Exploring Factors, Comorbidities, Quality of Life (DLQI), and Depression (PHQ-9) in Rosacea Patients: A Comprehensive Analysis

Abstract

Background: Rosacea is a chronic inflammatory skin condition primarily affecting the face, which greatly influences patients' quality of life and mental well-being.

Aim: This research aimed to examine environmental and dietary factors, systemic comorbidities, and their effects on the quality of life and psychological impact of rosacea in Chinese patients.

Methods: The study was an observational case-control design involving 200 individuals with rosacea and 200 healthy participants. Participants completed a questionnaire addressing skin color, specific habits, dietary and environmental factors, comorbidities, and assessments of quality of life and depression levels using the Dermatology Life Quality Index (DLQI) and the Patient Health Questionnaire-9 (PHQ-9), respectively.

Results: The chi-square test was employed to compare the distribution of general characteristics. Univariate analysis was conducted using Pearson's chi-square test. DLQI is a continuous scale analyzed via independent t-test and PHQ-9 is an ordinal scale analyzed via Mann-Whitney U test. Spearman's rank correlation coefficient was used for nonparametric correlation between two ranked variables. A p value < 0.05 was considered statistically significant. Chi-square results with OR and 95% CI indicated significant associations between rosacea and factors such as female gender, age, smoking, alcohol consumption, environmental influences (sun exposure, use of cosmetics/hair products, exercise, exposure to hot weather, hot baths), dietary factors (dairy products, hot coffee consumption), and comorbidities (diabetes mellitus). No significant links were found with skin colors, dietary factors (fatty food, hot and spicy food, hot tea, sweet food), or other comorbidities (hypertension, high cholesterol, Helicobacter pylori, cancer, Crohn's/ulcerative colitis, dry eye syndrome, chronic kidney disease, and migraine). The rosacea group showed notably higher DLQI scores with moderate effect (9.0%), large effect (40.5%), and extremely large effect (45.5%), along with elevated PHQ-9 scores for depression compared to controls, highlighting a significant impact on their quality of life and mental health. Spearman's rank correlation coefficient demonstrated a significantly positive correlation between DLQI and PHQ-9 scores among participants (rho = 0.423, p < 0.001), indicating that greater quality of life impairment is linked to increased depression levels.

Conclusions: These results underscore the complex nature of rosacea and its significant psychosocial burden. Addressing modifiable risk factors (e.g., smoking cessation, avoid alcohol, hot coffee and dairy products intake, sun protection, cessation of cosmetic products) and incorporating (DLQI/PHQ-9 screening) mental health screening and psychological support into treatment could enhance patient outcomes. Further research is necessary to clarify causal mechanisms and improve management strategies, which will aid in preventing and improving rosacea conditions and treatment approaches in the future.

Keywords: DLQI (Dermatology Life Quality Index); PHQ‐9 (Patient Health Questionnaire‐9); QoL (quality of life); acne rosacea; comorbidities.

FIGURE 1

Distribution of DLQI score in the rosacea and control groups.

FIGURE 2

PHQ‐9 score. Depression level among rosacea (N = 200) and control (N = 200).