An evidence-based, peer-reviewed journal for practicing clinicians in the field of dermatology
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49 JCAD JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY February 2018 • Volume 11 • Number 2 O R I G I N A L R E S E A R C H A substantial proportion of participants in both cohorts indicated that they worry about how others perceive them based on their rosacea (Tables 1 and 2). Overall, both the ETR and PPR cohorts expressed negative views as to how others might perceive them; 27 percent of the ETR cohort and 42 percent of the PPR cohort agreed or strongly agreed that they worry how people would react to seeing their rosacea. Following the same pattern, 43 percent of the ETR cohort and 59 percent of the PPR cohort agreed or strongly agreed that their rosacea is unattractive to others. A total of 30 percent of the ETR cohort and 44 percent of the PPR cohort agreed or strongly agreed that they worry that people jump to false conclusions based on their facial redness. In addition, variable but substantial proportions of the ETR and PPR cohorts agreed or strongly agreed that they worry that others perceive them as less likely to be successful, confident, or have a romantic partner, and more likely to be shy or unhealthy (Table 2). Rosacea facial redness had a negative impact on all study participants for all domains of the IA-RFR questionnaire (Figure 1). In the PPR cohort, bumps and pimples had the greatest negative impact in the Emotional and Grooming domains of the IA-RFB questionnaire (Figure 2). Notably, in the PPR cohort, comparison of the overall impact of facial redness (IA-RFR) and of bumps and pimples (IA-RFB) indicated that the negative impact of facial redness was numerically greater. A greater negative impact of facial redness was also observed in the Self- perception and Grooming domains. However, facial redness had a less negative impact than bumps and pimples in the Emotional and Social domains. RosaQoL total scores and Emotion, Symptom, and Functioning domain scores were similar within each cohort, and ranged from 2.0 to 2.9, indicating responses of "rarely" to most of the questionnaire items (Figure 3). The PPR cohort had numerically higher mean scores than the ETR cohort overall and in all RosaQoL domains, suggesting that PPR might have a slightly greater negative impact on QoL than ETR. Results from the SF-36 questionnaire (Figure 4) showed that both the ETR and the PPR cohorts had lower scores than the US general population overall and for each individual domain within the questionnaire. 19 Mean Role Limitations Due to Emotional Problems, Energy/Fatigue, Emotional Well-being, and Social Functioning scores were numerically lower in the PPR cohort than the ETR cohort. DISCUSSION This comprehensive survey of a large cohort of individuals who reported a diagnosis of rosacea found that the condition has a considerable negative impact on QoL, irrespective of subtype. Approximately half of the participants in each cohort were dissatisfied with their facial appearance because of rosacea and felt unattractive because of it. Many participants in both cohorts reported worrying about how people react when they see the rosacea or were concerned about the possible misperceptions of others, possibly because they might think the participant is alcoholic, shy/blushing, unconfident, or unhealthy. Furthermore, multiple assessment instruments, including the IA-RFR, RosaQoL questionnaire, and SF-36 in both cohorts and the IA-RFB in the PPR cohort, pointed to rosacea having a substantial negative impact on participants in several aspects of QoL, including self-perception, emotional well-being, and functional limitations due to emotional problems. While rosacea generally had a slightly greater negative impact on QoL in the PPR cohort than it did in the ETR cohort, specifically in domains of dissatisfaction with facial appearance, feeling TABLE 1. Satisfaction with facial appearance a STATEMENT (AGREE AND STRONGLY AGREE), N (%) ETR (N=409) PPR (N=191) I am satisfied with the appearance of my face in relation to my rosacea. b 96 (24) 35 (18) I worry how people will react when they see my rosacea. 110 (27) 80 (42) Because of my rosacea, I am uncomfortable in public. 63 (15) 61 (32) Because of my rosacea, I am uncomfortable in the presence of my friends and/or family. 35 (9) 31 (16) I feel rejected/discriminated against because of my rosacea. 23 (6) 17 (9) I feel rejected/discriminated against in the workplace because of my rosacea. 17 (4) 12 (6) I feel that my rosacea is unattractive to others. 175 (43) 113 (59) Changes in my appearance due to rosacea have interfered with my relationships. 21 (5) 20 (10) I worry that people jump to conclusions about me based on my facial redness (ie, alcoholic or shy/blushing). 124 (30) 84 (44) I worry that people jump to conclusions about me based on my facial bumps or pimples (ie, poor diet or poor hygiene). — 75 (39) ETR: erythematotelangiectatic rosacea; PPR: papulopustular rosacea; a Satisfaction with appearance questions modeled on the Satisfaction With Appearance Scale (SWAP) questionnaire (created for burn patients) and the SWAP questionnaire modified for patients with scleroderma 13,14 ; b The proportions of participants who disagreed or strongly disagreed with this statement were 45% and 53% for the ETR and PPR cohorts, respectively. TABLE 2. Participants' concerns about others' perceptions based on their rosacea STATEMENT (AGREE AND STRONGLY AGREE), N (%) ETR (N=409) PPR (N=191) I worry that, based on the appearance of my rosacea symptoms, people feel that: I am less likely to be intelligent. 23 (6) 16 (8) I am less likely to be successful. 47 (11) 39 (20) I am less likely to be confident. 96 (23) 68 (36) I am more likely to be shy. 99 (24) 81 (42) I am more likely to be unhealthy. 98 (24) 71 (37) I am less likely to have a romantic partner. 46 (11) 43 (23) I am less likely to be happy. 45 (11) 35 (18) ETR: erythematotelangiectatic rosacea; PPR: papulopustular rosacea.