Background: Rosacea is a chronic skin condition that affects self-esteem and quality of life. However, data on depression and anxiety in patients with rosacea are scarce. Objective: The aim of this study was to investigate the relationship between rosacea and new-onset depression and anxiety disorders. Methods: Data on all Danish citizens aged ≥18 years between January 1, 1997, and December 31, 2011, were linked at individual level in nationwide registers. Incidence rates per 1,000 person-years were calculated, and crude and adjusted incidence rate ratios (IRRs) with 95% confidence intervals (95% CIs) were estimated by Poisson regression models. Results: The study comprised a total of 4,632,341 individuals, including 30,725 and 24,712 patients with mild and moderate-to-severe rosacea, respectively. Mild and moderate-to-severe rosacea increased the risk of both depression [IRR 1.89 (95% CI 1.82-1.96) and IRR 2.04 (95% CI 1.96-2.12)] and anxiety disorders [IRR 1.80 (95% CI 1.75-1.86) and IRR 1.98 (95% CI 1.91-2.05)]. Conclusions: Rosacea was associated with a disease severity-dependent, increased risk of depression and anxiety disorders. The findings may call for increased awareness of psychiatric morbidity in patients with rosacea.

Lomholt G: Prevalence of skin diseases in a population; a census study from the Faroe Islands. Dan Med Bull 1964;11:1-7.
Berg M, Liden S: An epidemiological study of rosacea. Acta Derm Venereol 1989;69:419-423.
Tan J, Blume-Peytavi U, Ortonne JP, Wilhelm K, Marticou L, Baltas E, Rivier M, Petit L, Martel P: An observational cross-sectional survey of rosacea: clinical associations and progression between subtypes. Br J Dermatol 2013;169:555-562.
Schwab VD, Sulk M, Seeliger S, Nowak P, Aubert J, Mess C, Rivier M, Carlavan I, Rossio P, Metze D, Buddenkotte J, Cevikbas F, Voegel JJ, Steinhoff M: Neurovascular and neuroimmune aspects in the pathophysiology of rosacea. J Investig Dermatol Symp Proc 2011;15:53-62.
Buhl T, Sulk M, Nowak P, Buddenkotte J, McDonald I, Aubert J, Carlavan I, Deret S, Reiniche P, Rivier M, Voegel JJ, Steinhoff M: Molecular and morphological characterization of inflammatory infiltrate in rosacea reveals activation of Th1/Th17 pathways. J Invest Dermatol 2015;135:2198-2208.
Two AM, Wu W, Gallo RL, Hata TR: Rosacea. Part I. Introduction, categorization, histology, pathogenesis, and risk factors. J Am Acad Dermatol 2015;72:749-758.
Moustafa F, Lewallen RS, Feldman SR: The psychological impact of rosacea and the influence of current management options. J Am Acad Dermatol 2014;71:973-980.
Gupta MA, Gupta AK, Chen SJ, Johnson AM: Comorbidity of rosacea and depression: an analysis of the National Ambulatory Medical Care Survey and National Hospital Ambulatory Care Survey - Outpatient Department data collected by the U.S. National Center for Health Statistics from 1995 to 2002. Br J Dermatol 2005;153:1176-1181.
Sutcigil L, Oktenli C, Musabak U, Bozkurt A, Cansever A, Uzun O, Sanisoglu SY, Yesilova Z, Ozmenler N, Ozsahin A, Sengul A: Pro- and anti-inflammatory cytokine balance in major depression: effect of sertraline therapy. Clin Dev Immunol 2007;2007:76396.
Maes M: Depression is an inflammatory disease, but cell-mediated immune activation is the key component of depression. Prog Neuropsychopharmacol Biol Psychiatry 2011;35:664-675.
Miller AH: Depression and immunity: a role for T cells? Brain Behav Immun 2010;24:1-8.
Dowlati Y, Herrmann N, Swardfager W, Liu H, Sham L, Reim EK, Lanctot KL: A meta-analysis of cytokines in major depression. Biol Psychiatry 2010;67:446-457.
Sampogna F, Picardi A, Melchi CF, Pasquini P, Abeni D: The impact of skin diseases on patients: comparing dermatologists' opinions with research data collected on their patients. Br J Dermatol 2003;148:989-995.
Schmidt M, Pedersen L, Sorensen HT: The Danish Civil Registration System as a tool in epidemiology. Eur J Epidemiol 2014;29:541-549.
Baadsgaard M, Quitzau J: Danish registers on personal income and transfer payments. Scand J Public Health 2011;39:103-105.
Andersen TF, Madsen M, Jorgensen J, Mellemkjoer L, Olsen JH: The Danish National Hospital Register. A valuable source of data for modern health sciences. Dan Med Bull 1999;46:263-268.
Gaist D, Sorensen HT, Hallas J: The Danish prescription registries. Dan Med Bull 1997;44:445-448.
Egeberg A, Mallbris L, Gislason GH, Skov L, Hansen PR: Risk of multiple sclerosis in patients with psoriasis: a Danish nationwide cohort study. J Invest Dermatol 2016;136:93-98.
Jensen P, Ahlehoff O, Egeberg A, Gislason G, Hansen PR, Skov L: Psoriasis and new-onset depression: a Danish nationwide cohort study. Acta Derm Venereol 2016;96:39-42.
Rist PM, Schurks M, Buring JE, Kurth T: Migraine, headache, and the risk of depression: prospective cohort study. 2013;33:1017-1025.
von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP, STROBE Initiative: The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Epidemiology 2007;18:800-804.
Vazquez BG, Alikhan A, Weaver AL, Wetter DA, Davis MD: Incidence of hidradenitis suppurativa and associated factors: a population-based study of Olmsted County, Minnesota. J Invest Dermatol 2013;133:97-103.
Bohm D, Schwanitz P, Stock Gissendanner S, Schmid-Ott G, Schulz W: Symptom severity and psychological sequelae in rosacea: results of a survey. Psychol Health Med 2014;19:586-591.
Boehncke WH, Ochsendorf F, Paeslack I, Kaufmann R, Zollner TM: Decorative cosmetics improve the quality of life in patients with disfiguring skin diseases. Eur J Dermatol 2002;12:577-580.
Garvin P, Nilsson L, Carstensen J, Jonasson L, Kristenson M: Plasma levels of matrix metalloproteinase-9 are independently associated with psychosocial factors in a middle-aged normal population. Psychosom Med 2009;71:292-300.
Rybakowski JK, Remlinger-Molenda A, Czech-Kucharska A, Wojcicka M, Michalak M, Losy J: Increased serum matrix metalloproteinase-9 (MMP-9) levels in young patients during bipolar depression. J Affect Disord 2013;146:286-289.
Scharschmidt TC, Yost JM, Truong SV, Steinhoff M, Wang KC, Berger TG: Neurogenic rosacea: a distinct clinical subtype requiring a modified approach to treatment. Arch Dermatol 2011;147:123-126.
Martin-Merino E, Ruigomez A, Wallander MA, Johansson S, Garcia-Rodriguez LA: Prevalence, incidence, morbidity and treatment patterns in a cohort of patients diagnosed with anxiety in UK primary care. Fam Pract 2010;27:9-16.
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