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

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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.

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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
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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, sadly. 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 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.

….

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.

…

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 Support Group
• rosacea and depression
• rosacea can make sufferers life miserable
• facial blemishes: makeup is not enough
• Get help in our Psychological Aspects support forum

No real surprises here – this study finding that ocular rosacea affects sufferers’ quality of life.

Quality of life impact of ocular rosacea, Tanya Dannemann, Medical College of Georgia, Augusta, GA, United States; Kimberly Nicholson, Emory University, Atlanta, GA, United States; Justin Estaris, Emory University, Atlanta, GA, United States; Suephy Chen, MD, MS, Emory University, Atlanta, GA, United States

Many people with rosacea also experience ocular symptoms such as watery, bloodshot, irritated, burning or stinging eyes. The National Rosacea Society has termed these symptoms ocular rosacea which can coexist with the other cutaneous subtypes: erythematotelangiectatic, papulopustular, and phymatous.

We hypothesized that the quality of life (QOL) impact of patients with cutaneous rosacea varies depending on the presence or lack of ocular rosacea. QOL impact was measured using RosaQoL, a validated rosacea-specific QOL instrument, administered by telephone to rosacea patients from Emory University.

Answers to RosaQoL questions were structured on a scale of 1 (never) to 5 (all the time) and quantified the symptomatic (sx), emotional (em), and functional (fx) impact of rosacea on QOL. We calculated RosaQoL scores for each of the 3 domains (sx, em, fx) and determined QOL differences among patients with and without ocular rosacea using the ManneWhitney test. Of 628 patients called, 135 completed RosaQoL, 124 declined to participate, and 369 could not be reached. The only statistically significant difference between participants and non-participants was age (56.5 vs 51.3 years, respectively, P <.05). The two statistically significant demographic differences between patients with and without ocular rosacea were marital status and age. Forty-five percent of patients who were single and never married had ocular rosacea as compared to 75% for patients who were married or living with a partner and 69% for those reporting ‘‘other’’ (P = .031). In addition, patients reporting ocular rosacea had a mean age of 59.0 versus 51.3 for those without ocular rosacea (P = .003). Among patients who completed the RosaQoL, 70% (94/135) had ocular rosacea in addition to their cutaneous rosacea. There was no statistically significant difference in the proportion of ocular involvement between the three cutaneous subtypes.

Patients with ocular rosacea had worse QOL scores for both the sx and em constructs compared to patients without ocular rosacea (2.95 vs 2.27, P\.001 for sx; 2.93 vs 2.60, P = .03 for em). The presence or absence of ocular rosacea did not have a statistically significant functional QOL impact. A majority of patients in our survey with cutaneous rosacea report ocular complaints. Ocular rosacea appears to negatively impact a patient’s quality of life primarily in symptomatology and emotional burden of disease.

Commercial support: None identified

Poster Abstract P1309, American Academy of Dermatology, 65th Annual Meeting February 2-6, 2007, Washington, DC. Published in Journal of the American Academy of Dermatology Volume 56, Number 2.

Further Reading ;

• ocular rosacea treatment and pathogenesis
• diagnostic test for ocular rosacea
• treating ocular rosacea (from the AAO)
• ocular rosacea, MMP8 and doryx
• patent: ocular rosacea and `acne rosacea’ treated together
• ocular rosacea and tear enzymes
• ocular rosacea in children

Please do help Daphne if you can.

Dear all,

I’m Daphne, a Doctor of Psychology Student at Murdoch University in Western Australia investigating the relationship between stress and subtype 1 of rosacea (chronic facial flushing) under the supervision of Dr. Peter Drummond.

A couple of months ago, I enquired if rosacea sufferers encounter issues with stress and anxiety on this forum. I understand that rosacea sufferers often have to make lifestyle changes to cope with the disorder, but little formal assistance is provided. My study is interested in understanding how our skin might react to different stimulus as well as if psychological intervention (e.g. stress management strategies, relaxation..etc) will assist rosacea sufferers to better manage with this disorder.

Therefore, you are invited to participate in an study at Murdoch University to investigate the impact of blushing on rosacea and whether psychological treatment will assist in managing the symptoms of rosacea. It is anticipated that first part of the study, to investigate changes in skin blood flow in rosacea, will take no more than two hrs to complete. You may also be invited to participate in the treatment phase, where free psychological assistance will be provided to better cope with the distressing aspects of rosacea. This part of the study will involve filling out a daily diary of symptoms and attending Murdoch Psychology Clinic once/week for 12 weeks.

I’m pretty flexible with timings and welcome any enquires or interest in participation regarding this study.

Please feel free to contact myself, Daphne Su on email me at d.su@murdoch.edu.au . Alternatively, you can contact my supervisor, Dr. Peter Drummond on +61 08 9360-2415 or email p.drummond@murdoch.edu.au

This research has been approved by the Murdoch University Human Research Ethics Committee.

Thank you,
Daphne Su
Doctor of Psychology Candidate

• Daphne Su’s Request for Help
• Rosacea News: rosacea and depression
• Rosacea News: facial blemishes: makeup is not enough

The paper has since been picked up by the Ohio State University news service where the author has added some high level comments.

Science Daily: Corrective Cosmetics May Not Boost Quality Of Life For Women With Severe Facial Blemishes

OSU Research News: Corrective cosmetics may not boost quality of life for women with severe facial blemishes

Using makeup to cover a severe facial blemish may not improve the quality of a woman’s life, a new study suggests.It did not matter how severe or what kind of blemish she had, whether it was a case of severe acne, a noticeable facial scar or pronounced dark spots covering the face.

“The women who used foundations to cover these kinds of marks reported having a lower health-related quality of life than did the women who didn’t wear the same kind of makeup,” said Rajesh Balkrishnan, the study’s lead author and the Merrell Dow professor of pharmacy at Ohio State University.
….
“The women who used foundation to cover blemishes may have had a tougher time psychologically dealing with their blemishes than did the women who didn’t use corrective makeup,” Balkrishnan said. “Although it’s difficult to say why this is, it may be that the women who didn’t wear makeup to cover their blemishes felt more confident in their appearance.”
….
Whether or not they wore makeup, participants overwhelmingly felt that without their blemish other people would see them in a less negative light, and that the overall quality of their lives would improve.

Interestingly, the researchers found no difference in health-related quality of life scores based on the type and size of a blemish. For example, a woman with bad acne did not feel any worse or any better than a woman with melasma.

But the more fearful a woman was of being negatively evaluated in public, the lower she rated her health-related quality of life.

Researchers aren’t certain exactly how severe blemishes affect a woman’s mental health, and a study like this one may help in designing better treatments, including corrective cosmetics, for women, Balkrishnan said.

Featured Product:

The study was funded by a grant from Vichy Laboratoires, which makes DermaBlend, a line of corrective cosmetics. Vichy Laboratoires is owned by L’Oreal. Ann Bouloc, a study co-author and a scientist with Vichy , is the only researcher in this study with a financial link to Vichy.

Although it is not clear whether DermaBlend was the only product used in the study, it has been discussed on rosacea-support. A message posted to rosacea-support listed the ingredients of dermablend as ; Paraffinum liquidum, Cera alba, Talc, isopropyl palmitate, Magnesium carbonate, Carnauba, Propylparaben, Allantoin. May contain: Titanium dioxide – Iron oxides.

Related Articles:

• Abstract Online
• OSU Research News: Corrective cosmetics may not boost quality of life for women with severe facial blemishes
• Science Daily: Corrective Cosmetics May Not Boost Quality Of Life For Women With Severe Facial Blemishes
• rosacea can make sufferers life miserable
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Correlates of health-related quality of life in women with severe facial blemishes.

International Journal of Dermatology. 2006 Feb;45(2):111-5.

Rajesh Balkrishnan, PhD, Amy J. McMichael, MD, Judy Y. Hu, MD, Fabian T. Camacho, MS, Katherine R. Shew, BS, Anne Bouloc, MD, PhD, Stephen R. Rapp, PhD, and Steven R. Feldman, MD, PhD

Division of Management and Policy Sciences, University of Texas School of Public Health, Houston, TX.

Background: Facial appearance plays a large role in self-perception and interaction with others. Visible facial skin lesions are a common condition.

Purpose: This study assessed factors associated with health-related quality of life (HRQOL) in women with visible facial skin lesions.

Methods: The study included 73 women with one or more of the following conditions: acne, dermatosis papulosis, hypopigmentation, lentigenes, melasma, rosacea, vascular proliferations and other facial scars. The Skindex-16 was used as a measure of HRQOL. Fear of negative evaluation (FNE) was assessed to determine whether self-perception characteristics relate to HRQOL.

Results: There were strong correlations in both bivariate and multivariate analyses among increased FNE, heightened perception of QOL without the facial condition and lower overall HRQOL (P < 0.05 and P < 0.01, respectively). There were no differences in HRQOL by type of facial condition, as well as no effects of the area covered by the condition on HRQOL. Interestingly, women not using foundations represented only 10% of the study population and had better HRQOL than women who did use foundations.

Conclusions: Severe facial blemishes of any cause have a significant impact on women’s QOL, and the effect of these lesions is mediated in part by psychological characteristics related to self-perception and self-presentation.

• PubMed Extract
• Abstract Online
• Health Related Quality of Life
• Rosacea News: rosacea and depression

Background: Psychogenic factors have been considered to be important in the exacerbation and possibly the onset of rosacea. However, there are very few studies that have reported conclusive findings.

Objectives: To examine the association between rosacea and major depressive disease, a common and usually treatable psychiatric disorder.

Methods: Data from 1995 to 2002, collected by the National Ambulatory Medical Care Survey and the outpatient component of the National Hospital Ambulatory Care Survey, which are both nationally representative surveys of healthcare visits in the U.S.A., were studied. The basic sampling unit in both surveys is the patient visit or encounter. A ‘Rosacea’ variable was created by grouping all rosacea (ICD-9-CM code 695.3) visits and a ‘Depression’ variable was created by grouping the patient visits related to major depressive disorder (ICD-9-CM codes 296.2, 296.3 and 311). As alcohol abuse has been implicated in rosacea, and alcohol can confound symptoms of depression, an ‘Alcohol’ variable was created by grouping all ICD-9-CM codes related to alcohol dependence and abuse (codes 303, 303.0, 303.9 and 305.0). All analyses were conducted using the Complex Samples module of SPSS version 13, to account for the multistage probability sampling design used to collect the data.

Results: The weighted data were representative of over 608 million dermatology visits between 1995 and 2002. Logistic regression analysis using ‘Rosacea’ as the dependent variable and age, sex, ‘Alcohol’ and ‘Depression’ as independent variables revealed that the odds ratio for depressive disease in the rosacea group was 4.81 (95% confidence interval 1.39-16.62). The association between ‘Alcohol’ and ‘Rosacea’ was not significant.

Conclusions: The comorbidity between major depressive disease and rosacea may have important clinical implications. Alcohol abuse does not appear to play a significant role in this association.

• PubMed Extract

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