Ocular Rosacea: Curse of the Celts and Celebs

The presentation is given by Heather Potter, MD, an Ophthalmologist from the University of Wisconsin School of Medicine and Public Health.

Highlights

Some of the points that I thought were interesting;

• rosacea is not purely related to demodex mites because eradicating them with Lindane (quite a dangerous drug it seems) does not help rosacea symptoms.
• some good slides and description of the life cycle of demodex
• tea tree oil shampoo for lid hygiene as in normal blepharitis treatment is a good option for demodex infestation of the eyelid.
• Tea Tree Oil is the best treatment we have for demodex
• Tea Tree Oil 20% combined with macadamia or walnut oil is another option
• Otophyma gets a mention, with a slide where you are directed to the visible pores in the enlarged ear
• Azelaic Acid 20% is mentioned at a 1st line topical treatment, but I think they actually meant Finacea which is only 15%
• Sodium Sulfacetamide wash as a lid scrub is mentioned as an alternative to baby shampoo
• “Burst and Taper” or just starting out with 40mg a day of doxycycline is mentioned as an oral treatment
• 3000 – 4000 mg Omega 3, tapering to 2000 mg a day maintenance has worked well for her ocular rosacea patients. It takes 6 weeks to have an effect.
• Ocular rosacea is found equally in males and females.
• Cyclosporin gets a mention as a topical treatment. Azasite Plus drops (a steroid plus azithromycin) is shown on the topical treatments slide.
• Need to raise the body temperature by 5 degrees before attempting warm compresses to liquify the meibomian gland secretions you are trying to clean.
• Cyclosporin gets another mention for dry eyes, along with punctal plugs
• Doxycycline gets a mention specifically as an ocular rosacea treatment
• An image from a “throw away journal” with what looks like a device to heat and massage the eyelids to help clear the glands.

The video is 25 minutes long, but you can squash it down to 16 minutes if you select the 1.5x link at the bottom of the video player.

Well worth a watch.

Best Bit for You?

What bit of the video was most worthwhile for you?

Related Articles

• Treating Ocular Rosacea (from the AAO)
• Restasis (cyclosporine) as ocular rosacea treatment
• Get Ready for Oracea for Treating Ocular Rosacea
• Ocular Demodex, Tea Tree Oil as a treatment
• Just How do you Kill Demodex Mites ?
• Oracea to replace Periostat, new rosacea treatment launched
• Rosacea Resources: Ocular Rosacea

The patent covers many different combinations of ivermectin and metronidazole such as emulsion, cream, gel with ivermectin present in an amount of from 0.01% to 5% by weight and metronidazole is present in an amount of from 0.01% to 2% by weight.

Additional agents, claimed to be beneficial include “antibiotics, anti-bacterial agents, anti-viral agents, anti-parasitic agents, anti-fungal agents, anaesthetics, analgesics, anti-allergic agents, retinoids, free-radical scavengers, anti-pruritic agents, keratolytic agents, anti-seborrhoeic agents, anti-histamines, sulfides, and immunosuppressant or anti-proliferative products”.

Patents already exist that cover Ivermectin to treat demodex mites and also to indirectly treat rosacea. Galderma’s patent, if granted will cover the combination of Topical Avermectins and Metrondizole to treat rosacea.

A New Product Coming?

It is impossible to tell just from a patent application whether a company is actually pursing development of a related product.

We do know that Galderma a leading investor in dermatology research and development. If any company is able to progress a product from invention to approval, it is Galderma.

Personally I would like to see some solid clinical trials with topical products that contain ivermectin. Only then will we see exactly which rosacea sufferers will respond to this sort of treatment.

I would feel a bit nervous about using a product that only a vet would normally prescribe – so solid clinical data on ivermectin could only be a good thing.

Updated Patent Application

United States Patent Application 20110274631

KAOUKHOV; Alexandre ;   et al., GALDERMA S.A., November 10, 2011

France Filing Date: Jun 10, 2005, Application Number 0505918

AVERMECTIN/METRONIDAZOLE COMPOSITIONS FOR TREATING AFFLICTIONS OF THE SKIN, E.G., ROSACEA

Pharmaceutical/dermatological compositions containing at least one avermectin compound, e.g., ivermectin and metronidazole or salt, ester or derivative thereof, are useful for treating afflictions of the skin, especially rosacea.

1. A regime or regimen for treating rosacea, comprising topically applying onto the afflicted skin area of an individual in need of such treatment, a pharmaceutical/dermatological topically applicable composition comprising anti-rosacea effective amounts of ivermectin and metronidazole, formulated into a topically applicable, physiologically acceptable medium therefor.

Related Articles

• Just How do you Kill Demodex Mites ?
• Demodex Mites Treatment
• Ivermectin Patents for Rosacea

Firmly in the pure speculation category is a recent paper that proposes that pityriasis folliculorum (or demodex mite infestation) is the missing link in our understanding of rosacea.

Plainly put, Dr. Forton, a dermatologist from Belgium, suggests that rosacea is a two stage disease where 1) demodex mites are allowed to proliferate unchecked and then 2) some mites migrate to the dermis where an immune response leads to the inflammation of rosacea.

The first stage is important because in this theory, the absence of an immune response is able to keep the demodex mites from becoming an infestation.

The author suggests that further research into why there is no immune response during this first stage may lead to further understanding about rosacea.

What We Do Know

1. We know that a certain bacteria from demodex Bacillus oleronius – can induce an increased immune response in rosacea suffers.
2. We know that demodex mites are found in normal healthy skin.
3. Studies have found that in some rosacea sufferers demodex mites are more common.
4. Arguments still focus on whether demodex mites just enjoy the environment of rosacea skin, or are there making it worse.

My Thoughts

This theory is pretty far fetched I would have thought. We still can’t say what it is about the mites that find them prevalent in some rosacea sufferers, or for sure what link there is between demodex bacteria and an inflammatory response.

Some people do report a decrease in symptoms when they eradicate the mites, but showing that this applies more widely or proving demodex were the actual cause is elusive.

Demodex mites have always been an easy target for those looking for the cause of rosacea. Easy because the mites are easy to find – what has proved harder though is nailing a provable link.

We do need more research. Demodex have been the subject of an enormous amount of rosacea research, so it pains me to say this !

New Abstract

Papulopustular rosacea, skin immunity and Demodex: pityriasis folliculorum as a missing link.

J Eur Acad Dermatol Venereol. 2011 Oct 24., Forton FM, Dermatologist, Private practice, rue Franz Binjé, Brussels, 8-1030 Belgium.

Papulopustular rosacea (PPR) is a common facial skin disease, characterized by erythema, telangiectasia, papules and pustules.

Its physiopathology is still being discussed, but recently several molecular features of its inflammatory process have been identified: an overproduction of Toll-Like receptors 2, of a serine protease, and of abnormal forms of cathelicidin.

The two factors which stimulate the Toll-like receptors to induce cathelicidin expression are skin infection and cutaneous barrier disruption: these two conditions are, at least theoretically, fulfilled by Demodex, which is present in high density in PPR and creates epithelial breaches by eating cells.

So, the major pathogenic mechanisms of Demodex and its role in PPR are reviewed here in the context of these recent discoveries. In this review, the inflammatory process of PPR appears to be a consequence of the proliferation of Demodex, and strongly supports the hypothesis that:

(1) in the first stage a specific (innate or acquired) immune defect against Demodex allows the proliferation of the mite;

(2) in the second stage, probably when some mites penetrate into the dermis, the immune system is suddenly stimulated and gives rise to an exaggerated immune response against the Demodex, resulting in the papules and the pustules of the rosacea.

In this context, it would be very interesting to study the immune molecular features of this first stage, named "pityriasis folliculorum", where the Demodex proliferate profusely with no, or a low immune reaction from the host: this entity appears to be a missing link in the understanding of rosacea.

Related Articles

• Just How do you Kill Demodex Mites ?
• Demodex Mites Treatment
• Demodex Bacteria – could that be the cause ?
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This abstract promises to tell us everything we need to know about the possible role of micro-organisms in the way that the disease Rosacea starts and develops.

Even though the role of published research is not to provide reading material for the general public, I still look to journal articles to move the science forward.

This paper promises to review the currently available literature relating to how some micro-organisms might play a role in the way that disease rosacea progresses.

I don’t have access to the full text, but following  is some background information that will hopefully prove helpful.

Although not mentioned in the abstract, I would hope that the paper would also discuss the role of Small Intestinal Bacterial Overgrowth in rosacea.

Helicobacter Pylori

Long part of the rosacea folklore, Helicobacter Pylori is a bacteria that lives in the cell lining of the stomach. The link between HP and rosacea is muddied by the fact that the common treatment for h. pylori is also a possible treatment for rosacea in it’s own right. Here is a quote from the NRS:

H. pylori May Not Be a Rosacea Factor

A recent study suggested that treatment of Helicobacter pylori, a bacterium associated with peptic ulcers and other gastric disorders, may benefit the often small portion of rosacea patients who harbor this infection. However, another study has found that H. pylori itself does not appear to be a major factor.

…

"It should not be surprising that rosacea symptoms may improve during treatment for H. pylori, since antibiotics have long been successfully used to treat rosacea in all patients," said Dr. Larry Millikan, chairman of dermatology, Tulane University. "Smaller dosages of oral antibiotics are routinely prescribed to bring rosacea under immediate control, along with long-term use of topical antibiotics to maintain remission."

In a more recent controlled clinical study of 44 rosacea patients with H. pylori infection in the United States, half of the patients were treated for H. pylori and half were not. When examined two months after treatment, there was no statistical difference in rosacea symptoms between the treated and untreated groups.

Demodex Folliculorum

Also a long standing member of the rosacea folklore is the issue of demodex mites.

Always held back as a theory by the fact the demodex is found in both rosacea and non-rosacea skin, and researchers being unable to show whether the mites cause, or just like living in rosacea skin, demodex folliculorum has recently become interesting again.

This new interest has been sparked by a study that showed that a particular type of demodex bacteria was responsible for a greater immune response in rosacea sufferers.

Like all good theories, demodex mites needs more research to prove how strong the link is between their presence and rosacea symptoms.

staphylococcus epidermis

This is one of the organisms that is a normal part of human skin flora, i.e. it is normal to find it living in our skin. Typically it only causes problems for people who are immune compromised.

A 2010 study summarised here: Skin Bacteria Thrives in Rosacea Patients shows that researchers were able to prove that this bacteria was more prevalent in the pustules of rosacea and in the eyelids of people who suffer from facial rosacea lesions.

Would I sound too much like a broken record if I were to say that more research is needed here to prove or disprove this link?

clamydia pnuemonia

According to wikipedia, Chlamydophila pneumoniae is a small bacterium that infects humans and is a major cause of pneumonia.

At least one study has been able to show some link; concluding “preliminary data imply a possible link between C. pneumoniae and acne rosacea as well as suggest a need for further investigation with clinical trials.” Interesting the treatment used in that study, Azithromycin is also effective against H. Pylori.

One place to read more about CpN is RSRP: Chlamydia pneumoniae.

The potential role of microorganisms in the development of rosacea, J Dtsch Dermatol Ges. 2010 Nov 8.

Lazaridou E, Giannopoulou C, Fotiadou C, Vakirlis E, Trigoni A, Ioannides D., First Department of Dermatology-Venereology, Aristotle University Medical School, Thessaloniki, Greece.

Rosacea is a chronic cutaneous disorder characterized by centrofacial persisting erythema, telangiectases, papules, pustules, edema, phymas and ocular involvement. Despite being one of the most common skin disorders, its pathogenesis remains unclear and controversial. Although the disease triggering factors are well recognized, the underlying causes of rosacea have not yet been identified.

Several different postulates about its pathogenesis can be found in the medical literature. Abnormalities of the pilosebaceous unit, as well as genetic, vascular, inflammatory, environmental and microbial factors have been described.

The microorganisms that have been associated include Helicobacter pylori, Demodex folliculorum, Staphylococcus epidermidis, and Chlamydia pneumonia; all the studies have been inconclusive. We review currently available scientific data on the potential pathogenetic role of microorganisms in the development of rosacea.

How neat would it be to say that you belong to the Aristotle University Medical School – sounds impressive hey.

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Mites and Eye Symptoms

A new study has found there may be a link between ocular rosacea and bacteria associated with Demodex mites, microscopic inhabitants of normal skin that tend to occur in much greater numbers in those with rosacea.

In the recently published study of 59 rosacea patients, Dr. Jianjing Li and colleagues at the Ocular Surface Center in Miami found a significant correlation between facial rosacea, infestation of the eyes with Demodex mites and reaction to certain mite-related organisms previously shown to stimulate an immune response in rosacea sufferers.

Rosacea News covered this paper in April and resulted in a similar summary;

Ocular symptoms match Demodex Bacteria reaction too

This paper is one more small achievement using statistics to try to build a picture of how demodex mites might be involved with rosacea symptoms. We have learnt from recent research that rosacea sufferers are sensitive to 2 particular types of bacteria that have been isolated in demodex mites.

This study further establishes that a reaction to the bacteria correlates to ocular symptoms as well as facial symptoms.

So the small step forward is that for those with rosacea linked to demodex bacteria, ocular symptoms may also be exacerbated by a reaction to the bacteria.

As the NRS Blog notes, more research may help draw out exactly how strongly demodex bacteria and facial and ocular rosacea symptoms are related to each other.

Related Articles

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• demodex mite bacteria causes the inflammation ?
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This study further establishes that a reaction to the bacteria correlates to ocular symptoms as well as facial symptoms.

So the small step forward is that for those with rosacea linked to demodex bacteria, ocular symptoms may also be exacerbated by a reaction to the bacteria.

Correlation between Ocular Demodex Infestation and Serum Immunoreactivity to Bacillus Proteins in Patients with Facial Rosacea, Ophthalmology. 2010 Jan 14, Li J, O’Reilly N, Sheha H, Katz R, Raju VK, Kavanagh K, Tseng SC..

PURPOSE: To investigate correlation between ocular Demodex infestation and serum.

DESIGN: A prospective study to correlate clinical findings with laboratory data.

PARTICIPANTS: We consecutively enrolled 59 patients: 34 men and 25 women with a mean age of 60.4+/-17.6 years (range, 17-93).

METHODS: Demodex counting was performed based on lash sampling. Serum immunoreactivity to two 62-kDa and 83-kDa proteins derived from B oleronius was determined by Western blot analysis. Facial rosacea, lid margin, and ocular surface inflammation were documented by photography and graded in a masked fashion.

MAIN OUTCOME MEASURES: Statistical significance based on correlative analyses of clinical and laboratory data.

RESULTS: These 59 patients were age matched, but not gender matched, regarding serum immunoreactivity, ocular Demodex infestation, or facial rosacea. There was a significant correlation between serum immunoreactivity and facial rosacea (P = 0.009), lid margin inflammation (P = 0.040), and ocular Demodex infestation (P = 0.048), but not inferior bulbar conjunctival inflammation (P = 0.573). The Demodex count was significantly higher in patients with positive facial rosacea (6.6+/-9.0 vs. 1.9+/-2.2; P = 0.014). There was a significant correlation of facial rosacea with lid margin inflammation (P = 0.016), but not with inferior bulbar conjunctival inflammation (P = 0.728). Ocular Demodex infestation was less prevalent in patients with aqueous tear-deficiency dry eye than those without (7/38 vs. 12/21; P = 0.002).

CONCLUSIONS: The strong correlation provides a better understanding of comorbidity between Demodex mites and their symbiotic B oleronius in facial rosacea and blepharitis. Treatments directed to both warrant future investigation

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An article published today in the Irish Times takes one more step in the direction of showing an association between demodex mites and rosacea. Readers of Rosacea News will know that a lot of research has tried to find a causative link between the presence of demodex mites and rosacea symptoms.

Some progress towards a link between the two was realised when a particular type of bacteria present in demodex, called Bacillus oleronius was isolated. This bacteria was then analysed and 2 resulting proteins were found to be quite interesting. These proteins were shown to induce an increased inflammatory response specifically in rosacea sufferers.

The Irish Times newspaper article quotes Dr. Kevin Kavanagh from NIU Waynooth (who has received NRS funding for demodex research), who says that a survey of 30 patients found 80% had been exposed to large amounts of 2 demodex bacteria proteins. This appears to me to be a new discovery. Immune tests were performed on the patients to show that the patients had been exposed to Bacillus bacterium inside Demodex mites.

We know from previous studies that “two antigenic proteins of size 62 and 83 kDa” isolated in Bacillus oleronius have the potential to stimulate an inflammatory response in patients with papulopustular rosacea. This is the first time I’ve see mention of a high proportion of rosacea sufferers been shown to been exposed to these 2 proteins.

This short article suggests that an immune response to these 2 proteins is a very common occurrence in rosacea sufferers. So common in fact that it warrants further investigation to see what this really means for rosacea diagnosis and treatment. At the least, a blood test to confirm rosacea seems like a real possibility.

Suggesting that eradicating Bacillus oleronius via antibiotics is the reason for their success in treating rosacea does seem a bit of a stretch. Perhaps interrupting how these proteins induce an inflammatory response is another way of understanding how this all fits together.

As this is just a discussion article in a newspaper, it will be useful to see the full article when it is published later this year. My feeling is that we are still only making baby steps along this path of logic. They are steps that seem to be in the right direction, but it sure takes a long time to get there.

From Study finds cause of rosacea, Tuesday, July 14, 2009, CLAIRE O’CONNELL.

BACTERIA ARE to blame for the inflammatory skin condition rosacea, according to a study involving Irish scientists.

…

Working with the Mater hospital, the researchers previously identified a Bacillus bacterium inside Demodex mites. The bacteria release two proteins that trigger an inflammation in patients with facial rosacea.

…

Immune tests on 30 patients found that 80 per cent had been exposed to large amounts of the two bacterial proteins, said Dr Kavanagh of the study, which is to be published in Ophthalmology later this year.

“Now that we know it’s primarily probably a bacterial disease, we know the proper way to treat it is with antibiotics at a low level over a long period of time,” Dr Kavanagh said, noting that washing the skin with dilute tea tree oil also killed the bacteria.

“The other implication is that we could do a simple blood test to say whether a patient has rosacea or not. That’s something we will investigate in the future.”

The article also mentions a link between demodex bacteria and ocular rosacea.

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Here is a good example of why not to believe everything you read on the internet.

Today the internet news stream has a `release’ titled OCuSOFT(R) Lid Scrub(TM) PLUS Proven to Kill Demodex Mites. In it we read ;

“SYNACON/OCuSOFT(R) a broad based supplier of ophthalmic pharmaceuticals and supplies is pleased to announce the latest findings from a recent study(1). OCuSOFT(R) Lid Scrub(TM) PLUS, in its unique “Leave-On” formulation, was shown to effectively eradicate Demodex mites. Significantly, NO other eyelid cleanser used according to manufacturer’s instructions kills Demodex.” (emphasis added)

This is a pretty big claim, and I felt sure that I had never read this before. The brief product description from ocusoft.com says that Lid Scrub Plus is “An Extra Strength eyelid cleanser utilizing a low-level preservative and moisturizer blend offering a wide range of anti bacterial properties.”.

Further reading will reveal that indeed the only claim that is proven is that OCuSOFT Lid Scrub Plus is able to kill “Staphylococcus epidermidis — the most common bacteria associated with blepharitis. This bacteria is often found on the skin and in mucous membranes.” Note that there is no mention of demodex mites.

So the press release is a fabrication, who would have believed it Sadly the internet is full of inaccuracies about demodex mites.

Another page about OCuSOFT based research, Rid the Lid of Disease, reveals more about how their lid scrubs are used in practice.

I use OcuSoft Lid Scrub Plus for all my blepharitis patients. I recommend patients use a hot compress for 10 minutes and follow with the OcuSoft Lid Scrub Plus formulation once a day for two weeks. The hot compress expands the pores and oil glands. This doesn’t necessarily mean the lids absorb the scrub faster, but the product will at least dissolve the hardened meibum.

So eradicating S. epidermis may help your blepharitis symptoms, but what else do we know about demodex mites and ocular symptoms ? We do know that tea tree oil is effective at eradicating ocular demodex and that this might lead to a reduction in ocular rosacea symptoms.

We also know that demodex mites are resistant to a wide range of antiseptic solutions. Some of the products that are known to kill demodex mites include 100% alcohol, tea tree oil, carraway oil, dill weed oil, ether, benzen and xylol. Be careful with carraway oil and dill weed oil as they are toxic to the eye.

So keep an eye out for what you read and believe, especially these sorts of publicity seeking press releases. There may be truths behind press releases, but sometimes you have to dig deeper to see what information is worth taking home.

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Demodex mites and rosacea seem to be a popular, if not controversial pairing. Even there is no proven link between rosacea symptoms and the presensce of demodex mites, many rosacea sufferers are interested in eliminating demodex mites to see if your rosacea symptoms improve.

So just how can you kill them ? Demodex mites are tiny, and live naturally in everyone’s skin. They are quite difficult to kill.

Read on if you’d like to know more about how to elminate demodex mites.

First of all, why would you want to eliminate them ?

There may be some new evidence that proteins from a bacteria that can be isolated from demodex mites cause an immune reaction in rosacea sufferers. I’m still not a believer in the involvement of these critters in rosacea. Just in case more evidence is found in the future, though, demodex mites are worth further understanding.

Demodex mites have a life cycle of 14-18 days.

Killing Demodex Invitro (in the test tube)

We know from the paper In vitro and in vivo killing of ocular Demodex by tea tree oil, that various oils and solutions can kill demodex mites quite quickly in the test tube.

Note that carraway oil and dill weed oil are toxic to the eye.

Studies have also confirmed that ether, xylol, benzene, Danish (compound polysulfide ointment) ointment can kill demodex in a few minutes.

Ivermectin

Ivermectin is used in dermatology against some parasitic infestations in humans. The drug is used in the treatment of patients with different forms of scabies, human body lice, head lice, demodecicosis, et. al. Published literature includes a case study of one patient who was treated with topical permethrin and oral Ivermectin. In another case report of one patient, the papules and pustules of rosacea were difficult to treat until oral ivermectin was included in the treatment regime.

Several rosacea sufferers on the rosacea-support email group report success in treating their rosacea with Ivermectin, but the benefits were only short lived.

Ivermectin (Stromectol, Mectizan, Ivomec, Oramec, Cardomec) has been patented as a treatment for rosacea.

Tea Tree Oil

Tea Tree Oil is sourced from the Melaluca tree which is native to eastern Australia. Tea Tree Oil has been shown to kill demodex mites in as little as 4 minutes. External application of undiluted tea tree oil and/or at inappropriate high doses has been associated with toxicity, including death, in cats and other animals.

There is so much interest in the properties of tea tree oil that a research group has been created within the School of Biomedical, Biomolecular and Chemical Sciences at The University of Western Australia.

In a recent study, TTO was used to eliminate demodex mites living in the eyelashes of ocular rosacea sufferers. Study participants were given weekly lid scrubs with 50% tea tree oil and a daily lid scrub with a tea tree shampoo. After six weeks all 6 participants showed improvement in conjuctival irritation and inflammation.

TTO is not soluble in water, but is soluble in alcohol, but sadly that would be unsuitable for use around the eye. Tea Tree Oil can be diluted 50% in Macadamia nut oil for use around the eyes. Lid scrubs with 50% Tea Tree Oil did produce irritation in the participants but the effect was found to be minimised if care was used to avoid spilling it into the eye.

Full strength tea tree oil should never be used anywhere on the face.

Kwellada/Elimite (Permethrin)

Back in 2000, Annette Anderson advocated using Permethrin 5% on the face to eliminate the mites. Permethrin was originally used to treat scabies. She warned that getting it in your eyes burns terribly and that the instructions mention that you should not use it on your face. A few members of rosacea-support had bad reactions to using permethrin on their face, so use Permethrin with extreme care. In the U.S., 5% Permethrin (Elimite Cream) is only available by prescription.

If you are considering Permethrin in any form it would be wise to consider Dr. Linda Sy’s advice to “solicit the cooperation and supervision of their respective dermatologists, get a KOH skin scraping to establish the presence of florid demodex population … Participants try the Permethrin on a small area of face first, to determine if any immediate severe problem exists”.

Seabuckthorn Oil

Despite claims on various internet sites, I have not been able to find any published evidence that Seabuckthorn oil kills demodex mites. If you know of some evidence, please post in the comments below. In the meantime, please disregard any claims that you find that Seabuckthorn Oil kills demodex mites.

A natural approach

For those interested in a more natural approach to treating rosacea including using Olive Leaf Extract and Tea Tree Oil see Rachelle’s Alternative Treatments for Demodex Mites.

Over to You

Have you tried any treatments to eliminate demodex mites ? Did you have a bad reaction them ? any suceess ? Feel free to leave a comment below.

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Some recent NRS supported research has made more steps towards showing a possible link between demodex mites and rosacea symptoms. Although this Br J Dermatol paper was mentioned by Rosacea News in (see demodex mite bacteria causes the inflammation ?) June last year, I just got hold of the full text this week.

A couple of interesting thoughts arise. The researchers were able to extract 2 proteins from the bacteria cultured from a demodex mite. These 2 proteins more commonly produced an inflammatory response in rosacea sufferers, compared to non-rosacea sufferers.

This is an example of how medical research makes quite small and steady steps. This was, as I can see, the main result of this piece of research – 2 proteins from bacillus eleronius were extracted from a demodex mite from a rosacea sufferer, and these proteins might cause aggravated symptoms in rosacea sufferers.

Now for the bad news – the researchers could only isolate the bacteria from one mite from one sufferer out of 40. The researchers are unsure why this is the case- whether it is their methods or sufferers had taken antibiotics in the last 14 days. So we are still a long way from being able to say that demodex bacteria causes rosacea symptoms.

The paper makes the argument that the relative efficacies of different types of antibiotics in rosacea treatment leads to the suggestion that rosacea is bacterial in origin (b. oleronius is sensitive to tetracycline, doxycycline and minocycline) ;

The mechanism by which antibiotics successfully clear the inflammatory lesions of papulopustular rosacea is unknown. It has been suggested that antibiotics work through anti-inflammatory mechanisms, but other potent anti-inflammatory drugs are ineffective and immunosuppressive agents such as steroids (administered topically or systemically) and tacrolimus can make the inflammatory eruption of rosacea worse.

The fact that only selective antibiotics are effective in rosacea suggested to us the possibility that a bacterial agent may be involved in the pathogenesis of the disease. A D. folliculorum related bacterium sensitive to the antibiotics used in the treatment of rosacea could explain the induction of inflammatory changes in papulopustular rosacea.

The researchers conclude that the significance of finding b. oleronius in association with demodex mites and their biological functions need to be further defined. Other mite related bacteria also need to be investigated.

An enormous amount of research effort has been invested in demodex mites. This paper takes a baby step towards perhaps understanding a possible link.

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