Demodex Mites Continue to Confuse

Written by on August 24, 2006 in Demodex Mites with 9 Comments

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.

Read more about: Demodex Mites

About the Author

About the Author: David Pascoe started the Rosacea Support Group in October 1998. .

Follow Rosacea Support

Subscribe via RSS Feed

9 Reader Comments

  1. Mark Wallace says:

    I am no expert but I think there is definitely a link between rosacea and demodex mites for some people. I personally had rosacea (redness, acne) on my face and scalp. I also suffered minor hair loss due to it. After using products by mama nature that attack the demodex mites the skin on my face looks excellent compared to a month ago and the rosacea on my scalp has gone and it has been accompanied by the hair growing back. This helped within a couple of days. I think dermatologist and pharmaceutical companies should really focus on more research with regards to the demodex theory.

  2. Brady Barrows says:

    For a considerable time demodex has been discussed as a link to some cases of rosacea and the evidence is overwhelming now that not all cases of rosacea are demodectic. However, demodectic rosacea should be ruled out. Some continue to believe that demodex is an ‘innocent bystander’ or a ‘minor role player’ in rosacea and continue to parrot what some rosacea ‘authorities’ have postulated about demodex’s role in rosacea. However the evidence is fairly well established that demodex is involved in some cases of rosacea. The RRDi is the only non profit organization for rosacea sufferers that classifies demodectic rosacea as a rosacea variant. Without a doubt more research will be done on this since it is probably the single most researched topic other than research on prescription drugs for rosacea. As Dave has been following there are prescription drugs coming down the pipeline for rosacea that attack demodex. This shows that the pharmaceutical companies are well aware of demodex’s role in rosacea. More research is good.

  3. I’m not sure that is helps the debate to keep referring to demodectic rosacea when this naming hasn’t been proposed or accepted by the rosacea community at large.

    To me it doesn’t feel like a variant in the same way as the current designations as it is cause based and not symptom based like the other variants

    So perhaps it is better to stick to the official variants until a new one is accepted widely.


  4. Brady Barrows says:


    You are quite right that when discussing rosacea variants (or subtypes) is a controversial subject.

    Gerg Plewig, M.D., a noted authority on rosacea, came up with ‘demodectic rosacea’ who is a member of the RRDi MAC. Demodectic rosacea is mentioned by WB Shellby, et. al, in a recent paper published by the Journal of the American Academy of Dermatology.

    In the Journal of Clinical and Aesthetic Dermatology it is called ‘Demodex Dermatitis.’

    Whether demodectic rosacea should be classified as a variant or another subtype by rosacea community as a whole remains to be seen with all this controversy. In the meantime, demodectic rosacea differentiates from other variants or subtypes in a meaningful designation for rosacea.

    Classification Of Rosacea Remains Controversial

    Variant vs Subtype

  5. Brady Barrows says:

    It is odd that today the NRS published an article commenting on Forton’s saying that the mite may be the ‘missing link’ in understanding the onset of subtype 2 (papulopustular) rosacea.

  6. I find the argument that demodex might lead to papules and pustules much more convincing that the statement that says – “all these hundreds of abstracts mean we should create something called demodectic rosacea.”

  7. Brady Barrows says:

    How do you feel about Granulomatous Rosacea as a rosacea variant? Just curious.

  8. Denny says:

    Mark Wallace:

    What Natural products did you use for your Rosacea results? I am glad you have gotten over it.

  9. Susan says:

    The only thing that completely eradicated my rosacea was Nutropin injections (Human Growth Hormone) once daily. For the 7 years I took HGH, there was not a clogged pore, blushing, or any of the symptoms that have now returned with it’s non-use. I had virtually “perfect” skin. I definitely think it is immune system related and the HGH was amazing.

Leave your comment here


Subscribe to Rosacea News

Enter your email address to receive the latest news about rosacea in your inbox.