Psychophysiological aspects of rosacea

Rosacea is a chronic and progressive disorder characterized by extremely sensitive skin, burning and stinging sensations, and persistent flushing of the cheeks, nose, chin or forehead accompanied by acne-like facial papules or pustules (Elewski et al., 2010; Wilkin, 1994). Primary diagnostic features include one or more of the following signs: frequent transient flushing; persistent redness; papules and pustules; and prominent facial capillaries. Secondary features may include: burning or stinging sensations; elevated red plaques; rough and scaly ‘dry’ skin; facial swelling; ocular discomfort; lid inflammation and red eyes; and skin thickening (Wilkin et al., 2002). A standard classification system for rosacea, developed by the National Rosacea Society Expert Committee on the Classification and Staging of Rosacea, lists four subtypes: erythematotelangiectatic rosacea, characterized by persistent flushing, central facial redness and small blood vessels near the surface of the skin; papulopustular rosacea, characterized by persistent facial redness and red bumps (papules), some filled with pus (pustules); phymatous rosacea, associated with thickened skin, particularly around the nose (rhinophyma); and ocular rosacea, where the main features are red, dry irritated eyes and eyelids (Wilkin et al., 2002). Patients may have more than one subtype, or may progress from one subtype to another. As flushing often aggravates other symptoms of rosacea, many people with rosacea avoid vasodilator agents such as alcohol and foods high in histamine or nitrate content or that are highly spiced. They also avoid soaps, lotions and creams that irritate the skin or that dilate blood vessels directly, exercise, exposure to environmental stimuli that increase skin blood flow (e.g., extremes of heat or cold, strong winds and sunlight), and psychological factors that may aggravate symptoms (e.g., stress, anxiety and emotions such as anger and embarrassment) (Culp & Scheinfield, 2009; Scharschmidt et al., 2011). They may also avoid interacting with other people due to concerns about their appearance. Not surprisingly, then, the symptoms of rosacea can impact severely on self-esteem and quality of life