Facial erythema influences perceptions

Facial erythema associated with rosacea may be subconsciously associated with poor health and negative personality traits, according to a recent study. Both affected patients and the general public were found to hold these perceptions, which can have psychosocial implications and underscores the need to improve symptom management and provide appropriate patient support, says one expert.

Beyond the clinical symptoms, rosacea can often have a negative impact on the psychosocial and emotional health of the patient, according to Linda Papadopoulos, Ph.D., Mindwork Consulting Ltd, London, London, UK.

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“There is an assumption of what we think we look like and more importantly, what we think others think when they see us,” she says. “This all impacts our body image and how we feel about ourselves towards the outside, and rosacea is no exception. The perceptions of how rosacea sufferers see themselves and how others view them can significantly impact the psychological wellbeing and the quality of life of rosacea patients,” she says.

Dr. Papadopoulos and colleagues recently conducted a study¹ that gauged the subconscious perceptions and the initial reactions of others about facial erythema as well as to measure the impact that facial erythema has on a patient’s emotional and psychological wellbeing.

The study included 6,831 participants from eight countries who responded to questions using an online computer-assisted web interviewing comprising a psychological assessment. During this respondents were shown images of faces representative of their regions with erythema and then digitally altered to portray erythema and asked to associate words with each image. 

NEXT: Respondents questionaire

Following this interview, respondents were given a questionnaire to further find attitudes toward the affected versus non-affected images. Respondents who self-reported facial erythema were asked to also respond to questions about the impact of the condition.

People with facial erythema were strongly associated with having poor health and negative personality traits, while those with clear faces were strongly associated with positive health and personality traits. The greatest differences were seen with ‘relaxed’, ‘healthy’ and ‘well’, implying that those with redder faces were perceived as less relaxed, health and well then those with clear faces. The differences in strength associations were statistically significant (p<0.05).

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Participants responded that the skin was the first thing they noticed on the image with facial erythema. They were more likely to be friends with or hire the person shown in the image without facial erythema and presume the person was married or dating.

Of those participants who reported having facial erythema, the negative impact was noted emotionally, socially, and at work. Those with facial erythema were significantly less satisfied with the appearance of their skin (29% vs 63%, p<0.05), and they agreed that they were judged unfairly in another’s first impression of them (81% vs 70%, p<0.05). More than three quarters (77%) reported their erythema has an emotional impact. Many reported their facial erythema lead others to tell them that they drink too much, believe that they have acne, or to recommend a skincare routine.

Although the vast majority (80%) reported difficulty in controlling facial erythema, those patients who had been diagnosed with rosacea had significantly improved control over their rosacea disease (39%) compared with those who were undiagnosed (20%). Those who were diagnosed were much more motivated (90%) to deal with their erythema than those were undiagnosed (68%).

“I think we are increasingly becoming more aware of the psychological burden of rosacea,” Dr. Papadopoulos says. “We are very simply much more body aware now than we have ever been by virtue of the fact that our world has changed. We are creating more images than we have at any other time, we are manipulating those images, and as a consequence, the visual is impacting our sense of identity. Because we are producing and editing more images of ourselves, I think the way that we are analyzing our appearance is much more nuanced. We are micro-analyzing our bodies in terms of what norms we feel we need to live up to. As such, it’s important that doctors recognize that the psychological handicap resulting from perceived stigma has the potential to be just as debilitating as the physical handicap posed by certain conditions,”

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Dermatologists who understand their patients’ unique experiences with this condition can offer options to improve the potential quality of life issues, she says. Past treating the condition, some options might include recommendations for psychological support to help patients better cope with their condition.

“The skin is our barrier between ourselves and our outside world, so the idea that any condition is just going to be skin deep is just simply not true. It is crucial to treat the patient [beyond] their condition because everyone’s perception is going to be different depending on who they are,” Dr. Papadopoulos says.

Disclosures: Dr. Papadopoulos is a speaker for Galderma. The study was funded by Galderma.