The possible role of skin surface lipid in rosacea with epitheloid granulomas

The examination was carried out in 50 rosacea patients (30 females and 20 males) in order to establish the connexion between skin surface lipids, infestation with Demodex folliculorum and previous local corticosteroid treatment with the appearance of epitheloid granulomas. Our analysis showed three types of histological conditions: 1) chronic dermatitis of the rosacea type was noted in 15 patients (30%); 2) granulomas composed of epitheloid cells was found in 16 patients (32%). In three female patients of this group presence of caseous necrosis associated with epitheloid granuloma was noted, too; 3) prevalence of perifollicular absceses was found in 19 patients (38%). Demodex folliculorum was detected in 43 rosacea patients (86%), considerably more then in the control group. The normal value of the skin surface lipids was found in 9 female rosacea patients (30%) and in 9 female controls (43%), in 8 male rosacea patients (40%) and in 5 males controls (33%). Lower amounts of skin surface lipids were found in 19 female rosacea patients (63%) and in 9 female controls (43%), in 4 male rosacea patients (20%) and in 1 male control (7%). Higher amounts of skin surface lipids were found in 2 female rosacea patients (7%) and in 3 female controls (14%), in 8 male rosacea patients (40%) and in 9 male controls (60%). Lower quantities of lipids determined a higher incidence of Demodex folliculorum in rosacea patients. Demodex folliculorum were also more frequently detected in patients who had previously been treated with topical corticosteroids (even in 91.9%), what was often followed by epitheloid granulomas. The treatment with tetracycline yielded good or excellent results in 90% of all the patients.