An evidence-based, peer-reviewed journal for practicing clinicians in the field of dermatology
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51 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 Role Limitations Due to Emotional Problems, Emotional Well-being, Social Functioning, and Energy/Fatigue domains appeared to be clinically significant for the PPR cohort compared with the general population. The mean BMI in our population was slightly higher than the mean BMI reported for the general population in the 2009–2010 National Health and Nutrition Examination Survey, 22 with 69.0 percent classified as overweight or obese. 22 Since BMI was not controlled for in this analysis, it is possible that the higher BMI could account for some of the SF-36 results. However, given the increasing rate of overweight and obesity in the US, it is also possible that the population in this study, which was conducted in 2015, is representative of the current population. A recent systematic review reported on 12 observational and prospective studies investigating different aspects of QoL in participants with various subtypes of rosacea, each utilizing validated health-related QoL instruments. 7 While most studies enrolled fewer than 200 participants, enrollment in one-third of the studies ranged from 308 to 966 participants. All of the studies reported substantial negative effects of rosacea on the health-related QoL of the participants. In a separate survey of more than 400 individuals with rosacea conducted by the National Rosacea Society, rosacea was associated with substantial negative psychosocial effects, such as poor self-esteem, feeling embarrassed or frustrated, and feeling robbed of pleasure or happiness. 23 The current findings from a large population in a cross-sectional study confirm those of earlier studies that indicated that rosacea is associated with negative psychosocial effects and decreased QoL. 7,24 Prior studies have been limited to measurement of QoL with only one instrument, whereas the study reported here used multiple questionnaires evaluating different aspects of the psychosocial effects of rosacea. 7 A separate publication from this survey describes findings regarding the most bothersome rosacea symptoms, treatment profiles, and expectations from treatment for participants with ETR and PPR. The majority of participants with ETR reported facial erythema, blushing, and/or flushing to be the most bothersome symptoms, while those with PPR also identified bumps and/or pimples as among the most bothersome symptoms. These results complement the current findings in that rosacea-associated facial erythema had a substantial negative impact on participants in both cohorts. As described in the previous report from this survey, medication utilization was relatively low and satisfaction with both prescription and nonprescription agents by survey participants was low, with only about half of participants who used prescription agents being satisfied or very satisfied with treatment. Participants commonly reported relying on prescription agents to treat flare-ups rather than for continuous prophylactic use. Effective treatment for rosacea improves patients' psychological symptoms and QoL related to rosacea. 10,24,25 It might be helpful, therefore, for patients to be educated about the chronic nature of rosacea and the need for long-term treatment and to set reasonable expectations for treatment. 24,26 This might in turn lead to greater satisfaction with treatment and associated improvements in psychosocial symptoms and QoL. This study obtained a wide range of data from a single large cohort of participants with self-reported ETR and PPR. In addition, multiple survey instruments were used to assess the impact of rosacea from a variety of perspectives in this population. Questionnaires on coping and avoidance were modeled after the SWAP questionnaire, which was validated for use by burn patients, and the modified SWAP questionnaire, which was adapted and validated for use by patients with systemic sclerosis, 13,14 and examined attitudes, beliefs, self- perceptions, and satisfaction with appearance as a result of having rosacea. Rosacea-specific instruments, including the validated RosaQoL questionnaire 18 and the IA-RFR, addressed rosacea impact on QoL based on specific features of rosacea. Limitations. Limitations of this Internet- based survey include aspects of the electronic data collection methodology that could allow for selection bias, the reliance on self-reported disease diagnosis from participants and clinical history rather than on reports from medical professionals, and the relatively low recruitment of individuals with severe ETR and PPR. However, the last issue might be of limited importance when considering the psychosocial effects of rosacea, which do not always correlate with the severity of disease. 27 CONCLUSION Rosacea has wide-ranging negative effects on individuals who have a self-reported diagnosis of rosacea. These effects include impact on self- perceptions and emotional, social, and overall well-being, as well as rosacea-specific QoL, among individuals with ETR and PPR. Effective therapies that address the underlying etiology as well as the bothersome symptoms of rosacea, along with appropriate treatment education, are needed to achieve optimal aesthetic and psychosocial outcomes and improvements in QoL. ACKNOWLEDGMENTS Writing and editorial assistance was provided to the authors by Michael L. Pucci, PhD, of Peloton Advantage, Parsippany, New Jersey, and was funded by Allergan plc, Dublin, Ireland. FIGURE 4. Mean RAND 36-Item Short Form Health Survey version 1.0 scores in the ETR and PPR cohorts and in the general US population. Domain scores ranged from 0 to 100, with higher scores indicating better health status. The recall period was four weeks. ETR: erythematotelangiectatic rosacea; PPR: papulopustular rosacea; a General US population values from McDowell. 19