Abstract
Objective: Psychological stress is thought to exacerbate symptoms of rosacea. However, this view is based largely on cross-sectional surveys and retrospective clinical reports. Thus, the aim of this study was to determine prospectively whether psychological stress precedes increases in symptom severity in patients with rosacea. Method: Twelve women and four men aged between 35 and 70 years who had been diagnosed with rosacea by a general practitioner or dermatologist filled out a rosacea symptom checklist and rated psychological stress daily for up to two months (mean ± SD, 59 ± 14 days). Each day, they recorded the presence of papules and pustules and rated the average intensity of facial redness, stinging or burning, and psychological stress between 0 (“none”) and 10 (“extreme”). Results: In 12 of the 16 patients, higher levels of stress were associated with more severe symptoms. This association was similar in summer and winter, and in medicated and un-medicated patients. In the group as a whole, stress ratings increased the day before facial flushing increased, and remained high when symptoms were severe. In addition, stress ratings were higher when stinging was severe than when stinging was mild. Conclusion: These findings support the view that psychological stress exacerbates symptoms of rosacea. Further studies are required to determine whether a surge of cutaneous blood flow associated with stress-linked flushing aggravates inflammation in vulnerable facial vessels, or whether stress hormones such as corticotropin releasing factor activate cutaneous mast cells which, in turn, release vasoactive and pro-inflammatory mediators into the skin. Neurogenic inflammation (characterized by stinging pain) might further intensify the inflammatory process when symptoms are severe, so that symptoms and distress escalate in a vicious circle. If so, psychological treatments such as cognitive-behavioural therapy might not only help to alleviate symptom-related distress but could also decrease the frequency and/or intensity of rosacea flares.
Highlights
Rosacea results from an inflammatory disorder that provokes persistent flushing and stinging of the cheeks, nose, chin or forehead
Stress ratings were higher when stinging was severe than when stinging was mild. These findings support the view that psychological stress exacerbates symptoms of rosacea
Further studies are required to determine whether a surge of cutaneous blood flow associated with stress-linked flushing aggravates inflammation in vulnerable facial vessels, or whether stress hormones such as corticotropin releasing factor activate cutaneous mast cells which, in turn, release vasoactive and pro-inflammatory mediators into the skin
Summary
Rosacea results from an inflammatory disorder that provokes persistent flushing and stinging of the cheeks, nose, chin or forehead. The flushing is often associated with acne-like facial papules or pustules, prominent facial capillaries, swollen sebaceous glands, skin thickening and ocular discomfort [1,2,3,4]. Psychological stress may evoke flares of rosacea, but this belief is founded on cross-sectional surveys and retrospective clinical reports that could be influenced by expectancy effects and/or recall biases [6,8]. In a recent population-based case-control study, having an affective disorder did not increase the risk of developing rosacea in subsequent years [9]. In a cross-sectional study that compared patients with rosacea or psoriasis to healthy controls, rosacea was not associated with personality traits that increased vulnerability to stress [10]
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callMore From: Journal of Clinical & Experimental Dermatology Research
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
