Rosacea is a chronic skin condition that leads to redness, flushing and sometimes deformity of the face. Stress and other psychological factors such as a propensity for embarrassment are considered potential causes as well as exacerbators of the condition.
One study2 examined data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Care Survey to investigate whether rosacea is related to depression or alcohol use. Analysis of over 608 million dermatology visits that took place between 1995 and 2002 showed that individuals with rosacea were almost five times more likely to have depression than people without the condition. No such association was observed between rosacea and alcohol use.
Another investigation assessed whether frequent blushing or embarrassment was related to rosacea symptoms. This analysis3 included the following five studies:
The first study explored the propensity to blush among patients with type 2 rosacea. The results of five social anxiety scales showed that, compared to individuals without rosacea, sufferers of the condition were significantly more likely to blush more frequently and more intensely and to experience stress. They were not more likely to suffer from depression, anxiety or fear of negative evaluation.
The second and third study evaluated participants' vascular response when they were stimulated to have rosacea "flares-up". The second study achieved this through the administration of acetylcholine, which triggered an increased axon reflex response among type 2 rosacea patients. Interestingly, cutaneous endothelial responses remained similar between subjects and controls, suggesting that neural pathways rather than cutaneous vascular function are responsible for regulating blushing. The third study compared blood flow to the face when participants completed tasks designed to trigger embarrassment such as public speaking or singing. Type 2 rosacea sufferers were found to blush more intensely and reported higher embarrassment levels than type 1 rosacea sufferers and controls.
The two studies together, suggest a combination of physiological and psychological elements to the increased facial blood flow seen in Type 2 rosacea.
The fourth study examined the association between psychological indicators and rosacea symptoms. Fifteen rosacea patients who were asked to record their daily stress, anxiety and mood levels as well as the intensity of their rosacea symptoms, reported increased facial redness and stinging on the same day they experienced stress, an association that occurred over a period of two months. Anxiety and low mood or depression were not found to be associated with exacerbation of rosacea symptoms.
The fifth study evaluated the benefits of cognitive behavioural therapy and task concentration training in rosacea patients who suffered from social phobia, low self esteem and social anxiety leading to increased blushing. Results showed that patients with rosacea benefited from these approaches in managing their stress, anxiety and fear of blushing.
Reviewed by Sally Robertson, BSc