Topics Discussed Below:

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• Rosacea and anxiety
  
• Key symptoms of anxiety
  
• Important comments on anxiety
  
• Anxiety can be caused by facial flushing and trigger avoidance
  
• Anxiety can progress to erythrophobia and social phobia
  
• Depression & Anxiety: Their effect on rosacea
  
• Importance of treating depression and anxiety
  
• References

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I.  Rosacea and Anxiety

It is common for moderate to severe rosacea sufferers to report feelings of anxiety. (11, 36, 37) Anxiety is often triggered by bouts of facial flushing, burning sensations or progression of the disorder.

II.  Key Symptoms of Anxiety

• Nervousness or tension
  
• Dizziness or faintness
  
• Trembling or shaking
  
• Sweating
  
• Chest pain or tightness
  
• Rapid heart beat
  
• Choking or lump in the throat
  
• Nausea or abdominal discomfort
  
• Panic
  
• Irritable bowel or indigestion
  
• Difficulty sleeping or insomnia
  
• Preoccupation with illness
  
• Fear of growing crazy

III.  Important Comments on Anxiety

• Worry is the most common form that anxiety takes.
  
  
• Anxiety can include feelings of tension and agitation, or inability to relax. When patients talk of stress, they are usually referring to the underlying sense of anxiety and increased tension. (38)
  
  
• Generalized anxiety disorder is a persistent anxiety and worry that lasts for at least six months.

IV.  Anxiety can be caused by Facial Flushing and Trigger Avoidance

As rosacea progresses, most sufferers realize that any trigger that makes them flush, causes their faces to physically worsen and hurt (i.e. cause increased redness, inflammation, papules, pustules, and burning sensations). This can result in acute anxiety (short-term), and chronic anxiety (long-term).

Acute Anxiety: During flushing episodes rosacea sufferers can physically feel the blood rushing through their sensitive facial skin. This is often accompanied by uncomfortable sensations of burning, or stinging. Each of these sensations can trigger feelings of anxiety. This form of anxiety is usually short-lived, and dissipates after the flush subsides.

Chronic Anxiety: Sadly, chronic anxiety is primarily caused by the main treatment for this disorder -- total avoidance of anything that makes a rosacea sufferer's face flush. Most general physicians emphasize to their patients that they must avoid all triggers for flushing. However, what the general physician does not realize is that most rosacea sufferers have dozens of daily triggers for facial flushing; from skincare products, to food and drink, warmth and heat, exercise, mental concentration, embarrassment, emotions (feelings of excitement, happiness, or sadness), physical exertion, sun, wind, cold, and spontaneous flushing. Very few diseases, whether inflammatory, cardiovascular, or hormonal, have as many triggers for disease progression. Rosacea experts stress, "People don't realize the variety of minor things that can increase blood flow in the face, causing aggravation of rosacea." (39) So, in order for rosacea sufferers to avoid getting worse, they must stop performing activities that trigger flushing, and continuously think ahead in order to side-step potential triggers that may come up throughout the day. This can cause chronic anxiety in the most emotionally balanced person!

 

V.  Anxiety can Progress to Erythrophobia and Social Phobia

Erythrophobia: Erythrophobia is the fear of getting red. Some sufferers simply have a morbid fear of facial flushing -- they fear getting red in front of friends or strangers. However, in many cases, erythrophobia may develop in rosacea sufferers after they realize that flushing causes physical changes to the facial skin and burning sensations -- they fear the repercussions of facial flushing.

Social Phobia: Over time, rosacea sufferers may develop social phobia. The essential feature of social phobia is a persistent fear and avoidance of social situations in which flushing may occur such as speaking with others, dating, shopping, eating out, spending time with others in warm rooms or environments, etc. A vicious cycle is then created where the fear of flushing….. generates anxiety….. triggering even more flushing….. causing the sufferer to regress even further.

 

VI. Depression and Anxiety: Their Effect on Rosacea

Although depression and anxiety do not cause rosacea, they both can worsen rosacea symptoms through alterations that take place in the subconscious mind. The subconscious mind (an area of the brain that we do not have control over), has a powerful influence over nerve activity and hormone production. Depression and anxiety can cause alterations in brain activity and neurotransmitter production, resulting in increased sympathetic nerve activity and hormone release. (40, 41) This can worsen facial flushing and rosacea symptoms.

Depression and anxiety can alter nerve and hormonal activity in two ways (acute & chronic alterations):

Acute alterations in sympathetic nerve and hormonal activity: Depression and anxiety can change the subconscious brain activity, lowering the threshold for activation of sympathetic nerves, and release of dilator hormones. In effect, this would make the rosacea sufferer much more sensitive to certain flush stimuli (i.e., heat, exertion, stress, mental activity, exercise, emotions, etc.).

Chronic alterations in sympathetic nerve and hormonal activity: Depression and anxiety can change the subconscious brain activity, triggering the continual activation of sympathetic nerves, and release of dilator hormones. In effect, this would cause a constant, low-grade facial flush due to continuous activation of sympathetic nerves or increased hormone production. (40)

 

VII.  Importance of Treating Depression and Anxiety

In those rosacea sufferers who experience moderate depression or anxiety, it is highly recommended that they seek treatment. In some cases, treating the depression or anxiety may help break the vicious cycle, and give the rosacea sufferer a better chance for full recovery.

 

VIII.  References

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