The potential signs and symptoms of rosacea manifest primarily on the central face (cheeks, chin, nose, and central part of forehead) and are often characterized by repeated remissions and exacerbations.1 Though rosacea is not a life-threatening disorder, its signs and symptoms are conspicuous, and the disorder often places a heavy burden on patients’ quality of life. A multitude of reports from over the last 15 years, including those documented in the National Rosacea Society (NRS) patient newsletter Rosacea Review, have provided evidence of rosacea’s adverse impact on emotional, social, and occupational well-being, many of which are in proportion to the severity of the disease.2-12
In terms of social effects, NRS surveys have noted that more than 90% of rosacea patients said their condition had lowered their self-confidence and self-esteem, and 41% reported that its effect on their personal appearances had caused them to avoid public contact or cancel social engagements.13,14
Surveys on occupational effects show that workplace interactions may be affected in various ways. In a 2000 survey of more than 700 rosacea patients, 66% of those with severe symptoms said rosacea had affected their professional interactions, and 33% had cancelled or postponed business meetings because of their appearance. Twenty-eight percent said they had missed work because of the condition, and 28% also said rosacea may have influenced their being chosen for a new job or promotion.15 In a 2015 survey of 794 rosacea patients, more than 75% of all respondents—and 92% of those reporting severe symptoms—said their rosacea had affected interactions with others in the workplace, with more than 66% saying rosacea had negatively impacted interactions with customers or coworkers.16
In a 2007 NRS survey of 603 patients on the emotional effects of rosacea, nearly half said it had diminished their outlook on life. More than 69% said they had experienced embarrassment, 65% reported feelings of frustration, and 41% experienced anxiety. Thirty-five percent said they had felt helpless, 25% experienced depression, and 18% felt isolated.17
Other quality of life impacts included refusing food or drink that they normally would enjoy for fear of triggering a rosacea flare-up,18 cited by 50% of 801 survey respondents; not participating in physical activities they would enjoy (37%); and avoiding new or different experiences (28%).
While the NRS surveys frequently uncovered specific reactions, recent studies in the literature show that the psychological, social, and occupational impacts of rosacea are often intertwined. One investigation found that facial erythema was strongly associated with poor health and negative personality traits, with participants reporting negative impacts of rosacea emotionally, socially, and in the workplace. Patients with rosacea were less happy with their skin appearance and struggled emotionally and socially, both at work and in their relationships, as a result of their condition compared with those without facial erythema.8
Likewise, researchers in France found that rosacea may lead to feelings of stigmatization, and noted that those individuals were more likely to avoid social situations and had a higher rate of depression.12 In another study of 195 rosacea patients at a university dermatology clinic, 33% reported some level of depression, and the investigators noted that depression is associated with poor adherence to treatment.19 Dirschka and coauthors8 noted that rosacea can be a socially stigmatizing condition, as people with facial erythema already have to cope with the common misconception that the symptom is due to excessive alcohol consumption.
Interestingly, negative psychological, social, and occupational impacts may be based on correct assessments of others’ opinions rather than misperceptions. In a survey of global perceptions, Dirschka and colleagues8 noted that those experiencing dermatological conditions also face potentially negative first impressions and judgments from others according to responses from 6831 survey participants. Their questionnaire showed that people with facial erythema are judged more negatively on first impressions and are thought of as less trustworthy, less reliable, and less confident, purely on the appearance of their skin. Negative first impressions were also reflected in negative views on their work potential and social life.
Adding to the stress experienced by patients with rosacea may be the discovery of the likelihood of comorbidities, as many recent studies have uncovered associations between rosacea and increased risk for a variety of systemic disorders, many with potentially serious outcomes.20 In various studies, researchers found an increased risk of cardiovascular disease, gastrointestinal disease, neurological and autoimmune disorders, and certain cancers among patients with rosacea.
Dermatologists have an important role to play in helping patients relieve rosacea’s negative psychological effects. Initially, physicians can provide an overview of the disease, letting patients know what to expect and how to deal with rosacea’s signs, symptoms, and exacerbations. Effective long-term therapy and care will not only help minimize symptoms but also alleviate stress by providing the patient with a measure of control.
Dermatologists’ expertise in diagnosing rosacea and identifying patients’ individual signs and symptoms is also key to relieving their psychological burden, as advances in medical therapy have made it increasingly possible to achieve clear skin, with an accompanying dramatic improvement in quality of life.
1. Gallo RL, Granstein RD, Kang S, et al. Standard classification and pathophysiology of rosacea: The 2017 update by the National Rosacea Society Expert Committee. J Am Acad Dermatol. 2018;78:148-155.
2. National Rosacea Society. Emotional toll of facial redness equal to bumps, pimples: survey. Rosacea Review. https://www.rosacea.org/rosacea-review/2013/fall/emotional-toll-of-facial-redness-equal-to-bumps-pimples-survey. Accessed March 19, 2019.
3. National Rosacea Society. Survey shows controlling stress can reduce flare-up frequency. Rosacea Review. https://www.rosacea.org/rosacea-review/2011/fall/survey-shows-controlling-stress-can-reduce-flare-up-frequency. Accessed March 19, 2019.
4. National Rosacea Society. Rosacea patients feel effects of their condition in patient setting. Rosacea Review. https://www.rosacea.org/rosacea-review/2012/fall/rosacea-patients-feel-effects-of-their-condition-in-social-settings. Accessed March 19, 2019.
5. National Rosacea Society. Rosacea can affect workplace interactions, survey reveals. Rosacea Review. https://www.rosacea.org/rosacea-review/2015/fall/rosacea-can-affect-workplace-interactions-survey-reveals. Accessed March 1, 2017.
6. Aksoy B, Altaykan-Hapa A, Egeman D, et al. The impact of rosacea on quality of life: effects of demographic and clinical characteristics and various treatment modalities. Br J Dermatol. 2010;163:719-725.
7. Su D, Drummond PD. Blushing propensity and psychological distress in people with rosacea. Clin Psychol Psychother. 2012;19:488-495.
8. Dirschka T, Micali G, Papadopoulos L, et al. Perceptions on the psychological impact of facial erythema associated with rosacea: results of international survey. Dermatol Ther (Heidelb). 2015;5:117-127.
9. Van der Linden MMD, van Rappard DC, Daams JG, et al. Health-related quality of life in patients with cutaneous rosacea: a systematic review. Acta Derm Venereol. 2015;spring:395-400.
10. Elewski BE. Results of a national rosacea patient survey: common issues that concern rosacea sufferers. J Drugs Dermatol. 2009;8:120-123.
11. Bewley A, Fowler J, Scho€fer H, et al. Erythema of rosacea impairs health-related quality of life: results of a meta-analysis. Dermatol Ther. 2016;6:237-247.
12. Haliou B, Cribier B, Frey M, et al. Feelings of stigmatization in patients with rosacea. J Eur Acad Dermatol Venereol. 2017;31:163-168.
13. National Rosacea Society. Rosacea Awareness Month highlights emotional toll. Rosacea Review. https://www.rosacea.org/rosacea-review/2014/spring/rosacea-awareness-month-highlights-emotional-toll. Accessed March 18, 2019.
14. National Rosacea Society. Awareness month alerts public to warning signs of rosacea. Rosacea Review. https://www.rosacea.org/rosacea-review/2006/summer/awareness-month-alerts-public-to-warning-signs-of-rosacea. Accessed March 18, 2019.
15. National Rosacea Society. Survey shows rosacea disrupts work for patients with severe symptoms. Rosacea Review. https://www.rosacea.org/rosacea-review/2000/fall/survey-shows-rosacea-disrupts-work-for-patients-with-severe-symptoms. Accessed March 18, 2019.
16. National Rosacea Society. Rosacea impacts work life, according to new survey. Rosacea Review. https://www.rosacea.org/rosacea-review/2000/fall/survey-shows-rosacea-disrupts-work-for-patients-with-severe-symptoms. Accessed March 18, 2019.
17. National Rosacea Society. Survey shows rosacea’s emotional toll, positive effects of medical therapy. Rosacea Review. https://www.rosacea.org/rosacea-review/2007/spring/survey-shows-rosaceas-emotional-toll-positive-effects-of-medical-therapy. Accessed March 19, 2019.
18. National Rosacea Society. Rosacea patients feel effects of their condition in social settings. Rosacea Review. https://www.rosacea.org/rosacea-review/2012/fall/rosacea-patients-feel-effects-of-their-condition-in-social-settings. Accessed March 19, 2019.
19. Alinia H, Cardwell L, Tuchayi SM, et al. Screening for depression in rosacea patients. Cutis 2018;102:36-38.
20. Gallo RL, Granstein RD, Kang S, et al. Rosacea comorbidities and future research: The 2017 update by the National Rosacea Society Expert Committee. J Am Acad Dermatol 2018;78:167-170.