or Misdiagnosed Disease

酒渣（玫瑰斑）：一個常被忽略或誤診的疾病

10.29784/DS.200409.0002

謝富森(Fu-Sen Hsieh)；李玉雲(J Yu-Yun Lee)；許明隆(Mark Ming-Long Hsu)

Rosacea ； Steroid rosacea ； Red face syndrome ； Lupus erythematosus ； Taiwanese

中華皮膚科醫學雜誌

22卷3期（2004 / 09 / 01）

213 - 220

英文

酒渣（酒糟）常見於白種人，但少見於深膚色人種。文獻中有關中國人酒渣之報告很少。本文的主要目的是要探討國人酒渣的臨床表現。我們收集了本科於1989年至2002年間診斷為酒渣的病例。酒渣診斷依臨床之表現，包括臉部中央潮紅、非短暫性紅斑、丘疹、膿皰或皮脂腺增生並合併有明顯的惡化因子。為謹慎起見，我們將其中有臨床照片可供進一步確認，或經由皮膚病理切片證實的病例才納入此研究。統計共有74位女性及35位男性，年齡分佈為15到76歲（平均38歲）。有四分之三病患發病年齡介於20至50歲之間。50%病例歸類為紅斑血管擴張型（第一期），38%病例為丘疹膿庖型（第二期），11%病例為鼻瘤型（第三期），5例為肉芽腫性酒渣，九例患有眼睛酒渣。第一期及第二期男女比為l:3，但第三期則為1:1。酒渣佔本科門診新病人的比率約0.12%，但實際比率可能更高些。酒渣主要的惡化因子為熱天氣(71%)，曬太陽(67%)，室內悶熱(47%)，壓力(43%)，辣食(41%)及酒精(37%)等。11位同時有其他臉部疾病，包括痤瘡、類固醇酒糟、接觸性皮膚炎，脂漏性皮膚炎及紅斑性狼瘡。39個病人看過其他醫師並曾被診斷過，少於一半被診斷為酒渣，其他被當做臉部過敏、痤瘡、接觸性皮膚炎，脂漏性皮膚炎或紅斑性狼瘡治療。本研究顯示酒渣常被忽略或誤診，因為酒渣易和其他臉部發炎性皮膚病如痤瘡、脂漏性皮膚炎、接觸性皮膚炎及紅斑性狼瘡等混淆。因此臉部發炎性紅斑皮疹應小心作鑑別診斷，以避免誤診及不當治療。由於上述這些臉部皮膚疾病很常見，醫師應注意病患同時罹患一種以上的皮膚病的可能性。若病患臉部經常出現潮紅或持續性紅斑且合併明顯的惡化因子時，應考慮到酒渣的可能性。Rosacea之原義為”rosy”，但中文譯為“酒渣”，易引起錯誤聯想此病與飲酒過量有關，對病患的心理有不良影響。因此我們建議應改名為“玫瑰斑”較符合”rosacea”的原義。

Rosacea is a common disease in fair-skinned individuals but is less common in people with darker skin. Reports about rosacea among Chinese are scarce. The purpose of this study was to document the clinical aspects of rosacea among Taiwanese. Cases of rosacea diagnosed in our Department during 1989-2002 were retrieved. The clinical diagnosis was based on the findings of central facial flushing with obvious triggering factors, non-transient erythema, papules, pustules or/and sebaceous hyperplasia. Only cases whose diagnosis was further confirmed by clinical photos or/and skin biopsies were included in this report. There were 74 females and 35 males, aged from 15-76 years (mean 38 years). The onset was between 20 and 50 years in three quarters of the patients. Rosacea was classified as erythematotelangiectatic type (stage Ⅰ) in 50% of the patients, papulopustular type (stage Ⅱ) in 38%, and rhinophyma (stage Ⅲ) in 11%. Granulomatous rosacea was diagnosed in 5 patients and ocular rosacea in 9. The male/female ratio was 1:3 in stage Ⅰ and stage Ⅱ, but was 1:1 in stage Ⅲ. The incidence of rosacea was about 0.12% among our new patients (109/80,000 new patients), but the real number could be higher. The main trigger factors were hot weather (71%), sun exposure (67%), indoor heat (47%), stress (43%), spicy foods (41%) and alcohol (37%). Eleven patients had other concurrent facial lesions, including acne vulgaris, steroid rosacea, contact dermatitis, seborrheic dermatitis and discoid lupus erythematosus. Prior diagnoses were known in 39 patients; more than half of them were treated as facial allergy, acne vulgaris, contact dermatitis, seborrheic dermatitis or lupus erythematosus. Our study suggests that rosacea was frequently overlooked or misdiagnosed because it is easily con-fused with other inflammatory facial dermatoses, such as acne vulgaris, seborrheic dermatitis, contact dermatitis and lupus erythematosus. Therefore, these facial dermatoses should be carefully differentiated from each other. Since these dermatoses are fairly common, physicians should also be aware that patients may present with more than on disease at the same time. The finding of frequent facial flushing or persistent erythema with obvious triggering factors should alert physicians to the possibility of rosacea, so that misdiagnosis and mistreatment could be avoided. Since the former Chinese translation of ”酒渣” easily lead to misconception of excessive alcohol drinking and is unfair to the patient. We propose that name to be eschewed and replaced by ”玫瑰斑”, which is a better translation and convey the original meaning ”rosy” of the medical term ”rosacea”.

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