Willingness to pay for treatment of rosacea and its influencing factors: a survey of patients in Changsha region / 中华皮肤科杂志

Objective:To investigate the willingness to pay (WTP) for treatment and its influencing factors, to evaluate the correlation between the disease burden (quality of life) index and dermatology life quality index (DLQI) in patients with rosacea, and to provide a basis for individualized diagnosis and treatment.Methods:Patients with rosacea were enrolled via a WeChat platform at Department of Dermatology, Xiangya Hospital from August 2019 to February 2020. An online questionnaire survey was performed to investigate the WTP for a single session of treatment by which rosacea is assumed to be cured, and general information as well as data about clinical characteristics and DLQI scores were collected. Factors influencing high WTP were analyzed by using a logistic regression model.Results:Among the 435 respondents, 397 (91.3%) were females and 38 (8.7%) were males, with an age of 28.46 ± 8.33 years (range, 18- 63 years) . The respondents spent 10 474.95 ± 834.19 ( M[ P25, P75], 5 000 [1 000, 10 000]) RMB Yuan on previous medical treatment; the WTP was 12 510.86 ± 990.84 ( M[ P25, P75], 5 000[2 000, 10 000]) RMB Yuan; the DLQI score was 11.2 ± 0.38. Logistic regression analysis showed that lesions on the cheeks ( OR= 1.89, P= 0.041) , annual household income of > 100 000 RMB Yuan ( OR= 1.63, P= 0.029) , disease duration of > 1 year ( OR= 2.82, P < 0.001) , high number of visits in the past 1 year ( OR= 1.62, P < 0.001) , high self-rated rosacea severity score ( OR= 1.16, P= 0.002) and high DLQI score ( OR= 1.52, P < 0.001) were associated high WTP for treatment. Spearman correlation analysis showed that the DLQI score was positively correlated with WTP ( rs= 0.27, P < 0.05) and relative WTP (the proportion of WTP to monthly income, rs= 0.133, P < 0.05) . Conclusions:Among the patients with rosacea in Changsha, the WTP was at a moderate to high level, reflecting a serious impact on the quality of life. The WTP value can indirectly reflect the quality of life and help to rapidly understand the burden of disease in patients with rosacea.

Analysis of clinical features of rosacea and rediscussion of a Chinese diagnostic criterion for rosacea / 中华皮肤科杂志

Objective:To propose a Chinese diagnostic criterion for rosacea on the basis of clinical feature analysis of rosacea, and to assess its sensitivity and specificity.Methods:A total of 3 350 Chinese patients with newly diagnosed rosacea were collected from Department of Dermatology, Xiangya Hospital, Central South University between December 2017 and July 2018, their phenotypes and clinical features were retrospectively analyzed, and a Chinese modified diagnostic criterion for rosacea was put forward. A national multi-center clinical observational trial, which included 2 269 patients with rosacea and 2 408 patients with other facial skin diseases from 28 centers, was conducted to verify this diagnostic criterion. Then, the sensitivity and specificity of the modified diagnostic criterion were evaluated by comparing with the 2017 standard classification of rosacea developed by the National Rosacea Society Expert Committee (NRSEC) .Results:Fixed centrofacial erythema occurred in 3 350 (100%) patients with rosacea. Flushing occurred before or simultaneously with fixed erythema in 1 850 (99.4%) of the 1 861 patients with erythema on the cheeks; among the 1 489 patients with erythema on the nose or perioral area, only 52 (3.5%) had flushing; all the 342 patients presenting with phymatous changes had fixed erythema before phymatous changes. Based on the above clinical findings, it was proposed that patients with periodically aggravated fixed erythema on the cheeks accompanied with flushing could be diagnosed with rosacea; patients with fixed erythema on the nose and perioral area accompanied with at least one of selective phenotypes (flushing, telangiectasia, papules and pustules, phymatous changes, or ocular manifestations) could be diagnosed with rosacea. The national multi-center clinical observational trial revealed that the sensitivity of the Chinese modified diagnostic criterion for rosacea was 99.6%, which was close to the sensitivity (100%) of the NRSEC standard, and its specificity was 91.9%, higher than the specificity (73.3%) of the NRSEC standard.Conclusion:The Chinese modified diagnostic criterion for rosacea has good sensitivity and specificity, and can facilitate the early diagnosis of phymatous rosacea.

Expression pattern of mTOR subunits Raptor and Rictor in mouse hair follicle cycle / 中南大学学报(医学版)

To detemine the expression pattern of mTOR complex subunits Raptor and Rictor in the hair follicles of mice at different hair follicle stages, and to explore its significance. 
 Methods: Immunostaining of Ki-67, a proliferative marker, was used to determine the precise hair follicle stages of mouse dorsal skin at different postnatal time points. Real-time PCR was used to detect the mRNA expression of Raptor and Rictor in mouse dorsal skin at 43 days after birth (P43, early telogen), 56 days after birth (P56, mid-telogen), 69 days after birth (P69, late telogen) and 74 days after birth (P74, early anagen). The expression intensity and localization of Raptor and Rictor at different stages of hair cycle were tested by co-immumostaining.
 Results: Ki-67 immunostaining showed that the time points (P43, P56, P69, P74) and hair follicle stages (early telogen, mid-telogen, late telogen, early anagen) of the dorsal skin were consistent with each other. The results of real-time PCR and immunostaining were consistent, showing that the expression of Raptor and Rictor did not changed in the early-, mid-, late telogen, and early anagen. However, Raptor was specifically expressed in the bulge where hair follicle stem cells (HFSCs) are residing in, and Rictor was mainly detected in inner root sheath (IRS) cells. 
 Conclusion: The expression of Raptor and Rictor does not altered in the hair follicles at different hair follicle stages, but Raptor and Rictor are specifically expressed in the HFSCs and IRS cells, respectively, indicating that Raptor might be a molecular marker for HFSCs, and Rictor might be involved in the maintenance of IRS and formation of hair shaft.

mTORC1 signaling specifically promotes proliferation of hair follicle stem cells during the telogen-to-anagen transition / 中华皮肤科杂志

Objective@#To identify the time window during which the mammalian target of rapamycin complex 1 (mTORC1) signaling pathway plays a key role in telogen-to-anagen transition of hair follicles, and to explore whether the pathway specifically promotes the proliferation of hair follicle stem cells (HFSCs) .@*Methods@#Totally, 36 newborn ICR mice were randomly and equally divided into 3 groups: RAPA-P19 group intraperitoneally injected with 5 mg·kg-1·d-1 sirolimus on days 19-24 after birth, RAPA-P21 group intraperitoneally injected with 5 mg·kg-1·d-1 sirolimus on days 21-24 after birth, and control group intraperitoneally injected with the same volume of solvent on days 19-24 after birth. Four mice were sacrificed in each group on days 22, 23 and 24 separately. Skin tissues were resected from the back, and hematoxylin-eosin staining of the skin tissues were performed followed by observation of hair follicle morphology to evaluate whether murine hair follicles progressed into the anagen phase on day 24. Immunofluorescence costaining was conducted to determine the expression and localization of mTORC1 downstream molecular marker pS6 and cell proliferation marker Ki67 on days 22 and 23.@*Results@#On day 24, hematoxylin-eosin staining showed anagen hair follicles in the control group and RAPA-P21 group, but telogen hair follicles in the RAPA-P19 group. On days 22 and 23, immunofluorescence costaining revealed positive staining for both pS6 and Ki67 in HFSCs in the control group, negative staining for both pS6 and Ki67 in the RAPA-P19 group, negative staining for pS6 and positive staining for Ki67 in the RAPA-P21 group. On day 23, epidermal cells and sebaceous gland cells in the upper hair follicle bulge were stained positively for Ki67 in all the 3 groups.@*Conclusion@#mTORC1 signaling specifically promotes the proliferation of HFSCs during telogen-to-anagen transition, but not affects proliferation of other cells in hair follicles.

Clinical analysis of 1 090 cases of rosacea and exploration of new diagnostic criteria for rosacea / 中华皮肤科杂志

Objective To propose a new diagnostic criterion for rosacea based on the analysis of clinical features of rosacea in a large sample.Methods A total of 1 090 Chinese outpatients with rosacea were enrolled from Department of Dermatology of Xiangya Hospital,and their demographic data,clinical manifestations and subjective symptoms were collected.According to results of descriptive analysis,clinical features of rosacea were summarized,and a new diagnostic criterion for rosacea was set up.Then,the sensitivity and specificity of the new diagnostic criterion were verified among 1 200 outpatients clinically characterized by facial erythema.Results Of 1 090 patients with rosacea,131 (12.0％) were male and 959(88.0％) were female,and the average age was 33.5 ± 11.1 years (range,10-66).Among the 1 090 patients,715 (65.6％) had initial lesions on the cheek,of whom,712 (99.6％) had intermittent flushing as the initial symptom,and 689 (96％) had sensitive skin symptoms such as dryness,burning and itching sensations;208 (19.1％) had initial lesions on the perioral region,of whom,204 (98.1％) had persistent erythema as the initial symptom;167 (15.3％) had initial lesions on the nose,of whom,163 (97.6％) had persistent erythema as the initial symptom;in addition,311 (28.5％) had lesions on the ocular region,and only 24 (2.2％) had lesions outside the face on the neck and retroauricular region.Based on these clinical features,a new diagnostic criterion for rosacea was proposed,including 1 major condition (intermittent flushing or persistent erythema on the cheek,perioral region or nose) and 5 minor conditions (1.sensitive skin symptoms such as burning,tingling,drying or itching sensations;2.telangiectasia;3.papules or pustules;4.hypertrophy;5.ocular symptoms).If with the major condition and at least one minor condition were met,patients could be diagnosed with rosacea.After verification among 1 200 patients with facial dermatitis clinically characterized by facial erythema,the new criterion was proved to have a sensitivity of 99.3％ and a specificity of 95.8％.Conclusion A new diagnostic criterion for rosacea with high sensitivity and specificity is proposed,which is worthy of clinical application.