Results of a meta-analysis and systematic review indicate rosacea is significantly associated with depression and anxiety.
Rosacea is significantly associated with anxiety and depression, according to results of a systematic review and meta-analysis, while having rosacea may predispose patients to develop depression and anxiety, authors wrote. Findings were published in Journal of Affective Disorders.
Rosacea is a chronic inflammatory disease that has been classified into 4 subtypes: erythematotelangiectatic, papulopustular, phymatous, and ocular rosacea. The pathogenesis of rosacea is slightly different for each subtype and “may include interactions among genetic predispositions, abnormalities of innate and adaptive immunity, neurovascular dysregulation, and neurogenic inflammation,” the researchers explained.
Affected individuals have reported low self-esteem and emotional stress while psychosocial factors like social anxiety can trigger and even worsen the condition.
In an effort to better understand the relationship between rosacea, anxiety, and depression, the investigators searched PubMed, Web of Science, Embase, and Wanfang databases for relevant studies. Nine studies with 101,114,209 patients with rosacea and 599,464,745 individuals without rosacea met inclusion criteria. The mean patient age ranged from 30 to 50 years and all studies were rated as having high quality. Five of the studies were cross-sectional in nature, 2 were case-control studies, and 2 were cohort studies.
A pooled analysis of the cross-sectional and case-control studies showed “patients with rosacea were significantly more likely to have depression (crude odds ratio [OR], 2.855; 95% CI, 1.258-6.481) and anxiety (crude OR, 2.373; 95% CI, 1.448-3.888) than matched controls; however, adjusted ORs showed no significant association.”
In addition, a meta-analysis of the cohort studies alone revealed “patients with rosacea have significantly higher risks of developing depression (adjusted incidence rate ratio [IRR], 2.443; 95% CI, 1.603-3.723) and anxiety (adjusted IRR, 2.181; 95% CI, 1.660-2.864).” These findings indicate rosacea may predispose patients to develop anxiety and depression.
Previous research has shown individuals with skin conditions are more likely to suffer from depression, anxiety, and suicidal ideation compared with matched controls. The authors noted rosacea-induced appearance changes are expected to have a greater impact on the mental health of female and younger patients.
However, “studies have suggested that male patients usually suffer more than female patients from depression because of feelings of stigmatization, possibly due to more severe symptoms and complications in men,” they said.
Furthermore, previous investigations have established a significant association between rosacea and inflammatory bowel disease, potentially pointing to the role of the gut-brain axis in rosacea-associated comorbidities.
In the current analysis, the researchers did not have sufficient data to perform age- and sex-based subgroup analyses. Future studies to better understand these relationships are warranted. The methods used to evaluate depression and anxiety varied across inlcuded studies, marking a limitation to the analysis.
Overall, "this study reminds clinicians of the significant relationship between rosacea and mental health,” the authors concluded. “Physicians should evaluate psychological symptoms when diagnosing rosacea and should provide psychological counseling for patients as part of the treatment.”
Chang H-C, Huang Y-c, Lien Y-J, Chang Y-S. Association of rosacea with depression and anxiety: a systematic review and meat-analysis. J Affect Disord. Published online December 5, 2021. doi:10.1016/j.jad.2021.12.008