The biological interplay among rosacea, depression and anxiety may offer important opportunities for improved treatment and prevention of all three disorders, according to a recent meta-analysis published in the medical journal Clinical, Cosmetic and Investigational Dermatology.

Because of the often overlapping physical processes in the development of these conditions, as well as their frequent simultaneous occurrences, their relationships should not be considered solely a result of emotional responses to changes in facial appearance, according to Drs. Xiaoting Yang and Mai Cai, researchers in dermatology at Kunming Medical University in China.

They pointed out a number of the identical pathogenic pathways that underly each of the disorders. For example, forms of the same neurological factors, known as transient receptor potential (TRP), not only play a role in vascular regulation related to flushing and redness and innate immunity related to bumps and pimples (papules and pustules) of rosacea, but are also linked in the development of depression and anxiety.

Dysfunction of the main neuroendocrine links between perceived stress and physical reactions, called the hypothalamus-pituitary-adrenal axis (HPA), plays a vital role in the course of rosacea, while it is also associated with the development of anxiety and depression disorders. Chronic stress, either internally or from external stimuli, alters HPA activity and disrupts its correction.

Studies have also found that the same immune cells, Th1/Th17, are involved in the development of both rosacea and the two psychiatric conditions.

These findings demonstrate that the relationship between neuropsychiatric disorders and skin disorders is not simply based on appearance as understood by the general public, and that there may be a medical connection in their treatment, the researchers concluded. They emphasized that this area deserves more study to clarify the specific mechanisms of action in order to identify potential advances in effective therapy.

Reference
Yang X, Cai M: New Insights into the Mutual Promotion of Rosacea, Anxiety and Depression from Neuroendocrine Immune Aspects. Clin Cosmet Investig Dermatol. 2023 May 29;16:1363-1371. doi: 10.2147/CCID.S413237.