Increased long-term risks of depression, anxiety, stress, and suicidality in rosacea and perioral dermatitis

Background Rosacea and perioral dermatitis (PD) are chronic inflammatory skin conditions of the face that may adversely affect psychological well-being. Objective To investigate the long-term risk of depression, anxiety, stress, suicidal ideation, and suicide attempts in patients with rosacea or PD. Methods Large-scale, retrospective cohort study comprising over 116 million patients. Rosacea or PD patients were matched 1:1 with controls. Mental health outcomes were assessed across multiple follow-up time points. Results The study included 335,314 patients with rosacea and 212,557 with PD. At five years post-diagnosis, individuals with rosacea had a significantly increased risk of depression (HR 1.488, 95 %CI 1.451–1.527, p < 0.001) and anxiety (HR 1.664), while those with PD had even higher risks (depression HR 1.799; anxiety HR 1.988). Both groups also showed markedly elevated risks for stress (rosacea HR 2.457; PD HR 2.876). All observed risks continued to increase over time. The risk of suicidal ideations was significantly increased only in the PD group (HR 1.324), while no significant associations with suicide attempts were observed. Limitations Potential miscoding, lack of causal inferences and severity ratings. Conclusion Rosacea and PD are associated with significantly elevated long-term risks of depression, anxiety, and stress. PD may also confer increased risk of suicidal ideation. Capsule summary • This study expands current understanding by quantifying long-term mental health risks, including depression, anxiety, stress and suicidality, in patients with rosacea and perioral dermatitis (PD), using a large, matched cohort. • Findings highlight the need for routine psychological screening in dermatologic care, particularly for PD, which shows elevated suicidality risk.