Psychodermatology and Rosacea
Dr Livia Soriano & Dr Anthony Bewley
Rosacea is a common persistent facial skin disease. Signs and symptoms of rosacea include red or pus-filled spots, dilated blood vessels, facial redness which can resemble blushing, and in some cases, it can be disfiguring. It tends to begin between 30 and 60 years of age and persists in later life.
Symptoms can be worsened by regular day-to-day activities such as drinking hot caffeinated drinks, alcohol, eating spicy foods, staying in hot environments and under direct sunshine. Its impact on one’s quality of life results in psychological stress, and over time it impairs an individual’s emotional well-being.
Patients with rosacea have higher rates of depression, anxiety and embarrassment compared with the rest of the population. (1) The presence of depression is often not related to the objective severity of rosacea, rather in individuals who perceive their condition to be severe. (2) Psychological distress is common in patients who are anxious about social consequences of facial redness and blushing, and relates to feelings of stigmatization, reducing self-esteem and self-confidence. (3) (4) Patients affected by rosacea often find that it affects their social activities, work, diet, exercise and even sleep. Symptoms can lead individuals to avoid public contact, cancel social engagements, and resign from work. It is important to recognize the impact of rosacea on one’s emotional well-being and seek help. (5)
Currently, there is no permanent cure for rosacea, but symptoms can be controlled by avoiding triggering factors and by using medication. Treatments are targeted to the different forms of the disease, and often a combination of treatments is recommended. For example, red spots can be treated with anti-inflammatory agents such as ivermectin cream, oral doxycycline or isotretinoin tablets. Dilated blood vessels can be treated with ND:Yag or Pulse Dye Laser, and redness can be controlled with brimonidine gel. Cosmetic camouflage can also be used to conceal redness and irregularities of the skin and has been shown to provide emotional benefit for individuals with skin conditions. (6) (7)
As rosacea often affects a person’s emotional health, an assessment of an individual’s psychological well-being and appropriate treatment is also recommended. Psychological treatments are tailored to a patient’s individual needs, which include oral medications and talking therapies such as cognitive behavioural therapy, which is helpful for managing social anxiety in patients with a fear of blushing (4).
A psychodermatology clinic enables access to both skin and psychological expertise and treatments. Management of patients in this clinic is recommended for patients with skin conditions with mental illness, from both patient and cost perspective. (8) Where a patient suffers from depression or anxiety associated with rosacea, referral to a psychodermatology clinic is recommended.
Talking to other individuals with similar experiences can also help one cope with rosacea. Online support groups available such as the Skin Support Group, Talk Health Partnership, Rosacea Support Group and National Rosacea Society can provide emotional support and advice. It is important to realise that you are not alone and there is hope for recovery.
Dr Livia Soriano is a Clinical Fellow in Dermatology at Barts Health NHS Trust, London.
Dr Anthony Bewley is a Dermatology Consultant at Barts Health NHS Trust, London.
- Moustafa F, Lewallen RS, Feldman SR. The psychological impact of rosacea and the influence of current management options. J Am Acad Dermatol. 2014 Nov;71(5):973-80.
- Abram K, Silm H, Maaroos HI, Oona M. Subjective disease perception and symptoms of depression in relation to healthcare-seeking behaviour in patients with rosacea. Acta Derm Venereol. 2009;89(5):488-91.
- Halioua B, Cribier B, Frey M, Tan J. Feelings of stigmatization in patients with rosacea. J Eur Acad Dermatol Venereol. 2017 Jan;31(1):163-168.
- Su D, Drummond PD. Blushing propensity and psychological distress in people with rosacea. Clin Psychol Psychother. 2012 Nov-Dec;19(6):488-95.
- Dirschka T, Micali G, Papadopoulos L, Tan J, Layton A, Moore S. Perceptions on the Psychological Impact of Facial Erythema Associated with Rosacea: Results of International Survey. Dermatol Ther (Heidelb). 2015 Jun;5(2):117-27. doi: 10.1007/s13555-015-0077-2.
- Mikkelsen CS, Holmgren HR, Kjellman P, Heidenheim M, Kappinnen A, Bjerring P, Huldt-Nystrøm T. Rosacea: a Clinical Review. Dermatol Reports. 2016 Jun 23;8(1):6387. eCollection 2016.
- Levy LL, Emer JJ. Emotional benefit of cosmetic camouflage in the treatment of facial skin conditions: personal experience and review. Clin Cosmet Investig Dermatol. 2012;5:173-82.
- Altaf K, Mohandas P, Marshall C, Taylor R, Bewley A. Managing patients with delusional infestations in an integrated Psychodermatology clinic is much more cost effective than a general dermatology or primary care setting. Br J Dermatol. 2016 Sep 28. doi: 10.1111/bjd.15088.