Rosacea and Dry Eyes Part 7 - the mental aspects of rosacea.
Updates on the Risk of Neuropsychiatric and Gastrointestinal Comorbidities in Rosacea and Its Possible Relationship with the Gut-Brain-Skin Axis.
Rosacea and related dry eye can have a host of impacts on a patient’s mental status (which also needs to be addressed and in many cases, also treated):
(adapted and annotated from: Woo YR, Han YJ, Kim HS, Cho SH, Lee JD. Updates on the Risk of Neuropsychiatric and Gastrointestinal Comorbidities in Rosacea and Its Possible Relationship with the Gut-Brain-Skin Axis. Int J Mol Sci. 2020 Nov 10;21(22):8427. doi: 10.3390/ijms21228427. PMID: 33182618; PMCID: PMC7696644.)
-Chronic pain syndrome (chronic erosive and corrosive impact on the surface of the eyes, with secondary irritation, inflammation) – eyes are important and help define our relationships to people, places and things. When eyes hurt, we may act out – or withdraw – with either reaction likely to affect our mental state.
-Anxiety/Body Dysmorphism (most have a degree of red eyes/lids/red face, many have frequent chalazia/styes, some have pustules (whitehead zits), papules (red bumps/zits), more rarely a phymatous (swollen) reaction. These changes can make us nervous and can negatively affect the way we see ourselves (dysmorphism).
-Depression (chronic anxiety, poor sleep, chronic, progressive nature of the disease) and slow, sometimes painful & painfully slow progress from treatments, with variable effects on vision, work performance, family life and the ability to enjoy common outdoor activities from weather impacts).
-High prevalence of GI issues associated with Rosacea. (poor absorption, increased circulating inflammatory mediators and abdominal pain with irregular bathroom habits and related social stressors).
Psychological aggravating factors such as stress, anxiety, personality issues with excessive feelings of shame and guilt, and social anxiety secondary to easy blushing could worsen the flushing in patients with rosacea and be a factor involved in the vicious cycle of rosacea.
-Known association with cardiovascular disorders (hypertension and coronary artery disease – adding additional psychic stress).
-Another chronic neurovascular disorder, migraine, shares a variety of clinical features with rosacea. Migraine and rosacea both have features of chronic, recurrent paroxysmal episodes with disabling symptoms in the trigeminal nerve (the nerve responsible for sensing pain in and around the eye as well as areas of the face). Indeed, Tan et al. first reported that 44% of the patients with rosacea had experienced migraines. Ocular rosacea appears to have a special connection to migraines, in that the more extreme “Phymatous” version of Rosacea is not commonly associated with migraine and Ocular Rosacea, is. It is also true that many of the “triggers” for rosacea are shared as equal triggers for migraines (especially the “vasoactive” foods like spices and alcohol, as well as extremes of hot and cold weather).
-Migraines independent of rosacea can be disabling with its own major effects on life-balance.
Because inflammation is central to many disease states, it should not be a stretch to understand that other neurological illnesses, such as Parkinson’s and Alzheimer’s Diseases are also more common in rosacea patients - though I should point out that there is much for medicine to learn about the intricacies of these “associations” and just because one has one disease, does not mean one is destined to acquire others.
This and future posting should help us understand why it often takes a village to best help our rosacea patients - with eye-affected ones requiring substantial assistance from eye care professionals.
To schedule an appointment with Dr. Jaccoma, call Excellent Vision at either of these two dry eye offices:
(1) 155 Griffin Rd, Portsmouth, NH 03801 (603) 574-2020
(2) 3 Woodland Rd, STE 112 Stoneham, MA 02180 (near Boston) (781) 321-6463