Patients with Rosacea Experience Higher Levels of Anxiety, Depression

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Patients with rosacea face substantial psychological and emotional challenges, with disease severity emerging as a major predictor of poor outcomes.

The physical manifestations of rosacea — facial redness, lesions and disfigurement — can significantly impact a patient’s quality of life, self-esteem and psychosocial functioning. These patients can also develop psychiatric comorbidities. Results from a meta-analysis of more than 100 million patients with rosacea revealed the condition was significantly linked to anxiety and depression, indicating that patients with rosacea are more likely to develop these psychological conditions than the general population.

“Clinicians must consider the psychological impact of rosacea and provide appropriate support and treatment for their patients,” wrote a team of investigators led by Khaled Seetan, MBBS, associate professor of dermatology at Yarmouk University, Jordan.

To evaluate the health-related quality of life and emotional well-being of patients with rosacea compared with that of healthy individuals, investigators conducted a case-control study between September 2022 and November 2023 at a government secondary hospital in northern Jordan.

A total of 198 patients and 198 controls matched for age and sex were recruited into the study. Eligible patients were adults with a clinical diagnosis of rosacea and disease duration of at least 3 months. The mean age of patients was 37 years, and 75% of the sample was female.

Health-related quality of life was measured using the Dermatology Life Quality Index (DLQI), and depression and anxiety were assessed using the Hospital Anxiety and Depression Scale (HADS). The Clinician’s Erythema Assessment (CEA) grading system evaluated disease severity.

Patients with rosacea reported significantly lower quality of life (higher DLQI scores) than the controls. The distribution of DLQI grades varied significantly between groups, with 85% of controls classified as Grade 1 — indicating a small effect on patients’ life — compared with only 11% of patients. Conversely, 60% of the patient cohort were classified as Grade 3-5, which implies a “very large, extremely large or unbearably large” effect of the disease on a patient’s quality of life.

Patients reported a considerably reduced quality of life across DLQI subscales, including daily activities, symptoms and feelings, work and school, personal relationships, leisure and treatment. The most significant differences were observed in the symptoms/feelings and performance of daily activities subcategories, which supports previous research revealing flushing and facial redness induces distress across geographic regions and cultures.

These patients also reported higher levels of anxiety and depression than the controls. Moderate or severe anxiety was present in 57% of rosacea patients compared with 28% of controls, and 31% experienced moderate or severe depression compared with 13% of controls. Higher disease severity was strongly associated with reduced quality of life and increased anxiety and depression. Patients with clear rosacea exhibited the lowest mean DLQI and anxiety scores.

Female patients were more vulnerable, while longer disease duration had a protective effect on emotional outcomes. Patients with a disease duration of longer than 3 years had significantly lower anxiety scores compared with those with a shorter duration.

Investigators mentioned recruiting patients and controls in a hospital setting may have limited generalizability of the results, particularly among those who were not receiving medical care. Additionally, they were unable to assess possible confounding influences, such as stress levels and lifestyle factors. They emphasized that longitudinal studies would help to assess the temporal relationship between rosacea and psychological distress.

“These findings emphasize the need for routine psychological screening and a holistic treatment approach, particularly for newly diagnosed patients with severe disease manifestations,” investigators concluded.