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

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

Objective: To investigate the brain activity changes of rosacea and their links with clinical symptoms and psychosocial measurements.

Methods: This cross-sectional study included 32 treatment-naïve female patients with rosacea and 29 age- and gender-matched healthy controls. Neuroimaging, clinical, and psychosocial assessments were conducted. Resting-state functional magnetic resonance imaging (rs-fMRI) data were analyzed for amplitude of low-frequency fluctuations (ALFF). We examined associations between ALFF 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 right SFG's ALFF values were positively correlated with erythema scores (r = 0.395; P < 0.05). Meanwhile, activity in the left ORBmid correlated significantly with Social Avoidance and Distress Scale (SADS) (r = 0.528; P < 0.01) and Social Appearance Anxiety Scale (SAAS) (r = 0.535, P < 0.01) scores. Mediation analysis showed that appearance anxiety mediates the association between left ORBmid's ALFF values and social avoidance (indirect effect = 0.217, 95% CI, (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 neuro-psycho-social aspects in comprehensive rosacea management.