It's well known that stress is a top trigger for rosacea flare-ups, but new research may point to the direct effect stress has on the skin.

"Nearly everyone has some form of stress in their life, so it's difficult to determine whether stress can actually make the skin diseases worse," said Dr. Richard Granstein, chairman of the department of dermatology at Weill Cornell Medical College and a member of the National Rosacea Society's Medical Advisory Board. "However, it's been known for a long time that the nervous system, which processes our stress, has an impact on conditions such as psoriasis and rosacea."

In a presentation at the summer meeting of the American Academy of Dermatology, Dr. Granstein discussed research into the relationship between the nervous system and the skin, and the pathophysiologic processes involved in that interaction.

He explained that many types of cells in the skin -- including immune cells, endothelial cells and mast cells -- can be regulated by neuropeptides and neurotransmitters, chemicals that are produced by nerve cells. Some of these chemicals in turn cause inflammation and dilate blood vessels in the skin. Some also appear to regulate immune processes in the skin.

"In stressed humans, parts of the nervous system are activated with enhanced release of some neuropeptides and neurotransmitters ," Dr. Granstein said. This can affect how and at what level the body responds -- causing inflammation, and dilating blood vessels in the skin of rosacea sufferers. These symptoms may in turn cause additional stress, he noted, resulting in a vicious cycle. There is now direct evidence of a role of certain neuropeptides in rosacea.

"If we could block specific steps in certain pathways involving nervous system signaling to the skin -- without impacting the whole body -- we would likely have new ways to prevent or treat skin disorders like rosacea," said Dr. Granstein. "We're gaining a greater understanding of the mechanisms underlying many skin conditions, which will help us develop new therapies."

The good news is that stress management can be an effective method of getting your condition under control. In a recent NRS survey on emotional stress and rosacea, two-thirds of the respondents said they were able to reduce their flare-ups by minimizing the causes of their stress and their emotional reactions.