Rosacea’s appearance can cover the spectrum from a perpetual rosy glow to an angry red mask, but the emotional pain it inflicts varies little from patient to patient, according to recent surveys by the National Rosacea Society (NRS). April has been designated Rosacea Awareness Month by the NRS to alert the public to the early warning signs of this conspicuous, red-faced disorder now estimated to affect more than 16 million Americans.
“Even mild symptoms of rosacea can be embarrassing, and even more so if the sufferers are unaware that it’s a medical condition and assume the redness, bumps or pimples are ‘their fault,’” said Richard Odom, MD, professor of dermatology at the University of California-San Francisco. “It can easily turn into a tailspin where the emotional stress of being seen in public triggers a worsening of symptoms, causing yet further anxiety, and so on.”
Fortunately, for individuals who recognize rosacea’s warning signs and seek medical help, diagnosis and appropriate care can bring their signs and symptoms under control and minimize the condition’s social and emotional impact.
According to new surveys conducted by the NRS, most rosacea patients have felt the negative emotional effects of their condition regardless of severity or subtype. In a survey of 1,675 rosacea patients, 90% said that rosacea’s effect on their personal appearance had lowered their self-esteem and self-confidence, and 88% said they had suffered embarrassment. They also reported a wide range of other negative feelings, including frustration, cited by 76%; anxiety and helplessness, each noted by 54%; depression, 43%; anger, 34%; and isolation, 32%. Fifty-two percent of the respondents said they had avoided face-to-face contact because of the disorder.
Among survey respondents who suffer from the facial redness of subtype 1 (erythematotelangiectatic) rosacea alone, 8% said the condition had a negative impact on their general outlook on life—and for those with moderate to severe redness, the figure rose to 90%.
In a previous NRS survey on the social impact of rosacea, 61% of those with only subtype 1 symptoms said their condition had inhibited their social lives, and the number rose to 72% among those who reported their redness was moderate or severe. Seventy-seven percent of patients with the bumps and pimples of subtype 2 (papulopustular) rosacea alone noted that their social life had been negatively impacted, and 85% of patients whose symptoms included subtype 3 (phymatous) rosacea, involving thickening of the skin, had been negatively affected. Among the respondents who had the eye irritation of subtype 4 (ocular) rosacea, 71% said the disorder’s effects had inhibited their social lives.
The good news is that more than two-thirds of respondents in both surveys said effective medical therapy had improved their emotional and social well-being, and this is now expected to further improve with the availability of medical treatment for facial redness.
“Research into the potential causes of rosacea continues to grow, and as a result, so do the treatment options,” Odom said. “Recognizing that rosacea is a manageable medical condition is the first step for those individuals who feel the sting of a stranger’s stare or an unintentionally disturbing comment.”
Rosacea typically first strikes individuals between the ages of 30 and 60, and may initially resemble a simple sunburn or an inexplicable blush. Suddenly, without warning, a flush comes to their cheeks, nose, chin or forehead. Then just when they start to feel concerned, the redness disappears.
Unfortunately, it happens again and again, becoming ruddier and lasting longer each time, and eventually visible blood vessels may appear. Without treatment, bumps and pimples often develop, growing more extensive over time, and burning, itching and stinging are common.
In severe cases, especially in men, the nose may become enlarged from the development of excess tissue. This is the condition that gave comedian W.C. Fields his trademark red, bulbous nose. In some people the eyes are also affected, feeling irritated and appearing watery or bloodshot. Severe cases of this condition, known as ocular rosacea, can result in reduced visual acuity.
Among the most famous rosacea sufferers is former President Bill Clinton, whose doctors disclosed that he had this condition in The New York Times. Others reported to have suffered from the disorder include Princess Diana, financier J.P. Morgan and the Dutch painter Rembrandt.
Adding insult to injury is the common myth that rosacea sufferers who have an enlarged nose or ruddy complexion may be heavy drinkers. In fact, while alcohol may aggravate rosacea, these symptoms can be just as severe in a teetotaler. Another common misconception is that rosacea is caused by poor hygiene, when in reality it is unrelated to personal cleanliness.
Although the cause of rosacea is unknown, a vast array of lifestyle and environmental factors can trigger flare-ups of signs and symptoms in various individuals. Common rosacea triggers include sun exposure, emotional stress, hot or cold weather, wind, heavy exercise, alcohol, spicy foods, heated beverages, humidity, certain skin-care products and many others.
“Emotional pain can be as real as physical pain, but reducing the physical signs of rosacea through medical therapy and trigger avoidance can substantially reduce its impact on people’s lives,” Odom said. He urged individuals with any of the following warning signs of rosacea to see a dermatologist for diagnosis and appropriate treatment:
- Redness on the cheeks, nose, chin or forehead;
- Small visible blood vessels on the face;
- Bumps or pimples on the face; and
- Watery or irritated eyes.
During April and throughout the year, people who suspect they may have rosacea can contact the NRS for more information.