Rosacea Psychology - What to do about it?
and editorial by Brady Barrows
Please note: In my book, Rosacea 101, I wrote a chapter based on this editorial and you can read this in my book on page 25.
One of the theories of the pathophysiology of rosacea is psychological. More info
"The comorbidity between major depressive disease and rosacea may have important clinical implications." source
At the very least, psychological factors, particularly stress, can aggravate rosacea. Researchers have written reports on this subject. Many anecdotal reports from rosacea groups confirm that stress worsens this condition.
RosaQoL is one of the first QoL reports on rosacea.
One report done in 2002 on this subject puts the matter clearly, "Dermatoses may have a significant impact on a patient's quality of life, namely the relationship to others, self-image and self-esteem.' source The same report concluded, "Improvement of quality of life reached statistical significance among patients with acne (2.8 versus 7.8, p = 0.0078) and among individuals with a less severe initial impairment of quality of life (2.4 versus 4.2, p = 0.007)."
It has been stated that in "some cases, rosacea patients are so psychologically disturbed that that they may be unable to form a therapeutic alliance with their dermatologist or other skin specialist. In such cases, psycho-tropic medication and/or psychological therapy are essential." source
Another source says, "The problem is that many dermatologists are operating in the dark when it comes to how badly rosacea might be impacting their patients' quality of life." source However, another report says just the opposite, and states, "In treating patients with rosacea, we are well aware of the psychological effects of this disease, and the depression, anxiety and social isolation it can cause," but both reports substantiate the psycological factors. source
No one likes to think that rosacea is all in our mind, yet, there is evidence that at the very least your mind can aggravate this disease. Could rosacea have a psychological factor? One report says, "Recalcitrant dermatoses may be a manifestation of a symbolic transition object. Psychologically, the patient uses his skin eruption to assure himself that he is a separate person with his own boundaries." source
A whole field of medicine, psychodermatology or psychocutaneous medicine, addresses this aspect of rosacea and how experts in the field may be of help to some rosaceans. One article on the subject encourages health care practioners to consider their role in the treatment of a skin disease saying, "Quoting W. Mitchell Sams, Jr., 'although the physician is a scientist and clinician, he or she is and must be something more. A doctor is a caretaker of the patient's person--a professional advisor, guiding the patient through some of life's most difficult journeys. Only the clergy share this responsibility with us.' This commitment is and must always be the guiding force in the provision of comprehensive and compatient patient care." source
This is very important to a rosacean because if a physician is not trusted then this can have a detrimental effect on treatment. Note what this article pointed out:
"If the dermatologist allows the contemptuous patient to use his disdain to discredit him, the patient loses, for he can no longer respect his doctor." source If the physicians 'bed side manner' is not respected by the rosacea patient this can damage the treatment. Many rosaceans complain how physicians seem to have little compassion for their problem or little time to listen, moving quickly on to the next patient, sending a message of disinterest in the individual's feelings. Trusting your physician or treatment has a huge impact on whether the treatment works. When rosaceans find a treatment doesn't work and this happens over and over again, depression can set in and disappointment in a health care practioner, treatment or regimen can be affected. This can add stress to an already frustrating emotional mental state triggered by rosacea!
One study showed that "patients who were prescribed combination therapy had significantly greater improvement than those who were prescribed azelaic acid gel alone," which was a study designed "to examine both the short-term clinical efficacy and quality-of-life changes resulting from treatment of rosacea with regimens that reflect the participating physicians' standards of care while incorporating azelaic acid gel." source
Another psychological effect not to underestimate is the placebo effect, which has been researched extensively. One paper says, "Potential biological mechanisms for the placebo response are discussed, including the possibility of genetic predisposition to be a placebo responder." source While this editorial doesn't go into the placebo effect, this often misunderstood mystery is worth mentioning here since it is a psychological factor in rosacea. More on the placebo effect.
Several research papers conclude that emotional and psychological factors are involved in skin diseases. One report done in 2005 says:
"CONCLUSIONS: (1) Patients with rosacea in the period before the occurring of first symptoms of the disease, comparatively with persons from the control group, they experienced the bigger number of critical life events. (2) The stress intensity resulting from the number of critical life events, is significantly higher at sick people in the relation to the control group. (3) At patients with rosacea emotions resulting of the estimation of the primary stressful situation tightening symptoms of the disease. (4) The subjective estimation of patients' health is essential predicate of psychodermatological therapy releasing potential health possibilities at the patient." source
Another report in 2005 about quality of life says, "Change in Investigator's Global Assessment score, measuring the severity of rosacea symptoms, from baseline to follow-up, and change in scores on the RosaQoL, a rosacea-related quality-of-life instrument with 4 component measures (Overall, Emotion, Symptom, and Function) completed by patients at both baseline and follow-up. RESULTS: Over the course of treatment, the mean Investigator's Global Assessment score dropped from 3.52 to 2.10 (P < .0001)." source
One report in 1986 on anxiety and skin problems said, "The test results proved a marked correlation between psychological factors and the activity of the adrenergic system. High level of activity, emotional unstableness, as well as tendencies to neurotic activities are connected with increased secretion of adrenaline and decreased secretion of noradrenaline++ and dopamine." source
What to do about it?
(1) Obtain a Skin-emotion Specialist you trust
This may be "may be a psychiatrist, psychologist, social worker, biofeedback therapist, or other mental health or behavioral specialist," or you may be able to work through your own emotions by careful study and meditation of any of the psychological factors that may be triggering your rosacea. Having a caring someone who listens and gains your trust is worth ten skin care specialists. source
(2) Read John Sarno's books on healing - Sources > 1 • 2 •
(3)Cosmetics can have a postitive effect on rosacea and improve over all self-esteem and quality of life. source • Skin camouflage •
Rosacea and Personality
Erik Karlsson1; Mats Berg2; Bengt Arnetz3
Source: Acta Dermato-Venereologica, Volume 84, Number 1, December 2003, pp. 76-77(2), Publisher: Taylor and Francis Ltd
In 1947, Moloney noted that acne patients experienced increased self-consciousness.
See: Lucas CJ. Personality of students with acne vulgaris. BMJ 1961; 5:354-356.
In 1957, Geist used the same MMPI test, Rorschach (inkblot test) and the "draw a person test" to compare five categories of skin disorder.
See: Gesit H. Emotional aspects of dermatitis. J Clin Exp Psychopathol 1957; 18:87-92.
1961 Acne Personality Study
Findings of the Lucas study which claimed a relationship between neurosis and acne
1945, Cohen used Lowenfield's Mosaic Test (a psychological test) but was unable to demonstrate any differences between the personalities of soldiers with acne and controls.
See: Cohen EL. Psychogenic factors in acne. Br J Dermatol 1945; 57:48-57
In 1949 Halliday reported increased obsessional behaviour and feelings of inadequacy, leading to difficulty in social situations.
See: Lucas CJ. Personality of students with acne vulgaris. BMJ 1961; 5:354-356.
In 1951, Whittkower published a detailed study of 64 cases, describing four classes of personality among acne sufferers.
See: Wittkower E. Acne vulgaris: a psychosomatic study. Br J Dermatol 1951; 63:214-223.
