Conspicuous disorders like rosacea can involve so many other areas of life that even a mild case can be severely distressing, said Richard G. Fried, M.D., clinical psychologist and director of Yardley Dermatology Associates, at the recent meeting of the American Academy of Dermatology. But giving patients control over their disease can break the self-destructive cycle and help keep flare-ups at bay.

An outbreak of bumps and pimples that may appear insignificant to others can be a disaster for the patient, he noted. "Research has shown that psychological distress over a flare-up can be independent of its severity, so the intuitive notion that a small outbreak has little emotional impact is often not true," he said.

In addition, uncertainty about when a flare-up will occur may have a profound effect on the patient's well-being. "Can you guarantee how your skin is going to behave for a business meeting the following week? The answer might be no," he said.

Such worries can spark a downward spiral, he noted, where a secondary wave of psychological and physical effects may feed off one another. People may not feel particularly sad or depressed, but may often experience a low level of the "blahs," he noted. "Food may not taste as good, or they may not be as excited about a holiday, for example," he said.

He emphasized that this destructive cycle can be turned around when patients take control of their condition. "The key for rosacea patients is to do their part -- faithfully using medication, as well as identifying and avoiding personal flare-up triggers," he said. "We know that rosacea can be devastating, but it can also be controlled."

In addition to compliance with medical therapy, rosacea patients can help control their symptoms by identifying and avoiding those factors that trigger or aggravate their condition. Equally important is treating the skin gently. Above all, patients must keep their doctors aware of any lack of progress. "Patients and doctors partnering together are the key to keeping this conspicuous and embarrassing disorder at bay," Dr. Fried said.