High Frequency of Fibromyalgia in Rosacea: Sleep Quality and Depression as Major Drivers of Disease Burden in a Controlled Cross-Sectional Study

Abstract

Background Rosacea is a chronic inflammatory dermatosis associated with systemic and psychosocial comorbidities. While a link to psychiatric distress has been established, its relationship with central sensitization syndromes remains unclear. We aimed to determine the prevalence of fibromyalgia syndrome (FMS) in patients with rosacea and investigate the potential contributions of sleep quality, fatigue, depression, and anxiety to disease burden and FMS severity. Materials and Methods This cross-sectional study included 54 patients with rosacea and 51 age-and sex-matched healthy controls. Participants were assessed using the 2010 American College of Rheumatology (ACR) criteria for FMS. Disease burden and psychological status were evaluated using the Fibromyalgia Impact Questionnaire (FIQ), Hospital Anxiety and Depression Scale (HADS), Pittsburgh Sleep Quality Index (PSQI), and Fatigue Severity Scale (FSS). Results The prevalence of FMS was significantly higher in patients with rosacea than in controls (68.5% vs. 9.8%;p< 0.001; OR = 20.02; 95% CI: 6.75-59.37). Patients with rosacea exhibited significantly higher anxiety, depression, and functional disability scores (allp< 0.05).Multivariate regression analysis identified depression (beta= 1.963,p< 0.001) and poor sleep quality (beta= 2.364,p< 0.001) as the strongest independent predictors of FMS severity, explaining 48% of the variance (R-2= 0.48). Fatigue was the only independent predictor of FMS (OR = 7.17,p= 0.013). ROC analysis showed high discriminative performance for fatigue (AUC = 0.851) and for sleep quality (AUC = 0.816). Phenotypically, subjective dryness was significantly associated with the erythematotelangiectatic rosacea (ETR) subtype (p= 0.009) but less common in the papulopustular rosacea (PPR) subtype (p= 0.024). Conclusion Patients with rosacea harbor a substantial burden of undiagnosed FMS, driven primarily by fatigue, sleep disturbance, and depressive symptoms rather than cutaneous severity alone. The distinct association between dryness and the erythematotelangiectatic subtype suggests a subtype-specific sensory profile. Dermatologists should consider screening for sleep and mood disorders to manage the systemic symptom burden in patients with rosacea.