A paper that I highlighted in January (see clinically measuring facial blood vessels) is now available as a full text web page and also as a PDF file.
Occasionally the Journal of the American Academy of Dermatology puts full text articles from an Issue up for free on their web site.
Given that we can now view the whole paper including photographs, it is worth revisiting this article.
The paper comes up with the conclusion that it is possible to discriminate rosacea from seborrheic dermatitis and those with healthy skin by accurately measuring the facial blood vessels.
Videocapillaroscopic alterations in erythematotelangiectatic rosacea (or as a PDF) Journal of the American Academy of Dermatology,
Volume 54, Issue 1, January 2006, Pages 100-104.
Outline
There are currently no objective measures or laboratory tests for assessing and monitoring the severity of rosacea, which rests only on clinical judgment. Most studies on rosacea have utilized subjective assessment of severity, sometimes supplemented by photographs or, in a few instances, measurements of color or hue. The development of instrumental techniques is obviously important for a more reproducible disease assessment and may allow a more rigorous comparison between studies, especially on drug efficacy. Erythema and telangiectases have been measured indirectly by assessing color changes. Capillaroscopy has been considered superior to indirect technique (eg, laser-Doppler, transcutaneous Po2) for the clinical investigation of cutaneous microcirculation in various skin diseases.
In this study, we have used the videocapillaroscopic technique to evaluate qualitative and quantitative microvessel alterations of facial rosacea and compared them with those of seborrheic dermatitis. Our results indicate that videocapillaroscopy may represent a valid adjunctive method in the early identification and measurement of erythematotelangiectatic rosacea.
Discussion
Capillaroscopy is widely used on the nailfold region to diagnose and monitor rheumatologic diseases (scleroderma, dermatomyositis) and to distinguish primary from secondary Raynaud’s phenomenon. More recently, capillaroscopy has been used to study the dynamics of microcirculation and to quantitate microvessel abnormalities in psoriasis. In this study, we used videocapillaroscopy to characterize and provide objective measures of vessel changes in erythematotelangiectatic rosacea. Facial rosacea was found to present characteristic alterations of skin vessels, with a pattern distinct from that of facial seborrheic dermatitis. In particular, neoangiogenesis, larger polygons, more prominent telangiectases, and larger vessel diameter was observed only in rosacea, whereas seborrheic dermatitis displayed polygon irregularities and vessel tortuosity. In contrast, no alterations were found in the nailfold region, suggesting that rosacea specifically affects the facial microvasculature.
Therapy for rosacea is directed primarily at reducing overall erythema, and many therapies are expected to only marginally alter telangiectases. Therefore objective evaluation of erythema in rosacea is very important. In this study, erythema was assessed in a 2-color arbitrary scale, as videocapillaroscopy is not suitable for measuring this parameter. Nonetheless, videocapillaroscopy is a noninvasive and easily repeatable technique that can disclose specific and measurable vessel alterations in the skin affected by erythematotelangiectatic rosacea and that may thus represent a valid adjunctive method in the early diagnosis and measurement of this common disorder.
