Rosacea and Personality Erik Karlsson 1 , Mats Berg 2 and Bengt B. Arnetz 3 1 Department of Social Sciences, Va ¨xjo ¨ University, 2 Section of Dermatology, Department of Medical Science and 3 Section for Social Medicine/CEOS, Department of Public Health, Uppsala University, Uppsala, Sweden. E-mail: erik.karlsson@vaxjo.mail.telia.com Accepted August 24, 2003. Sir, Rosacea is a common facial disease (1). Research on possible psychosomatic causes of the origin of rosacea is relatively scant and in general fairly old. Guilt and shame, mostly concerning sexual problems and social anxiety, were previously thought to play a considerable part in the aetiology of rosacea, and it was asserted that patients with rosacea had homosexual fantasies and signs of paranoia (2, 3). Suggestions have been made that rosacea patients show signs of immaturity, strongly inhibited affective responses, shyness, lack of self- confidence and feelings of inadequacy (4). In com- parison with patients with alopecia areata and lichen planus, rosacea patients have a greater tendency to neurotic disorders, self-aggression, self-criticism and a greater discrepancy between desires and capabilities. Higher states of permanent anxiety were also noted compared to the other groups of skin disease patients; in many cases traumatic situations preceded the out- break of rosacea (5 – 7). Other authors assert that no satisfactory single cause for the onset of rosacea has been found (8) and that there is no consensus regarding the role that personality factors play in rosacea (9). The aim of our study was to investigate how rosacea patients handle and react to aggression and personal detachment, and whether they exhibited differences in those respects when compared to psoriatic patients and to healthy controls. MATERIALS AND METHODS A group of 51 rosacea patients (35 females and 16 males; mean age 50, median 49, range 20 – 82 years) and a gender- matched group with 42 psoriasis patients (27 females and 15 males; mean age 47, median 50, range 20 – 78 years) were studied. Also studied were 47 office employees without skin disease (32 females and 15 males; mean age 47, median 46, range 29 – 60 years). The rosacea patients were all consecutive dermatological patients at the Karolinska Hospital in Stock- holm and were all examined by the same dermatologist. Their symptoms varied from moderate to severe. The mean duration of disease was 9.5 years. The psoriasis patients were also consecutive patients at the Swedish Psoriasis Organization in Enskede outside Stockholm, and their symptoms varied from mild to more serious. Mean duration of disease was 24.5 years. The office employees with healthy skin had jobs in medical administration in a county council, and they were randomly chosen from the employment list. A modified version of Schalling’s (10) Karolinska Scales of Personality (KSP) was used. The factors studied from the test were inhibition of aggression, verbal aggression, indirect aggression, irritability and aggression in the form of guilt, as well as detachment in relation to other people. Comparisons were done between the rosacea group and the control groups. Variance analyses were performed with the one-way ANOVA method. The Alpha level for significance was set to pv0.05, two-sided. RESULTS No statistically significant differences were found between the rosacea group and the control groups in any of the six categories (Table I). However, the rosacea group tended to score lower on the degree of ‘‘verbal aggression’’ compared to the corresponding group of healthy office employees ( p~0.069), but not compared to the psoriasis group. DISCUSSION The starting-point for our assumption was the body of studies indicating that rosacea patients show a higher degree of aggression towards themselves (5 – 7). The assumption was further strengthened by the fact that no previous study had shown any form of externally directed aggressive behaviour in rosacea patients. Consequently it was assumed that they would show significantly lower degrees of aggressive behaviour in the form of indirect aggression, verbal aggression and Table I. Patients with rosacea as compared to psoriatics and healthy controls. Mean score¡SD. No statistical difference was shown. KSP a scores Rosacea (n~51) Psoriasis (n~42) Healthy skin (n~47) All controls (psoriasiszhealthy skin) (n~89) Verbal aggression 11.5¡2.7 12.3¡2.8 12.5¡2.5 12.4¡2.6 Indirect aggression 10.0¡2.2 10.5¡2.4 10.4¡2.4 10.5¡2.4 Inhibition of aggression 23.6¡4.6 23.5¡5.2 23.4¡3.7 23.4¡4.4 Irritability 10.5¡2.3 10.9¡2.8 11.2¡1.8 11.0¡2.3 Guilt 12.1¡2.4 11.4¡2.7 12.0¡1.9 11.7¡2.3 Detachment 20.0¡4.4 19.3¡5.3 19.3¡3.5 19.3¡4.4 a Results of KSP interviews/questionnaires. KSP~Karolinska scales of personality. 76 Letters to the Editor Acta Derm Venereol 84 DOI: 10.1080/00015550310005799