When Redness Makes You Blue

Monday, April 2, 2012

"It would be hard to invent a more embarrassing disease than rosacea," said Dr. Ted Grossbart, a psychologist at Harvard Medical School. "It affects the one part of the body that cannot be hidden — the face — and tends to strike people at a time in life when they may be increasingly self-conscious about changes in their appearance. Moreover, especially because this condition is not widely understood, it can leave its victims feeling isolated and even alienated from society."

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In new NRS surveys, 69 percent of rosacea patients said they experienced a flare-up related to emotional stress at least once a month, and more than 90 percent of the respondents said they had suffered some form of physical pain from their condition. A burning sensation was the most commonly reported discomfort, named by 75 percent, followed by itching, cited by 65 percent, and stinging, mentioned by 62 percent. Other types of pain associated with rosacea included swelling (44 percent), tightness (42 percent), tenderness (40 percent), tingling (31 percent), prickling (23 percent) and headache (20 percent).

Perhaps even more ravaging than its physical effects, rosacea often inflicts significant damage to people’s emotional, social and professional lives.

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“While rosacea is a long-term disorder and there is no cure, the good news is that it can be effectively controlled with medical therapy and lifestyle modifications,” Dr. Granstein said. “This can substantially improve the quality of people’s lives.”

The article summarise what we all know, that rosacea can be pretty debilitating on both a physical and emotional level. Although it doesn’t offer any direct advice for dealing with a red angry face, it does link to their medical therapies page which has a high level run down of treatment options. “See your dermatologist” seems to be the NRS’s best advice.

Helpful Articles

• RSRP: Rosacea and Psychology: Peter D. Drummond, PhD, & Daphne Su, DPsych
• Feeling depressed about rosacea ? get some help here
• Rosacea Psychology questions answered

The trial found that Niacin, which is known to induce a facial flush, actually causes more flushing in people that worry about what others think of them.

By blinding participants to whether they were given Niacin or placebo, and measuring facial blood flow, and further interviewing all participants, the trial was able to show that participants who worry more about what others think of them will also flush more.

Researchers call this `worry more’ condition an Elevated Fear of Negative Evaluation.

What Does This Mean?

I take this to further confirm that for some sufferers of facial flushing, Cognitive Behavioural Therapy may be a useful treatment method.

The effect of niacin on facial blood flow in people with an elevated fear of negative evaluation.

Eur Neuropsychopharmacol., 2011 Aug 17., Drummond PD, Lazaroo D.

The vasodilator niacin may provoke greater facial flushing and other symptoms of anxiety in patients with social anxiety disorder than in non-anxious controls. To determine whether this also applies in non-clinical samples, niacin (100mg) or placebo was administered double-blind to 33 young adults and flushing was investigated in relation to fear of negative evaluation (a cardinal feature of social anxiety).

Increases in facial blood flow were greater in people with high than low fear of negative evaluation in the niacin condition, but were similar in both groups in the placebo condition. However, changes in pulse rate and ratings of embarrassment, anxiety, blushing and facial heat were similar in both groups in both drug conditions.

These findings suggest that the facial vessels of people with a heightened fear of negative evaluation are particularly responsive to niacin under conditions of low anxiety and embarrassment.

Keywords: Facial blood flow; Vasodilatation; Niacin; Fear of negative evaluation; Social anxiety

We also know from Blushing Propensity and Psychological Distress in People with Rosacea that the stress and fear of blushing can be mitigated by psychological intervention such as Cognitive Behavioural Therapy and Task Concentration Training.

Related Articles

• Flushing: it’s all in your nerves and emotions
• Do Naturopathic or Homeopathic treatments work for rosacea ?
• Sympathetic Nervous System: interview with Peter Drummond
• Test Your Fear of Negative Evaluation

As well any physical symptoms such as facial burning, blurred vision and debilitating flushing, the secondary worries about what others will think about your appearance make it tough for rosacea sufferers at work.

Will others think that if you can’t get your `acne face’ under control that something is wrong and pass you over when thinking about promoting you on merit? We would all like to think that this doesn’t happen, but what about the reality of it?

This survey suggests that the vast majority of those who suffer from severe rosacea do suffer negative effects in their career and in their relationship to their workplace.

Rosacea Takes Toll on Sufferers in the Workplace, Survey Shows

BARRINGTON, Illinois (June 1, 2011) — Unless effectively controlled, rosacea can play havoc on job interactions and employment, according to a new survey by the National Rosacea Society (NRS) on the impact in the workplace of this red-faced, poorly understood disorder now estimated to affect more than 16 million Americans.

In the survey of 1,134 rosacea patients, 60 percent of all respondents and 88 percent of those reporting severe symptoms said the disorder had negatively affected their interactions with others in the workplace. Among those with severe symptoms, 51 percent said they had even missed work because of their condition.

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In the new survey, 69 percent of all respondents and 87 percent of those with severe symptoms said they had noticed others staring at their face when they were experiencing a rosacea flare-up. Forty-five percent of all respondents, including 66 percent of those with severe symptoms, had also heard rude or inappropriate comments in the workplace about their facial appearance.

Of the survey respondents who were affected by rosacea in the workplace, 78 percent said effective medical treatment had improved their professional interactions with others.

Does Rosacea Hold You Back at Work?

Does your rosacea cause problems for you at work, or finding work? Any tips for covering up?

How about the other way round; Is your workplace bad for your Rosacea?

Related Articles

• Does Using a Computer Screen Worsen Rosacea Symptoms ?

Being a teenager can be tough. Being a teenager with bad skin and good mental health can be even tougher.

If this study bears out in the larger population, then it is worth knowing that acne alone can be responsible for teenagers, most especially boys, thinking about suicide.

Suicidal Ideation, Mental Health Problems, and Social Impairment Are Increased in Adolescents with Acne: A Population-Based Study

Journal of Investigative Dermatology (2011) 131, 363–370;

Jon A Halvorsen, Robert S Stern, Florence Dalgard, Magne Thoresen, Espen Bjertness and Lars Lien

We performed a cross-sectional, questionnaire-based study to explore the relationship of suicidal ideation, mental health problems, and social functioning to acne severity among adolescents aged 18–19 years. A total of 4,744 youth were invited and 3,775 (80%) participated. In all, 14%reported having substantial acne (a lot and very much). Among those with very much acne, as compared those with no/little acne, suicidal ideation was twice as frequently reported among girls (25.5 vs. 11.9%) and three times more frequently reported among boys (22.6 vs. 6.3%). Suicidal ideation remained significantly associated with substantial acne (odds ratio 1.80, 95% confidence interval 1.30–2.50) in a multivariate model including adjustments of symptoms of depression, ethnicity, and family income. Mental health problems, as assessed by the Strengths and Difficulties Questionnaire (2.25, 1.69–3.00), low attachment to friends (1.52, 1.21–1.91), not thriving at school (1.41, 1.12–1.78), never having had a romantic relationship (1.35, 1.05–1.70), and never having had sexual intercourse (1.51, 1.21–1.89) were all associated with substantial acne in a multivariate model. Acne is frequently found in late adolescence and is associated with social and psychological problems. Adverse events including suicidal ideation and depression that have been associated with therapies for acne may reflect the burden of substantial acne rather than the effects of medication.

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In this study, we could not directly address the claim that isotretinoin intake increases suicidal ideation and depression.

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Although psychiatric difficulties are the main risk factor for suicide (Bridge et al., 2006), lack of attachment to friends and family is also associated with increased suicide risk (de Jong, 1992; Ledgerwood, 1999). In our study, the separate introduction of social variables (relation with family and friends, thriving at school, bullying, and experience with romantic relationships and sexual intercourse) in the multivariate model did not change the association between acne and suicidal ideation. As such relationships are important for many adolescents, these findings further strengthen our suggestion that acne is an independent risk factor for suicidal ideation.

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Our study demonstrates and quantifies the association of reported acne to increased risk of suicidal ideation, mental health problems, and social impairment in a large population-based sample. Acne may influence life in a large number of adolescents in the community, as seen in the percentage of increase, even though the relative increase reflected in the Odds Ratios is quite modest. Especially relevant is the 80% higher level of suicidal ideation in adolescents with substantial acne than among those with no/little acne, independent of symptoms of depression, ethnicity, and family income in this population with low use of isotretinoin. Our results are helpful for clinicians, as subjective complaints are important when choosing treatment. Furthermore, these findings have public health implications because they underscore the need of appropriate health care for adolescent boys and girls in the community.

Related Articles

• Feeling depressed about rosacea ? get some help here
• Rosacea sufferers have more anxiety and depression
• Rosacea can make sufferers life miserable
• Anxiety, depression and being obsessed with your skin

Having the resource of the internet  for health issues is a good thing. The internet becomes a bitter pill when all manner of rare and severe cases become confusing to those seeking information. The worst outcomes for rosacea sufferers is quite rare, the vast majority of rosacea sufferers achieve good relief. It is worth remembering this when you surf the internet for information.

Some good advice here also; find a GP that you trust and work with them.

Confessions of a hypochondriac

Health anxiety, By Louise Carpenter, The Observer, Sunday 17 January 2010

‘What right have I to complain in the face of real suffering? If you find yourself thinking this as I tell my story, then I can only say I have thought it a million times myself’

For the past five years, at the very least, there has been something in my life I have tried to deny. I have hidden it from others, or at least I thought I had – they would tell a different story – and I have tried to deny it to myself. But if I’m honest, it has always been there in one way or another, born in my adolescence and nurtured to strength by middle age and by motherhood. I can say two things with equal certainty: the first is that I cannot remember with any real clarity what it feels like not to worry, sometimes obsessively, about my health; the second is that acknowledging this causes me great shame. If the conscious, unspoken refrain in my head has been, at fairly frequent intervals, the absolute certainty of the end of my functioning life as I know it, its counterpoint has been to reproach and chastise myself for such self-indulgent introspection.

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John Naish, in his book The Hypochondriac’s Handbook: A Disease for Every Occasion, An Illness for Every Symptom, points out how modern sanitation and medicine have eliminated the old dangers, but modern civilisation has given us more time, money and energy to fixate on illness. There has been a huge drop in mortal illness in the western world, but a massive increase in new diagnoses. As these new "illnesses" emerge, they are over-reported and given disproportionate significance.

There have been two other major shifts in society. The first is the rise of the internet, which has spawned "cyberchondria". Health is now the second-most popular internet search topic after pornography. Millions of people tap symptoms and diseases into Google and wait for some dreadful outcome. I am an aficionado of these sites (my favourite is the NHS site, patients.co.uk [Ed note: I assume she meant patient.co.uk, but this site is not a NHS site]). We terrify ourselves as we read information we do not understand and use to justify our worst fears.

The second change is the role of the GP. As one told me recently: "People don’t trust their GPs any more. We haven’t the time to give patients what they need, and it’s resulted in a breakdown of trust. They go on the internet themselves."

Related Articles

• Rosacea Psychology questions answered
• rosacea sufferers have more anxiety and depression
• anxiety, depression and being obsessed with your skin
• rosacea can make sufferers life miserable

Recently we put some questions on the psychology of rosacea to Professor Peter Drummond, Ph.D., from the School of Psychology at Murdoch University in Perth, Western Australia, and his colleague Daphne Su, D.Psych, Clinical Psychologist (Registrar) with the Department of Health in Western Australia.

Professor Drummond’s research into the clinical psychophysiology of health-related conditions (pain, emotions, headaches including migraines, cardiovascular disorders) includes the neural control of facial blood flow, and the role of the sympathetic nervous system (SNS) in pain and inflammation. (See also Rosacea and the Sympathetic Nervous System: Dr. Peter D. Drummond, PhD )

Dr Su’s doctoral thesis entitled "Psychological stress and vascular disturbances in rosacea" can be accessed electronically from the Murdoch University library catalogue using the above link.

The Rosacea Support team would like to express our warmest thanks to Professor Drummond and Dr Su for generously sharing their time and knowledge with us.

Some of the questions we asked;

• Do you have any advice on how to cope with flushing caused by crippling shyness and social anxiety?
• Rosacea can have a major impact on self-esteem. Have you any advice for single people who fear dating in case they are rejected because of their rosacea
• Some rosaceans also suffer from depression and suicidal thoughts. At what stage should professional help be sought?

To see the full list of questions and answers please visit; Rosacea and Psychology: Peter D. Drummond, PhD, & Daphne Su, DPsych

Also feel free to check out our other Experts Questions and Answers;

• Ocular Rosacea: Dr. Eric Jones, MD
• Ocular Rosacea: Dr. Mark J. Mannis, MD
• Rosacea and the Sympathetic Nervous System: Dr. Peter D. Drummond, PhD
• Combining Light-Based Treatments and Topicals for Rosacea: Dr. David J. Goldberg, MD
• Laser & IPL: Dr. Peter Crouch, MB.BS, Dr Steve Johnson, MD, Dr. Nicholas Soldo, MD

Related Articles

• rosacea sufferers have more anxiety and depression
• anxiety, depression and being obsessed with your skin
• rosacea can make sufferers life miserable
• rosacea and depression

Finding good advice on how to cope with the anxiety of rosacea can be hard to find.

Well now you have an opportunity to ask some questions of experts.

Psychology Question and Answer session

Professor Peter Drummond, Ph.D., from the School of Psychology at Murdoch University in Perth, Western Australia, has a particular sympathy for those suffering from rosacea and has been a good friend to the Support Group over the years. His research into the clinical psychophysiology of health-related conditions (pain, emotions, headaches including migraines, cardiovascular disorders) includes the neural control of facial blood flow, and the role of the sympathetic nervous system (SNS) in pain and inflammation, so we were thrilled when he allowed us to interview him a few years ago on possible links between rosacea and the SNS. In the interview article, Professor Drummond explained how "emotional responses can be controlled to some extent with stress management techniques and anti-anxiety drugs" including beta-blockers.
Rosacea and the Sympathetic Nervous System: Dr. Peter D. Drummond, PhD

Professor Drummond will be joined by a colleague, Daphne Su, D.Psych, a clinical psychologist whose doctoral thesis entitled "Psychological stress and vascular disturbances in rosacea" can be accessed electronically from the Murdoch University library catalogue.
Psychological stress and vascular disturbances in rosacea / Daphne Su

This is your chance to get some external insights into ways you can gain the upper hand against your rosacea stresses and anxieties. For example, you might also want to know what types of counselling or other therapies are proving particularly helpful for people with the kind of issues many rosaceans suffer from, or what kind of therapist to consult, or you might want recommendations for online or offline resources for self-help.

We would prefer that you ask your question over as the Rosacea Support Community forum site in the thread: Psychology Question and Answer session

Go For It !! Let us have your questions.

Related Articles

• rosacea sufferers have more anxiety and depression
• anxiety, depression and being obsessed with your skin
• Flushing: it’s all in your nerves and emotions
• rosacea can make sufferers life miserable
• rosacea and depression

In the past there hasn’t been a lot of research into the relationship between rosacea and mental health. Many rosacea sufferers know that there is a strong relationship between their symptoms and how they feel about themselves. This abstract mentions some research comparing rosacea sufferers with people without any facial lesions. They found that the rosacea sufferers had several psychological problems not found in non-rosacea sufferers.

Do you related to having difficulty in everyday life, have a generally poor health perception, feel high levels of anxiety and depression, feel like you have poor social support or social integration ? Well then you are not alone. It might even be claimed that these feelings are normal for rosacea sufferers.

Do you have any suggestions for how you cope with the anxiety and general negative feelings of rosacea ? Leave a comment below, or check out the Psychological Aspects support section.

Psychosocial impact of rosacea, [Article in Polish], Chodkiewicz J, Salamon M, Miniszewska J, Woźniacka A.

Rosacea is a common skin disease. Because of its recurrent character, frequent unsatisfying results of treatment and a cosmetic problem, the skin lesions cause negative patients’ psychosocial functioning. The purpose of this study was to evaluate life satisfaction, social support, general health, anxiety and depression level in people with rosacea. An attempt to select conditions which determine the life satisfaction in these patients was also made. 40 people with rosacea and 40 people with no skin lesions were the subjects of the study. It was demonstrated that in comparison to the control group, patients with rosacea are less satisfied with their lives, subjectively feel that they receive poor social support, develop great intensity of symptoms, have difficulty in functioning in everyday life, worse general health perception, along with a higher level of anxiety and depression. Level of anxiety and depression as well as social integration proved to be the predictors of life satisfaction.

Related Articles

• rosacea and depression
• anxiety, depression and being obsessed with your skin
• Flushing: it’s all in your nerves and emotions
• facial blemishes: makeup is not enough
• Get help in our Psychological Aspects support section

In November 2006 I blogged about taking part in some research at Murdoch University investigating the relationship between stress and the flushing of rosacea.

Recently the researcher, Daphne Su, has thanked the trial participants by circulating a summary document. The research has been written up as a thesis so this summary was a short description of some the research findings. Here is what I have taken away from the summary. Three of the findings look interesting for rosacea sufferers.

1. The over activity of axon reflexes contributes to facial flushing.

   By measuring the axon reflex response with acetylcholine iontophoresis it was suggested that the neural pathways (how your nerves mediate a flush) were more important in the flushing response compared to cutaneous endothelial function (blood vessel dilation).

2. Emotional flushing in rosacea sufferers may be maintained by a combination of both cognitive and physiological factors.

   Type 2 rosacea sufferers had more facial blood flow and felt more aroused during an embarrassing task, compared to Type 1 rosacea sufferers. Taken together with Point 1, it is suggested that it is a combination of both physiological and cognitive factors causing increased facial blood flow. 
    

3. The stress and fear of blushing can be mitigated by psychological intervention such as Cognitive Behavioural Therapy and Task Concentration Training.

As it appears that both the perception of a facial flush and the physiological response are important factors, psychological intervention may also be an important part of a treatment regime. The trial participants in the final phase of the research were offered CBT and TCT to help them cope with stress and anxiety. All showed a decrease in anxiety symptoms.

Daphe Su has submitted her PhD thesis, so when it has been accepted she will become a bone fide Rosacea PhD. It is thought that this is the first PhD thesis on rosacea. Well done !! Her supervisor, Professor Peter Drummond is also interested in supervising more Rosacea students in the future.

Related Articles

• doing my bit for rosacea research; Perth wake up !
• Sympathetic Nervous System: interview with Peter Drummond
• Rosacea and the SNS
• rosacea and stress: trial participants wanted
• rosacea and depression

What a terribly sad story. Rosacea can be an all consuming disease and there is definitely a danger in becoming obsessed with your skin. The struggle to look normal can be too much for some.

Please everyone realize that other people really aren’t as interested or worried about your skin as you are. If you feel you aren’t coping with your anxiety or feelings about yourself then please be brave enough to see a doctor and ask for some help.

Your mental health is just as important as your overall physical health. Also, please be encouraged that there are some wonderful treatments for rosacea out there, you just need to reach out to find them.

From: This is London, from the Evening Standard: Train suicide of woman depressed by her wrinkles

A woman who became depressed that she was losing her youthful looks committed suicide by lying down in front of a 90mph train, an inquest has heard.

Amanda Barr, 44, had become obsessively preoccupied with the condition of her skin.

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She would not even let her partner of 13 years kiss her on the cheek for fear it would inflame her rosacea, a skin condition causing redness, the Norwich jury hearing was told.

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Mr Thirsk said Miss Barr’s obsession with imperceptible skin blemishes had snowballed since their relationship started in 1994 and it became apparent in the months before her death that the problem was a psychological one.

But she refused medication for her problems in case it made her skin worse.

Her rosacea was actually nothing more serious than a “slight red mark” on her face, he said, but she was unable to keep it in perspective.

“She felt it was huge and that everyone was staring at it and saying: ‘Look at her!’ She became very, very obsessed with it, really, and the way she looked.

Mr Thirsk said his partner would not even walk ten yards to the bins from their front door for fear of the wind inflaming her skin.”

Further Reading

• Rosacea and Depression
• Rosacea can make Sufferers Life Miserable
• Facial Blemishes: makeup is not enough
• Get help in our Psychological Aspects support forum