Zeitschrift für klinische und experimentelle Dermatologieforschung
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Increases in Psychological Stress Precede Flares of Rosacea: A Prospective Study

Peter D Drummond, Daphne Su

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.