demodex mites continue to confuse

The elusive link between rosacea symptoms and demodex folliculorum (and demodex brevis) is still generating research reports. What rosacea sufferers really need is something more than just a statistical link (or studies with just 1 or 2 subjects) ; something that at least shows a histopathological link between the mite, the mite’s environment and rosacea symptoms – would be a good start.

Here are 3 recent papers that try to make a link.

Some aspects of the skin infestation by Demodex folliculorum, Wiad Parazytol. 2004;50(1):41-54 (Article in Polish) Raszeja-Kotelba B, Jenerowicz D, Izdebska JN, Bowszyc-Dmochowska M, Tomczak M, Dembinska M. (09 Aug, 2006)

The importance of demodicids (Demodex folliculorum and D. brevis) infestation and their effect on skin lesions has been described based on literature data and our own clinical and parasitological investigations. Hair follicle mites have been detected in 45% of patients with rosacea, 27% of patients with perioral dermatitis, 28% of patients suffering from seborrhoeic dermatitis and in 3 out of 7 patients with chronic blepharitis. Clinical picture of demodecosis included erythemato-papulous and pustulous (rosacea-like) skin lesions together with erythemato-desquamative changes of the face.

Here is an epidemiological study: ie. trying to show using statistics and a process of elimination that there may be a link.

Demodicosis and rosacea: Epidemiology and significance in daily dermatologic practice, Journal of the American Academy of Dermatology, Volume 52, Issue 1 , January 2005, Pages 74-87

Background: Demodicoses are thought to be rare, occurring mainly for patients with immunosuppression.

Objective: We sought to demonstrate the high frequency of demodicoses and the overlapping with papulopustular rosacea (PPR).

Methods: We conducted a prospective epidemiologic study among 10 dermatologists. High Demodex density (Dd) was confirmed by standardized skin surface biopsy.

Results: In all, 4372 diagnoses, in which 115 were demodicoses, were collected among 3213 patients. Demodicosis was the 9th most frequent diagnosis (13th new). Each dermatologist observed an average of 2.4 demodicoses a week (1.2 new). The proportion of demodicoses varied greatly according to the dermatologist. The general status was good in 110 patients; only 3 had known immunodeficiency. The most frequent symptoms were follicular scales (71%) and telangiectasia (63%). The mean Dd was higher in pityriasis folliculorum (m = 61 D/cm2) than in PPR (m = 36 D/cm2; P = .04); 42 patients with PPR had a high Dd, 6 had a low Dd.

Conclusion: Demodicoses are frequent and occur among patients who are immunocompetent. PPR with normal Dd are rare.

Here is a paper based on one patient with “painful erythematous pustular skin lesion along the right face and scalp”.

Brief Report: Cytologic findings in Demodex folliculitis: A case report and review of the literature, Diagnostic Cytopathology, Volume 34, Issue 3 , Pages 232 – 234

Keywords: Demodex • folliculitis • cytomorphology • pustule • parasites

Abstract: Infectious folliculitis of the head and neck has various etiologies, including bacteria, viruses, fungi, and parasites. Accurate morphologic recognition of microorganisms in biopsy and cytologic specimens is paramount in facilitating appropriate therapy. We report a case of a 37-yr-old white male with Demodex folliculitis, who presented with an extensive and painful erythematous pustular skin lesion along the right face and scalp in a dermatome pattern clinically suggestive of Varicella zoster. Examination of scraped smears obtained from one of these pustules revealed numerous parasitic organisms having morphologic features typical of Demodex. Herein, we describe the patient’s clinical presentation, discuss the cytologic findings of scrape smears, and briefly review the literature.

Further Reading.

• demodex mites treatment ?
• demodex mites
• Alternative Treatments for Demodex Mites
• demodex bacteria – could that be the cause ?
• demodex mites and blepharitis eye lashes
• MMP-9 and demodex – the missing link ?
• demodex mites, ivermectin (stromectol) and its use in dermatology
• ivermectin patents
• can sea buckthorn oil cure rosacea ? can it touch demodex ?

Read more about: demodex mites