Stress, a common trigger for rosacea?

A study conducted by Daphne SU and Peter D DRUMMOND in 2017 aimed to determine whether psychological stress precedes an increase in the severity of symptoms in 16 patients suffering from rosacea. Stress was measured by having them fill out forms, using a rating system from 0 (not stressed at all) to 10 (very stressed), and their symptoms were recorded in journals (presence of papules/pustules, redness, rating of burning intensity from 0 to 10). They found that in 12 out of 16 patients, higher stress levels were associated with more severe symptoms.

Furthermore, the assessment of stress increased the day before a rise in vasomotor flushes, and the increase in stress coincided with the onset of severe episodes of skin tingling. The entirety of these results then suggests an association between stress and the symptoms of rosacea, through an intensification of symptoms in patients.

Stress can also be a result of the onset of rosacea. The impact on one's appearance can lead to a lack of self-confidence and anxiety, which in turn causes mental stress. This relationship is therefore reciprocal.

Vasomotor flushes are reactions in response to episodes of physical and psychological stress, for example, and can result in skin reddening. During these situations, the autonomic nervous system responds by secreting adrenaline. The vessels dilate, and this vasodilation leads to an increase in facial blood flow and reddens the skin. Repeated episodes of vasodilation associated with vasomotor flushes may lead to a loss of vascular tone and permanent dilation of the vessels.

When this vasodilation combines with the activation of cutaneous mast cells, and the subsequent release of vasoactive and pro-inflammatory mediators in the skin by stress hormones, such as corticotropin-releasing factor, it could intensify inflammations and the telangiectasias that are permanent characteristics of the rosacea.

Ultimately, to date, no study has demonstrated that stress can induce the onset of rosacea in healthy individuals without a history, primarily due to the lack of experiments conducted on individuals not initially affected by the disease. However, scientific data shows that the stress can intensify and worsen symptoms in patients suffering from rosacea.

Stress would therefore be a worsening factor of rosacea, more than a trigger. Additional studies would allow us to clarify these results.