Rosacea: comorbidities and psychosocial health

Agnė Bubilaitė1, Laura Krupelytė1

1 Lithuanian University of Health Sciences. Academy of Medicine. Faculty of Medicine.


Rosacea is a chronic inflammatory disease of the skin with a prevalence of 2 to 22% in Europe and the United States. Rosacea affects central part of the face, including the cheeks, chin, nose, central part of the forehead and is characterized by transient or persistent erythema, telangiectasias, papules and pustules. The pathophysiology of rosacea is not fully understood, but it is thought that cumulative ultraviolet radiation, alcohol consumption, smoking and genetic predisposition play a significant role. Patients affected by rosacea may have congenital immune system disorder – higher levels of vasoactive and inflammatory peptide cathelicidin in blood serum and damaged tissues is detected. Skin microflora may also play an important role – in patients with rosacea, a higher density of Demodex folliculorum is found comparing to healthy subjects. Moreover, in rosacea pustules there are a higher growth of Streptococcus epidermidis compared to healthy skin. There is an evidence of rosacea comorbidities. It is known that rosacea patients are at higher risk for ulcerative colitis and Crohn’s disease. Due to similar pathogenesis to those of neurodegenerative diseases, rosacea patients are at significantly higher risk for Alzheimer’s disease, especially in subjects aged 60 years and older. Moreover, in patients with rosacea there is a higher incidence of migraine. Compared to healthy population people affected by rosacea have a higher risk of dyslipidemia, coronary artery disease and hypertension. Although rosacea has been associated with systemic diseases, it is not clear whether rosacea is the cause or the consequence of these diseases. The appearance of the face skin is very important for the person’s self-confidence and for communicating with others. Rosacea adversely affects the psychosocial health – patients experience low self-esteem, underestimate their overall health and are at greater risk of depression and anxiety disorders. It is known that self-perception depends on the severity of the rosacea – satisfaction with facial appearance significantly decreases, feelings of unattractiveness to others increases. Significant improvements in quality of life are only observed after effective treatment. In conclusion, it is important to assess the psychological state of the patient, to reduce the symptoms and progression of the disease and to improve quality of life. Deeper understanding of rosacea may help to identify possible comorbidities and to provide better care for the patients.

Keywords: rosacea, systemic diseases, depression, anxiety disorder