It is well documented that rosacea, along with other skin conditions, can result in a diminished quality of life in terms of social outcomes. In a survey of more than 860 patients with rosacea conducted by the National Rosacea Society, 86% reported having low self-esteem and 82% reported being embarrassed by their skin condition. Feelings of depression, fear, embarrassment and anger can lead to less socializing, more time alone, loss of physical intimacy (romantic and platonic) and ultimately decreased connection.¹

Clinical psychologist Dr. Eleanor Chatburn spoke with the National Rosacea Society about the intersection of rosacea and relationships, and identified some common patterns she has seen in her practice that patients may want to be aware of. 

Hypervigilance to Triggers
We know that certain environmental conditions and behaviors can trigger a rosacea flare-up, but if managing the exposure to those triggers is causing more stress and anxiety than a flare-up would, it might be worth taking a step back. “Sometimes patients can be so fearful of a flare-up that they unconsciously create a world that is very small and confined, robbing themselves of even the simplest of life’s pleasures — no eating out, no exercise, no outdoor activities — which can then trigger more depression and anxiety,” said Dr. Chatburn. This can be of particular concern for those in the early stages of their rosacea journey who want to avoid a flare-up at all costs and haven’t found the right balance of medical therapy, skin care and trigger avoidance yet.

Social Avoidance
Anxiety about one’s appearance or fear of negative comments may be enough for some rosacea sufferers to cancel plans or avoid making them in the first place. “Flare-ups can be very emotional for some and they don’t feel comfortable explaining it or talking about it,” said Dr. Chatburn. For those who struggle with social avoidance, she suggested starting with a few people you can trust and be yourself around to build up your confidence. Social connection, even for introverts, is an important part of a well-balanced and fulfilling life. 

Reassurance Seeking
It is natural to seek some reassurance when confronted with uncertainty about your looks. Reassurance can help to calm a doubt or allay a worry. However, people can get caught up having relentless reassurance-seeking conversations with their partner or friends. This can develop into an unhealthy cycle of looking for external validation and self-worth from others. If you’re feeling down about your appearance, Dr. Chatburn suggested being up front with those feelings instead of seeking reassurance. “It opens up the opportunity for connection and allows the conversation to pivot to something more positive.”

Automatic Negative Thoughts
We tend to notice, focus on, and give greater credence to evidence that fits with our existing beliefs — even when those beliefs and thoughts are negative or unhelpful. “If you believe people are going to stare at you because your skin is red and inflamed, then it just takes one person to say something to make that belief a reality. And the other 50 people who didn’t look at you get discounted because their actions did not confirm that original belief,” Dr. Chatburn said. The concern is when automatic, negative thought patterns dictate where you go, who you spend time with and your mood.

Managing the psychosocial impacts of rosacea is just as important as managing its physical symptoms and discomfort. If short-term solutions to manage strong feelings and anxiety start to manifest into the long-term loss of social interactions, meaningful relationships or joyful activities, a therapist or counselor may be able to help. “It usually comes down to having some degree of acceptance about your skin condition,” said Dr. Chatburn. And the good news is that there’s support available to do the hard work it can take to live the life that you want.
 

Reference
1. Chren MM, Lasek RJ, Quinn LM, Mostow EN, Zyzanski SJ. Skindex, a quality-of-life measure for patients with skin disease: reliability, validity, and responsiveness. J Invest Dermatol 1996;107(5):707-713. doi:10.1111/1523-1747.ep12365600