Exploring the neural basis of rosacea: altered brain activity and its links with social anxiety

Rosacea is a chronic dermatological condition primarily affecting the face, known for its links to the central nervous system and its significant social impact. However, the specific neurological underpinnings remain largely unexplored.

To investigate the brain activity changes in patients with rosacea and their links with clinical symptoms and psychosocial measurements.

This cross-sectional study included 32 treatment-naive female patients with rosacea and 29 age- and sex-matched healthy control participants. Neuroimaging, and clinical and psychosocial assessments were conducted. Resting-state functional magnetic resonance imaging (rs-fMRI) data were analysed for amplitude of low-frequency fluctuations (ALFFs). We examined associations between ALFFs and clinical symptoms and psychosocial measures.

Increased ALFF was observed in the prefrontal cortex (PFC) of patients with rosacea, particularly in the right superior frontal gyrus (SFG) and left orbital middle frontal gyrus (ORBmid) (voxel level P < 0.001, cluster level P < 0.05). The ALFF values of the right SFG were positively correlated with erythema scores (r = 0.395; P = 0.03). Meanwhile, activity in the left ORBmid correlated significantly with Social Avoidance and Distress Scale (r = 0.528; P = 0.002) and Social Appearance Anxiety Scale (r = 0.535, P = 0.002) scores. Mediation analysis showed that appearance anxiety mediates the association between the ALFF values of the left ORBmid and social avoidance (indirect effect = 0.217, 95% confidence interval 0.022-0.440; P < 0.05).

This study offers novel insights into rosacea's neuropathology, linking PFC activity with physical and psychosocial symptoms. The findings underscore the potential of targeting neuropsychosocial aspects in comprehensive rosacea management.