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

BACKGROUND: 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. OBJECTIVES: To investigate the brain activity changes in patients with rosacea and their links with clinical symptoms and psychosocial measurements. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.