¹Edward Via College of Osteopathic Medicine, Auburn, AL, USA

²Wake Forest University School of Medicine, Winston-Salem, NC, USA

³Rush Medical College, Chicago, IL, USA

⁴University of Missouri School of Medicine, Columbia, MO, USA

⁵A.T. Still University School of Osteopathic Medicine Arizona, Mesa, AZ, USA

⁶Department of Dermatology, Northwell Health, New Hyde Park, NY, USA

*Corresponding author: Kelly Frasier, DO, MS, Department of Dermatology, Northwell Health, New Hyde Park, NY, USA, Phone: 3105956882, Email: [email protected]

Received Date: July 14, 2025

Publication Date: September 03, 2025

Citation: Harper H, et al. (2025). The Psychosocial Impact of Rosacea: How Early Intervention Can Improve Quality of Life. Dermis. 5(4):44.

Copyright: Harper H, et al. © (2025).

ABSTRACT

Rosacea is a common, chronic inflammatory skin condition that causes facial redness and inflammatory lesions. Beyond the physical symptoms, it can significantly impact a persons’ quality of life, often leading to social stigmatization and emotional distress. The psychosocial effects such as anxiety, low self-esteem, and social withdrawal are often overlooked, even though they can be just as debilitating as the visible symptoms. This literature review will examine the burden of rosacea, its impact on mental health, and the importance of early comprehensive intervention. Although current treatment options like topical and oral medications can help manage symptoms, they are not curative. However, early diagnosis, patient education, equitable access to care, and psychosocial support can improve outcomes. More research is needed to fully understand the extent of rosacea’s impact, which could lead to more personalized, comprehensive treatment approaches. Addressing both the emotional and physical aspects of this condition is essential for enhancing patient well-being and overall quality of life.

Keywords: Skin Disorder, Mental Health, Diagnosis, Social Anxiety, Stress Management, Patients

INTRODUCTION

Background and Epidemiology

Rosacea is a chronic, inflammatory dermatological condition characterized by facial erythema, flushing, and inflammatory lesions, primarily affecting the central face. Rosacea affects an estimated one to ten percent of the global population, though prevalence varies by geographic region, ethnicity, and diagnostic criteria [1]. Despite being a common skin disorder, the exact etiology of rosacea remains unclear. Potential contributing factors include immune system dysregulation, nervous system abnormalities, environmental triggers like UV exposure and alcohol consumption, and genetic predisposition [2]. In addition, Demodex mites appear to play a role in rosacea as higher numbers are usually found in these patients. Although not fully understood, it is thought that these mites trigger an immune response that leads to inflammation and redness [3]. Given the multifactorial nature of this condition, effective management and treatment can be a challenge.

The complexity of rosacea is reflected in the way it presents clinically. It is categorized into four subtypes: erythematotelangiectatic, papulopustular, phymatous, and ocular. These subtypes can overlap, and patients can present with a combination of features that may evolve over time [3]. In addition to the physical symptoms, the impact of rosacea extends beyond the skin, with the visible and unpredictable nature of the condition leading to significant psychological distress. This includes low self-esteem, social anxiety, and depression. These psychosocial challenges can be particularly pronounced in patients with more severe symptoms or visible lesions [4]. While managing the physical symptoms is vital, addressing the psychosocial aspect is equally important, as the emotional toll can impact daily life and social interactions [5]. By addressing the condition early, physicians can help patient’s feel more seen and more in control, improving mental health and self-image.

Objective of this Review

This literature review explores the psychosocial burden of rosacea by examining its impact on mental health, social well-being, and quality of life. The objective is to enhance understanding of how rosacea affects patients beyond the skin and how early diagnosis and intervention can improve outcomes. This review will examine findings from peer-reviewed journal articles, clinical studies, and patient reported outcomes on the mental health effects of rosacea, including anxiety, depression, social withdrawal, and stigma. It will also investigate the role of early therapeutic approaches in improving the outcomes of patients. Finally, this review will identify current gaps in knowledge, encouraging future research to focus on more comprehensive management approaches that address both the physical and emotional challenges faced by individuals living with rosacea.

DISCUSSION

Psychosocial Impact of Rosacea

Beyond its physical symptoms, rosacea significantly affects patients' psychosocial well-being, impacting their emotional health, social interactions, and overall wellness. Studies indicate that rosacea often leads to embarrassment, emotional distress, and social avoidance, increasing the risk of anxiety and depression [5]. A meta-analysis using the Dermatology Life Quality Index (DLQI) found that patients with severe rosacea had worse scores than those with moderate disease, showing greater daily life impairment [6]. In addition, many patients report low self-esteem and self-worth due to perceived changes in their physical appearance, leading to heightened psychological stress [4]. The subjective burden of rosacea often outweighs clinical assessments, highlighting the importance of integrating patients' reported experiences when determining treatment plans.

Psychological and Emotional Burden

The psychological burden of rosacea is well-documented, with multiple studies demonstrating an increased prevalence of anxiety and depression. Due to the visible nature of the condition, patients experience emotional distress, which is often exacerbated by associated social stigma [5]. Many individuals report feeling a range of negative emotions, including anger, rejection, shame, depression, social isolation, embarrassment, and low self-esteem [8]. The chronic nature of rosacea further contributes to emotional distress, leaving many patients feeling frustrated and powerless in managing their symptoms. This emotional toll is further reflected in studies linking rosacea to psychiatric conditions. Gupta et al. found a notable correlation between rosacea and major depressive disorder, while a nationwide Danish cohort study found a relationship between disease severity and psychological distress. Patients with mild rosacea exhibited an increased risk of depression (IRR 1.89) and anxiety (IRR 1.80), while those experiencing moderate-to-severe symptoms experienced even greater risks (IRR 2.04 and IRR 1.98, respectively) [9,10]. These findings highlight the importance of addressing mental health as an integral part of rosacea management. A multidisciplinary approach that includes psychosocial support may be pivotal in improving overall patient outcomes.

A key contributor to the psychological distress of rosacea patients originates from the visibility of symptoms, particularly facial erythema and recurrent flushing. Bewley et al. reported that facial erythema negatively impacts health-related quality of life (HRQoL) significantly more than inflammatory lesions [11]. Recurrent flushing episodes can provoke anxiety, with some patients exhibiting symptoms resembling social anxiety disorder or panic attacks [12,13]. This cycle of self-consciousness and anxiety exacerbates symptoms and can lead to avoidance behaviors. This can also lead to barriers in care due to fear of judgement. The persistent emotional strain of rosacea is further reflected in broader studies. A 2019 survey by Kanji examining the psychological impact of chronic dermatological conditions revealed that stress and mood disturbances were some of the most commonly reported challenges experienced by rosacea patients [14]. These findings highlight the importance of incorporating mental health screening and psychological support into routine rosacea management. Without addressing the emotional and psychological burden, even the most effective treatments may not improve a patient’s overall sense of wellness.

Social Consequences

Rosacea's visible symptoms can lead to significant social challenges, including stigmatization, feelings of rejection, and isolation. In a comprehensive survey including 807 rosacea patients, 30% reported substantial feelings of stigmatization due to their condition, which correlated with increased social withdrawal and depression [15]. The fear of negative judgment often leads to limiting social interactions, making it difficult to sustain personal and professional relationships [8]. To manage this condition, many people, especially women, turn to cosmetic camouflage. One survey suggested that corrective makeup significantly improves self-esteem but does not fully eliminate negative emotions such as frustration and embarrassment [16]. While these coping mechanisms have benefits, the persistent nature of rosacea can continue to impact individuals emotionally.

Beyond social isolation, rosacea symptoms can affect self-perception in more intimate parts of life, especially regarding romantic relationships and attractiveness. Many people believe that the facial erythema diminishes their sexual appeal, which adds another layer of stress and self-doubt [15]. The unpredictability of flare-ups further adds to the social anxiety, as individuals remain hyperaware of potential triggers to avoid embarrassment. Furthermore, current unrealistic beauty standards can amplify the insecurities experienced by these individuals. This emotional toll can significantly strain personal relationships and greatly decrease quality of life, further highlighting the condition’s psychosocial burden.

Reducing Psychosocial Burden Through Symptom Management

Effective clinical management of rosacea symptoms can significantly reduce psychosocial distress and improve confidence in social settings. Patients who experience symptom relief report improvements in emotional health and feel more comfortable engaging in daily interactions [4]. Rosacea imposes a substantial psychosocial burden on affected individuals and even small improvements in inflammation can enhance self-esteem and reduce social isolation. Although there is no cure for rosacea, timely intervention and effective management can allow patients to feel more in control of their symptoms, which will improve life satisfaction.

Table 1 summarizes key findings from different journal articles and studies assessing the psychosocial burden of rosacea. This table highlights trends in symptom burden, psychological distress, social withdrawal, and quality of life impact among affected patients.

Table 1. Summary of Patient-Reported Outcomes in Rosacea Studies

Reference	Assessment Tools	Reported Outcomes
Heisig M, et al. [5]	Literature Review	Rosacea is associated with embarrassment, emotional distress, low self-esteem, stigma, and social avoidance, contributing to anxiety and depression.
Dai R, et al. [6]	Meta-Analysis/Dermatology Life Quality Index (DLQI)	Severity-dependent impact: patients with severe rosacea had significantly lower DLQI scores, indicating worse quality of life. Flare-ups trigger emotional distress and social vigilance.
Huynh TT, et al. [4]	Self-Reported Surveys	Rosacea patients experience lower self-worth and diminished self-image compared to healthy controls. Treatment improves emotional well-being.
Gupta MA, et al. [9]	Clinical Assessment & Patient History	Rosacea is comorbid with major depressive disorder.
Egeberg A, et al. [10]	Nationwide Danish Cohort	Mild and moderate-to-severe rosacea significantly increase the risk of depression (IRR 1.89-2.04) and anxiety (IRR 1.80-1.98), indicating a dose-dependent relationship.
Bewley A, et al. [11]	Patient-Reported Outcomes	Facial erythema has a greater negative impact on quality of life than inflammatory lesions. Visible symptoms contribute to social withdrawal.
Su D, et al. [12] & Blount BW, et al. [13]	Psychological Assessment Surveys	Recurrent flushing episodes can lead to social anxiety disorder or panic-like symptoms, exacerbating self-consciousness.
Kanji A, et al. [14]	Psychological Impact Survey	Stress and mood are the most significantly affected aspects of daily life for patients with chronic dermatological conditions, including rosacea.
Halioua B, et al. [15]	Patient Questionnaires	30% of patients reported feeling stigmatized, which was associated with higher rates of social withdrawal and depression. Facial redness perceived as reducing sexual attractiveness.
Mokbel R, et al. [8]	Literature Review	Social stigmatization impairs personal and intimate relationships, reinforcing embarrassment and self-doubt.

Role of Early Intervention

Early intervention plays a critical role in the effective management of rosacea, not only by controlling the physical manifestations but also by addressing the psychosocial burden associated with the condition. Individuals with rosacea often experience social anxiety, increased levels of embarrassment, depression, and decreased life satisfaction, as previously mentioned [17]. Considering the profound effect rosacea can have on an individual's mental and emotional well-being, early intervention is key— not only in preventing worsening of the condition physically but also in mitigating its psychosocial impact.

Early diagnosis and treatment with topical agents such as azelaic acid, metronidazole, and brimonidine, as well as oral antibiotics like doxycycline for more severe cases, can significantly improve inflammation and erythema, consequently enhancing both dermatologic and psychosocial outcomes [18]. Improvement in physical symptoms often can lead to a meaningful increase in self-esteem, which in turn improves social functioning. Additionally, cognitive-behavioral therapy (CBT) has been shown to help patients with severe rosacea better cope with social anxiety and improve self-esteem [12]. CBT offers a structured and evidence-based way to help patients reframe their negative thought patterns and reduce social anxiety. In addition to medical treatments, lifestyle modifications— such as trigger avoidance, gentler skincare routines, stress management, and consistent sunscreen use— are commonly recommended for individuals with rosacea to prevent condition flare-ups [19]. This comprehensive approach not only helps to manage flares but also supports long-term skin health.

In addition to these proactive measures, individuals with rosacea often seek additional support through community-driven resources. Many participate in online forums to exchange information about disease management and offer mutual support [20]. By engaging in these communities, patients can gain better control over their condition, learn about new treatment options, and receive support for the emotional challenges of rosacea. When combined with medical treatment, CBT, social support groups, and lifestyle modifications allow clinicians to adopt a more holistic approach to managing rosacea. This integrated model ensures that patients receive care beyond the physical symptoms by addressing the emotional and psychosocial challenges as well. Early intervention that incorporates both medical and psychosocial care can significantly improve skin outcomes and overall happiness.

The benefits of early intervention extend beyond symptom control. Earlier treatment can reduce stress, enhance social function, and improve adherence to therapy. However, several barriers exist that may hinder early intervention, including delayed diagnosis due to misinterpretation of patient presentation, patient underreporting, perceived social stigma, and limitations in access to dermatologic care [4]. This highlights the need for further exploration of factors contributing to these barriers, including diagnostic challenges, psychosocial influences, and healthcare access limitations. It has been noted that delayed diagnosis can be commonly attributed to patients misinterpreting early signs of rosacea as normal skin sensitivity or sunburn, leading to underreporting and delayed medical evaluation [21]. These findings suggest a greater need for public and patient education on the signs of rosacea to promote early diagnosis and prevent progression. Clinicians must also maintain a high index of suspicion when evaluating patients with persistent facial erythema or sensitivity.

Furthermore, as previously mentioned, facial skin conditions like rosacea carry a significant psychosocial burden, which may prevent patients from seeking care due to embarrassment or shame— further contributing to delayed diagnosis. It is important to also consider geographic, systemic, and socioeconomic barriers that may limit access to specialized dermatologic evaluation, hindering timely diagnosis. Therefore, early intervention not only plays a role in controlling the disease trajectory but also helps restore quality of life, reduce emotional distress, and prevent the psychosocial toll that could accumulate over time.

FUTURE DIRECTIONS IN RESEARCH AND PATIENT CARE

Education & Awareness

Societal stigma plays a key role in shaping the psychosocial well-being of patients with rosacea. Given that dermatological diseases are visibly noticeable, many individuals experience fear of judgement and experience self-confidence challenges [22]. This fear can be debilitating for patients and can prevent them from seeking timely treatment. According to data from the National Rosacea Society (NRS), as many as 90 percent of patients with rosacea report diminished self-esteem and up to 41 percent reported avoiding social activities due to concerns about their appearance [19]. These statistics reflect the substantial negative impact societal perception has on patients’ daily activities and highlight the need for public education to challenge these misconceptions, leading to earlier medical intervention.

To address this, the NRS has designated April as Rosacea Awareness Month, promoting public education through blogs, social media campaigns, and patient testimonials [23]. The organization also publishes a quarterly newsletter titled Rosacea Review which provides care tips and a platform for patients to share their experiences and insights. While these efforts are tremendously beneficial in increasing awareness, future initiatives such as interactive webinars and influencer collaborations can help reach a broader audience. Additionally, the American Acne and Rosacea Society (AARS) supports this mission by offering professional members a social media toolkit to help spread and promote accurate information about rosacea [24]. The success of these educational campaigns in reducing stigma can guide future strategies to increase public understanding and encourage individuals to seek help sooner.

Expanding Access to Care

Despite increased awareness, many individuals with rosacea struggle with access to care, especially those in rural or underserved communities. To help with this, rosacea screening can be implemented in primary care settings, which will allow for earlier diagnosis and quicker referrals to dermatologists. The NRS currently houses a physician referral service to help connect new patients with dermatologists within their zip code [25]. These efforts are pivotal in providing access to care for this population, but further research is needed to explore how these programs can be improved and expanded.

Furthermore, cost remains a significant barrier for many patients since some rosacea treatments are considered cosmetic and not covered by insurance companies. For example, one survey of 560 patients found that light-based therapy—such as laser therapy— has been shown to reduce visible blood vessels and improve overall redness in rosacea, but this intervention was only covered by insurance for 3% of respondents [26]. This reflects the substantial role cost plays in influencing treatment options and highlights the need for greater insurance coverage for rosacea patients. These insurance limitations not only restrict access to beneficial treatment options but also contribute to substantial out-of-pocket expenses for patients. Among the 560 surveyed patients, 36% paid between $100 and $500, 12% paid between $500 and $1,000, and 13% reported paying over $1,000 [26]. This data emphasizes a significant financial burden for a considerable portion of patients and highlights how healthcare costs can further demotivate patients from seeking medical care. Such financial burdens can serve as an additional stressor for patients, potentially worsening existing mental health challenges identified in those battling this condition.

Early Intervention with Telemedicine

Telemedicine has transformed healthcare and rapidly grown following the COVID-19 pandemic. Before the pandemic, only 14.1% of dermatologists reported using teledermatology (telemedicine in dermatology), but this number significantly increased to 96.9% during the pandemic with 58.0% planning to continue its use post-pandemic [27]. This reflects the changing landscape within dermatological practices and shows the transformation of how dermatology services can be accessed. Despite challenges in healthcare such as geographical barriers, provider shortages, and unnecessary travel time and cost, telemedicine is able to play a key role in enhancing access to care [28]. While there is limited research assessing telemedicine’s role in managing rosacea, it has had success in treating other chronic skin conditions such as psoriasis and atopic dermatitis [29]. These findings suggest that telemedicine can benefit rosacea patients through earlier diagnosis, more timely management, and consistent follow-up — particularly for those in more rural areas. Future research should focus on telemedicine in dermatology and evaluate the clinical outcomes, satisfaction, and cost-effectiveness associated, specifically as it relates to rosacea. Teledermatology has the potential to expand the reach of dermatological services, improving access to timely, high-quality care.

Mental Health Counseling in Dermatology

As previously discussed, rosacea has a profound impact on patients’ mental health, and many individuals experience significant emotional distress. This is often due to high levels of internalized stigma where patients adopt negative societal stereotypes about their condition and withdraw from social interactions [30]. While affecting all individuals, females have been found to experience a greater decline in quality of life due to societal beauty standards [31]. This decline negatively affects patients’ overall life satisfaction and can potentially predispose patients to psychiatric illness. This intricate psychosocial relationship was emphasized by a meta-analysis from cross-sectional and case–control studies that identified a higher risk of depression or anxiety for patients with rosacea [32]. This underscores the need for a more integrated approach to rosacea care.

Despite studies linking rosacea with psychological distress, mental health resources remain underutilized in dermatology settings. Therefore, future research should explore the benefits of integrating mental health services into routine dermatologic care. Potential interventions include incorporating psychologists into clinics, creating peer support groups, offering cognitive behavior therapy (CBT), and implementing regular mental health screenings. However, research remains limited on whether these tools are being routinely offered or accessed by rosacea patients. One study using Latent Dirichlet Allocation (LDA), an unsupervised machine learning algorithm, analyzed Reddit forums and found that approximately 22.0% of all posts in the rosacea forum were emotional, suggesting that peer support groups function as a coping mechanism for these patients [33]. While peer groups can be an effective support system, online forums are not accessible for all patient populations. In-person peer support groups and structured therapy referrals can help bridge this gap. In addition, consistent mental health screenings in dermatology practices may significantly improve outcomes for patients affected by chronic skin conditions like rosacea. Addressing the psychological needs of patients is just as important as managing the physical symptoms and can lead to more comprehensive, effective care [34,35].

CONCLUSION

Rosacea is a chronic, multifactorial skin condition that affects patients’ emotional well-being, social interactions, and overall quality of life. While the physical symptoms such as inflammation and facial erythema are often the focus of management, the psychosocial burden of rosacea is often overlooked — yet it can be just as debilitating. As highlighted in this review, individuals with rosacea commonly report anxiety, depression, low self-esteem, societal stigma, and social isolation. Despite this, only a small percentage of these individuals will seek professional help.

Healthcare professionals, especially dermatologists, need to consider a comprehensive approach when developing treatment plans to ensure patients feel seen, supported, and empowered. Early intervention, such as timely diagnosis, treatment, patient education, psychosocial support, and lifestyle modifications, can improve outcomes. By addressing the physical symptoms and also supporting mental health, early management can help break the cycle of emotional distress and social withdrawal.

In addition, raising awareness, reducing stigma, and improving access to care through tools like teledermatology are important in creating a more inclusive care model. Therefore, future research should explore more innovative strategies to better support individuals living with this poorly understood, complex skin condition. By embracing a more comprehensive approach, including early diagnosis, equitable access, and integration of mental health support into treatment plans, dermatologists can make a significant difference in the lives of patients with rosacea.

ACKNOWLEDGEMENTS

None.

CONFLICTS OF INTEREST

The author declares that there are no conflicts of interest.

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