Psychological Impact of Rosacea and Coping Strategies.

Often referred to as the "Curse of the Celts" due to its prevalence among fair-skinned individuals, rosacea is a dermatosis that is initially benign from a medical standpoint. However, the situation is entirely different from a psychological perspective. Those affected suffer from facial redness, accompanied by invisible symptoms such as itching, tingling, and hot flushes. In the collective imagination, diffuse redness on the nose and cheeks is associated with alcoholism and excess, leading some individuals to attribute these behaviours to those suffering from rosacea, even though their lifestyle is entirely different. The language itself only confirms this fact: drinker's elephantiasis, alcoholic nose, wine nose, rum blossom (literally "rum flower") or whisky nose are just a few examples. It is therefore easy to understand why it is still so difficult today to escape this stigmatisation.

It is also worth noting that rosacea is a progressive disease. Over time, skin eruptions follow the initial redness and take the form of papules and pustules: this is then referred to as acne-rosacea, or more simply, papulopustular rosacea. For the majority of individuals, these lesions, reminiscent of acne, are commonly associated with adolescence and thus they provoke misunderstanding, even rejection, when they affect adults. They can also be associated with a lack of hygiene, which is completely untrue. Numerous examples of characters affected by rosacea or erythrosis can be found in 19th-century literature, notably in the works of Balzac and Proust. In these novels, rosacea already carries a negative connotation and is a sign of low social status or dubious morality.

The stigmatisation experienced by patients suffering from rosacea typically stems from the misunderstanding of their condition and can be a source of stress, anxiety, and depressive or social avoidance behaviours.

The symptoms of rosacea predominantly appear on the face and are difficult to conceal, often having a significant psychosocial impact on the lives of patients. A recent study conducted by the National Rosacea Society (NRS) involving 1,235 patients reported that 68% of the respondents felt a decrease in their self-esteem and confidence following the onset of their rosacea. Approximately 55% said they were embarrassed by this condition and an equal number expressed feelings of frustration. 30% felt helpless in the face of the disease, 25% reported feeling anxious and 20% had been depressed due to their rosacea. Finally, 43% reported that their outlook on life had been negatively affected by their rosacea. Furthermore, another study showed that patients were willing to pay an average of €2,880 to be completely cured, with the amount correlating to the deterioration in quality of life.

Furthermore, numerous cases of erythrophobia are recorded among individuals with somatic causes of blushing, such as rosacea. Erythrophobia is an anxiety disorder classified within the family of social phobias and is characterised by the fear of blushing in public. Those who blush easily do not wish to show others that they are affected by certain topics as they interpret this as a form of weakness. However, patients have no control over the onset of redness. This can indeed occur following a simple physical effort or under the influence of an emotion. A vicious cycle then sets in: the person worries about their next rosacea flare-ups while this emotional state promotes the appearance of symptoms.

This disease can thus be a hindrance in social life of the affected individuals. During periods when the symptoms are most visible, many patients tend to avoid social outings or family moments, for fear of stares and judgements, or simply because of their discomfort. Finally, rosacea also has a impact in the professional sphere, confirmed by a recent study conducted in various countries around the world (United Kingdom, France, Germany, Italy, Mexico, Switzerland, Denmark, Ireland). This showed that people suffering from erythrosis were nearly twice as less likely to be hired than others.

Although there is currently no definitive treatment for rosacea, this does not mean that no strategies can be implemented to alleviate flare-ups, space them out, and improve the quality of life of patients. It is first and foremost essential for those affected to benefit from an empathetic dermatological follow-up. Educating patients, reassuring them, and encouraging them to express their concerns and needs are all valuable interventions that are often overlooked. Moreover, consulting a dermatologist gives people with rosacea the opportunity to receive a tailored treatment, in topical or oral form, which allows them to keep their symptoms under control.

Finally, when the psychological impact of rosacea becomes too significant, it may be relevant for patients to seek help from a psychologist. They can provide professional support and stress management strategies to help individuals cope with the emotional aspects of rosacea, manage their thoughts and emotions related to the disease more effectively, and develop efficient coping strategies. People suffering from rosacea can also turn to a patient association. These organisations offer patients the chance to feel less isolated and more understood by meeting others living with the same condition, allowing them to share their experiences and practical advice for living better with the disease. Furthermore, patient associations can also provide educational support and medical guidance.

• CRIBIER B. Tales of Red Faces: Art, Culture and Medical Representations. Annals of Dermatology (2011).

• FELDMAN S. R. & al. The psychological impact of rosacea and the influence of current management options. Journal of the American Academy of Dermatology (2014).

• TAN J. & al. Feelings of stigmatization in patients with rosacea. Journal of the European Academy of Dermatology and Venereology (2016).

• TAN J. & al. Psychosocial Burden and Other Impacts of Rosacea on Patients’ Quality of Life. Dermatologic Clinics (2017).

• HEISIG M. & REICH A. Psychosocial aspects of rosacea with an emphasis on anxiety and depression. Clinical, cosmetic and investigational dermatology (2018).