Value of reflectance confocal microscopy for the monitoring of rosacea during treatment with topical ivermectin

Reflectance confocal microscopy (RCM) enables noninvasive <i>Demodex</i> mite detection in rosacea. Objective scoring of rosacea severity is currently lacking. To determine the value of RCM for monitoring <i>Demodex</i>, inflammation and vascular parameters in rosacea during treatment. In 20 rosacea patients, clinical and RCM examination were performed before, during, and 12 weeks after a 16-week treatment course with topical ivermectin. Using RCM, number of mites and inflammatory cells, epidermal thickness, and vascular density and diameter were measured. RCM features were correlated with clinical assessment. Treatment resulted in clinical reduction of inflammatory lesions. Mites were detected in 80% of patients at baseline, 30% at week 16, and 63% at week 28. The number of mites reduced significantly during treatment, but no changes in inflammatory cells, epidermal thickness or vascular parameters were observed. Correlation between number of inflammatory lesions and mites was low. None of the RCM variables were significant predictors for clinical success. RCM enables anti-inflammatory effect monitoring of topical ivermectin by determining mite presence. Quantifying exact mite number, and inflammatory and vascular characteristics is challenging due to device limitations. In its current form, RCM seems of limited value for noninvasive follow-up of rosacea in clinical practice.反射式共聚焦显微镜（Reflectance Confocal Microscopy, RCM）可实现玫瑰痤疮患者皮损中蠕形螨（Demodex）的无创检测。目前尚无针对玫瑰痤疮严重程度的客观评分方法。本研究旨在评估RCM在玫瑰痤疮治疗过程中，用于监测蠕形螨、炎症及血管相关参数的临床价值。本研究纳入20例玫瑰痤疮患者，在接受16周外用伊维菌素治疗前、治疗期间及治疗后12周，分别开展临床评估与RCM检查。通过RCM检测，统计患者皮损内的螨数、炎症细胞数、表皮厚度以及血管密度与血管直径。将RCM检测特征与临床评估结果进行相关性分析。治疗后患者的炎症性皮损数量较基线显著减少。基线时80%的患者可检测到蠕形螨，治疗第16周时该比例降至30%，治疗后第28周时回升至63%。治疗期间患者皮损内的螨数显著降低，但未观察到炎症细胞数量、表皮厚度或血管参数出现明显变化。炎症性皮损数量与螨数之间的相关性较弱。所有RCM检测变量均无法有效预测临床治疗成功。RCM可通过检测蠕形螨的存在情况，实现对局部外用伊维菌素抗炎效果的监测。但受限于设备性能，准确量化螨数以及炎症与血管相关特征仍存在较大挑战。就当前的技术形态而言，RCM在临床实践中用于玫瑰痤疮的无创随访，其应用价值较为有限。