The progression of rosacea is waxing and waning in nature, with episodes of "flare-ups" followed by periods where the sufferer is relatively symptom free.
There are several triggers that may worsen symptoms of the condition including, amongst others, sun exposure, spicy food and vigorous exercise. Another factor that is known to exacerbate rosacea symptoms is stress.
Just the facial redness associated with rosacea can itself cause a flare-up of symptoms due to the anxiety, self esteem issues, embarrassment, and fear of socializing it may cause. In addition, redness and flushing of the face is commonly perceived as a manifestation of alcoholism, a fact which can cause rosacea sufferers to feel acutely embarrassed and, in turn, exacerbate their symptoms.
One study1 showed that patients with rosacea were more likely than controls to have experienced a greater number of critical life events (defined as an event causing challenge, loss or danger) before presentation of the first rosacea symptom. Furthermore, the intensity of stress rosacea patients experienced in response to the increased number of such events was higher than in controls.
Another investigation assessed whether stress and embarrassment are important triggers for rosacea flareups2. The analysis included the following five studies:
In the first study, the propensity to blush was assessed in 62 participants. The results of five social anxiety scales showed that individuals with rosacea were significantly more likely to blush more frequently and intensely and to experience stress than individuals without the condition. Rosacea sufferers were not more likely to experience depression, anxiety or fear of negative evaluation.
In the second study, the participants' vascular response when stimulated to have a "flare-up" was evaluated. This was achieved with the administration of acetylcholine, which triggered an increased axon reflex response in individuals with Type 2 rosacea. However, the administration of acetylcholine did not cause a difference in the cutaneous endothelial responses between subjects and controls, suggesting that neuralpathways rather than changes in the blood vessels of the skin are responsible for regulating blushing.
The third study compared facial vessel blood flow among participants while they performed tasks designed to trigger embarrassment such as public speaking or singing. Individuals suffering from type 2 rosacea were found to blush more intensely and to experience greater degrees of embarrassment than individuals with type 1 rosacea and controls.
The fourth study explored the relationship between rosacea symptoms and psychological indicators. Fifteen patients with rosacea maintained records of their stress, anxiety and mood as well as the intensity of their rosacea symptoms. Results showed a positive correlation between stress and increased facial redness and stinging but no such association between these rosacea symptoms and depression or anxiety.
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.