From: “Annette Anderson”
Date: Fri Nov 24, 2000 10:59 am
Subject: Effective treatment ?

Hi, I’m new to this group.

I sought you out to share a treatment approach with you that has worked for me very well, and since then has also helped a number of others.

I’m a family doctor in Canada; I was diagnosed with rosacea 2 years ago. My symptoms were deep-red flushing with any exercise,warm environment such as a hot shower, sunny day, also when crying ( PMS 🙂 ), alcohol etc. I looked awful, like Rudolf the red-nose raindeer. Of course I was prescribed Metrogel, took it faithfully, but wasn’t impressed. I didn’t yet have the papules or telangiectasias ( permanently dilated spidery arteries ), but I sure didn’t want to let it go that far. It was also getting worse rapidly. My doctor gave me the usual spiel, how rosacea is incurable, just avoid trigger factors, etc. Well, I was upset. I struck out on my own so to speak and hit the net. I found a lot of research articles on rosacea, including on medical mebsites for doctors only, such as “mdconsult.com” , where I found the most relevant ones. The first interesting article I came across was about several children with leukemia, who developed a rosacea-like rash ( as you know, rosacea is an “adult” disease ). Skin biopsies showed — you guessed it— huge loads of the skin mite Demodex Folliculorum. Alright, I just had to emphazise this. 🙂

They treated the kids with standard anti-mite treatment, permethrin, same we use to treat the mother of all mites, Scabies . The rash cleared. I thought, aha, gotta look at more articles like this. Turns out, there were quite a number of small, independent medical studies, where skin biopsies showed rosacea patients had a much higher than usual load of the generally benign mite demodex folliculorum ( I’ll attach some studies as examples ).

So, I tried the treatment on myself. I used Kwellada on my face ( not supposed to do this as per instructions on the bottle ” use neck down ” ). I worked out that a once – weekly application ( leave on 24 hours ) does the trick.

** Please note the complete treatment instructions following below .

After 2 months I noticed steady improvement, slow but very steady. First I thought, when it was all gone , I didn’t have to use the Kwellada anymore, but in the meantime I found out I still have to do it every 3 weeks or so for maintenance, usually as soon as my nose starts up again. I measured the intitial steps of improvement by how red my face would get after a hot shower. The intensity of the redness gradually diminished, and the total area involved contracted. First, it was the cheeks,forehead, chin and nose, lastly just the nose ( Rudolf ) , then that went , too. Basically, over a total of six months, all of the symptoms completely disappeared ! And stayed away, with the maintenance treatments, for the last eight months..

Boy, was I excited about this. I had proved my original theory. Well, not a new theory, according to those studies I mentioned, but I also haven’t heard of a regular patient with rosacea being treated for the mite problem, only for the secondary bacterial problem, with antibiotic ointments such as Metronidazole (Metrogel) etc. Then I started to try it out on my patients ( it seemed that all of a sudden nearly everyone had rosacea—–selective perception is an interesting phenomenon…). So far, it worked on all but one (total patients so far 21) . I have heard things like my patients’ hairdresser tried it too and had good results. Things like that. I always say, it might NOT work, but what have you got to lose ?

The treatment is simple, available over the counter (in Canada at least), cheap ( one bottle of Kwellada lotion, i.e. Permethrin 5% , lasted me exactly a year. ), and side effects are rare and minimal —permethrin for scabies can be used even on infants ! Getting it in the eyes is not fun, it burns like heck.

I have also found studies linking demodex to animals. One study was of a boy and his dog. The boy had a rosacea-like rash, and both he and his dog were heavily loaded with demodex. Treatment for both eliminated their problem. Since then I found out that most patients with rosacea get in close contact regularly either with their own cats/dogs or with those of friends and family. I don’t want to cause undue concern about pets, but I have to report my observations.
In any case it would probably not be too difficult to treat the pets as well, on and off.

I think it’s probably impossible to eliminate the demodex from one’s environment, just like it’s pretty hard to get rid of scabies forever, unless it was picked up on one’s travels .If it developed at home, it often recurs eventually.

Therefore I think that if the original treatment works, maintenance treatments are the way to prevent recurrences.

I would like to send my self-concocted treatment outline to you to review and possibly to try it out.

As I said there are no guarantees it will work at all, and side effects are always a certain possibility….but there’s not too much to lose. And I would be absolutely ecstatic if it worked for you, too.

I would like to ask you, that if you want to try the treatment, please fill out the questionnaire pre-treatment, as outlined in the following pages. I haven’t yet had time to think up the 6 months follow -up questionnaire, but PLEASE PLEASE PLEASE , if the treatment works for you, also fill out the 6-months follow-up questionnaire for me, I’ll send it some other time. I would like to gather these data and maybe eventually publish a summary of the results in a G.P. medical magazine. ( The big magazines like dermatology etc. only accept scientifically and statistically sound research studies, which I found out cost upwards of 50,000 $, which I can’t afford. Organizing a study through a research agency would take about 5 years to do !). Also, of course , I would really like to know about any side effects, or if it doesn’t work for someone, even when following the once-weekly treatment guideline. I am also interested in knowing if you have pets in your lives somewhere. That would be so very much appreciated.The icing on the cake would be “before” and “after six months ” close-ups of your face, with the eyes blocked out if you want. I would love some of those, if it worked, of course.

Good luck, I hope you’ll give it a shot. Remember, I’ll append some relevant articles at the end of this, to verify that I didn’t dream this up.

For the treatment outline I use in my practice, the “ingredients” are as follows ( I’m giving you the real names because you already know you have rosacea.

A = Kwellada shampoo
B = Kwellada lotion (5% Permethrin)
C = Sulfacet face cream or equivalent antibiotic cream

DR. ANNETTE ANDERSON, B.A., M.D.

FAMILY PHYSICIAN

(Address withheld for people outside my medical group)

RE: ROSACEA STUDY

I am looking for patients with a one year + history of chronic recurrent rosacea, for a small study (N=50) involving a new treatment method . The aim is to substantially reduce symptoms. There are no guarantees, but so far, positive results.

The premise of the study is that rosacea may be caused or aggravated by an over-abundance of a mite called DEMODEX FOLLICULORUM. This mite is a common organism found in skin follicles, but in some people it overgrows, attracting bacteria which cause inflammation and the symptoms of rosacea.

Typically, rosacea develops in several stages ( not all people with rosacea go through all stages) . These stages are:*

• Flushing: periodic reddening of the face, aggravated by various trigger factors, such as hot showers ,emotional upset, alcohol, PMS, etc.
• Inflammatory lesions: papules, pustules (pimples)
• Edema may be present ( swelling over affected areas)
• Telangiectasias may be added with time ( dilated blood vessels)
• Ocular rosacea may occur (burning, stinging,tearing etc. of the eyes)
• Rhinophyma may sometimes occur in the advanced stages in men ( red, swollen nose)

Rosacea is a clinical diagnosis, i.e. based on appearance and history alone.There are no blood tests to confirm or refute the diagnosis. It is important to see how the symptoms behave when the condition is treated appropriately.

So far, the assumption is, and experience seems to show, that rosacea cannot be cured, only controlled with creams or gels. These are typically antibiotic based, such as Metrogel (reg. TM). Sometimes,oral antibiotics are also used and can be quite effective for treating an acute flare-up. Of course, it is also important to avoid trigger factors.

However, this small study, (as other similar ones ), tries to illustrate that one should also attempt to treat for the mite DEMODEX FOLLICULORUM, in order to achieve better, and more lasting results. This concept is based on a review of some of the available literature/studies.**

Basically, it might seem that DEMODEX can overgrow, attracting bacteria in the process.It may be that certain substances such as lipases result in the release of irritant fatty acids, which in turn lead to the observed skin changes.

So far, the antibacterial-based treatments reduce the bacterial, but not the DEMODEX load. So, the underlying problem, the DEMODEX ,causes further flare-ups eventually, and the whole process repeats itself.

ABOUT THE STUDY:

• Treatment is of a six months total duration.
• Topical mite therapy is in the form of cream and shampoo, plus oral antibiotics if a heavy bacterial load seems to be present also.
• Patients may continue own treatments during study.
• Short questionnaires, time 0 and 6 months, in conjunction with office visits.
• Patients are requested to supply a copy of the dermatology consult originally diagnosing rosacea.
• Please, no patients with body-dysmorphic disorder, history of anti-social behavior, unstable psychiatric conditions, or severe self-image problems.
• Please ask any interested rosacea patient to call my office to set up an appointment for the first visit/questionnaire.

Kind regards,
Annette Anderson, B.A., M.D.

* From: ROSACEA, a Guide For Physicians, Jonathan Wilkin,M.D.

ROSACEA TREATMENT TRIAL
Patient name: ______________________________
Patient’s GP: ______________________________
Date: ______________________________

QUESTIONNAIRE

* How long have you had rosacea? __________________________

* Did a dermatologist diagnose it, or confirm the diagnosis? Please provide a copy of the consultation letter from your GP’s
records.* Does anyone else in your family have rosacea?_____________________

* How much does your rosacea bother you, on a scale from 0 (not at
all) to 10 (unbearable)? ________________________

* Please list the factors that consistently seem to contribute to a
flare-up of your rosacea:______________________________

* Please tick off any factors you think might also act as triggers
for a flare-up ( if any) :
_____ hot rooms / hot showers / hot beverages
_____ caffeine
_____ alcohol
_____ sun/wind
_____ for women: PMS
_____ exercise
_____ dairy products
_____ emotional upset / crying
_____ chocolate
_____ spicy foods
_____ medications :(which ones)
_____ creams (which ones, eg. cortisone)
_____ natural herbs/supplements (which ones)
_____ cosmetics (eg. alcohol-based lotions, witch hazel, oil-based make-up… ,
which ones ______________________________

* Your rosacea usually consists of:

_____ generalized redness/flushing of the :
_____ cheeks
_____ chin
_____ nose
_____ forehead
_____ both cheeks and nose
_____ all of the above
_____ other
_____ redness/flushing plus pimples (papules, pustules)
_____ pimples only
_____ swelling over some areas of facial skin
_____ tiny, permanently dilated red blood vessels (telangectasias)
_____ eye irritation, such as intermittent burning, tearing etc.
_____ reddened, enlarged nose

* On average, how often do you get a major flare-up of rosacea?

* Which treatments ( creams or pills ) have you tried so far, and briefly mention the results:

TREATMENT RESULT

* Have you had any side-effects to these treatments?

* How effective have these treatments been in the reduction or elimination of your rosacea symptoms?

(a) not at all (b) somewhat effective (c) moderately effective (d) very effective

* Do you have any allergies?

* Are you willing to try another treatment for rosacea?

* This treatment is in a trial phase, i.e., has not yet been proven to be effective. There is no guarentee that it will work, although a number of people in my practice have tried it, and have had good results with it.

* The core ingredients used in the treatment are available over the counter. If you have allergies precluding you from using these ingredients, we might be able to find alternatives .

B) THE TREATMENT

OUTLINE

You will be asked to use three creams. ( Called for now “A, B, and C”. You will be advised of the names of these products upon receipt of the consultation report which diagnosed you as actually having rosacea, versus another skin condition. It is important for treatment success to establish the correct diagnosis.)

In order to improve the chances of success, I will suggest several additional measures, as outlined below. These are optional, but recommended.

TREATMENT PLAN

Choose a day when you are free from work or other obligations. You will need treatments A, B,and C . If you choose to follow the steps described as optional, you will also need laundry detergent, anti-mite spray, a plastic mattress cover, and a good vacuum cleaner.

1) In the morning, have a thorough whole-body cleanse.

2) Use A as a shampoo, as directed on the bottle.

3) Then, use B. Apply thoroughly to your face, neck, ears, and downwards to cover each inch of skin including feet and toes. Avoid mucus membranes, lips and eyes. Let dry for ten minutes, then put on clothes. Leave on for twenty-four hours.

Note: After several hours, you may note tingling or burning on your face in the distribution of your rosacea. This would feel worse when exposed to cold air. If needed, take two Tylenol tablets to decrease the discomfort. Try to persist with the treatment, unless the discomfort is severe (which has not happened to anyone yet).

4) Optional:

Wash all your clothes and bedding in as hot water as allowed by their labels.

Spray your furniture with an anti-mite/anti-scabies spray (available at any pharmacy)

Put a plastic mattress- cover on your mattress.

Vacuum your carpets thoroughly.

5) After twenty-four hours, wash off treatment B thoroughly, using a mild cleansing lotion (e.g. Cetaphil) , a mild soap ( e.g. Dove), or equivalent , not based on alcohol or witch hazel.

Towel off.

Apply treatment C to your face, covering every inch of skin including ears. On the rest of your body, you may use any lotion of your choice.

If your face feels quite dry and uncomfortable, after one hour you may apply a small amount of a high- quality moisturizer on top of C.

6) From now on, twice a day, wash your face thoroughly with warm water and a gentle soap (eg. Dove etc.), and then apply C. Leave C on during the day. Dab off any excess oilyness with a Kleenex. For women: you may apply a small amount of oil-free make-up on top of C, although it may compromise the treatment to some degree. (Unknown)

7) Once a week, repeat steps 3 ( this time, on the FACE only) and 5 for the rest of the six months ,or as long as needed , closely monitoring for side effects .

You may have noted some improvements in your rosacea after two months or so. Mostly, this would be noticeable through less frequent episodes of flushing, which might also be less severe. The dilated blood vessels in your face (which cause the redness) should slowly shrink further. This takes time!

The triggers you listed above may still cause flare-ups, but these should become less often and less noticeable as the blood vessels in your face keep going back to normal. It is still important to try and avoid these triggers, to let the blood vessels shrink. You might notice that the diameter of the total area involved is contracting.

In addition to the above, you might be prescribed an oral antibiotic to take, depending on the severity of your condition. This would be useful especially in the presence of a lot of pimples, which is the same concept applied in the treatment of acne. Acne also involves an overgrowth of bacteria, as in rosacea.

The significance of Demodex folliculorum density in rosacea. Erbagci Z – Int J Dermatol – 1998 Jun; 37(6): 421-5, Department of Dermatology, Faculty of Medicine, Gaziantep University, Turkey.Authors: Erbagci Z; Ozgoztasi O

BACKGROUND: Demodex folliculorum has been reported in rosacea in a number of clinical studies. As the Demodex mite is also present in many healthy individuals, it has been suggested that the mite may have a pathogenic role only when it is present in high densities. Moreover, some authors have proposed that a mite density above 5/cm2 may be a criterion for the diagnosis of inflammatory rosacea. In this study, the possible role of D. folliculorum and the importance of mite density in rosacea were investigated using a skin surface biopsy technique.

METHODS: Thirty-eight patients with rosacea and 38 age-and-sex-matched healthy subjects entered the study. With the skin surface biopsy technique, we obtained samples from three facial sites. We then determined the mite positivities, the mean mite counts in both study groups, the mean mite densities at each facial site and in the rosacea subgroups, and the mite densities above 5/cm2.RESULTS: The mean mite count in the rosacea group (6,684) was significantly higher than that in controls (2,868; p < 0.05). The cheek was the most frequently and heavily infested facial region. Ten rosacea patients and five normal subjects had mite densities over 5/cm2; the difference was not statistically significant (p > 0.05).

CONCLUSIONS: Rosacea is a disease of multifactorial origin, and individual properties may modify the severity of the inflammatory response to Demodex. We suggest that a certain mite density is not an appropriate criterion in the diagnosis of the disease; nevertheless, large numbers of D. folliculorum may have an important role in the pathogenesis of rosacea, together with other triggering factors.

Major Subjects:
.. Acne Rosacea / * Diagnosis / Pathology / * Parasitology
.. Facial Dermatoses / * Diagnosis / Pathology / * Parasitology
.. Mite Infestations / * Diagnosis / Pathology / * Parasitology

A study on Demodex folliculorum in rosacea. Abd-El-Al AM – J Egypt Soc Parasitol – 1997 Apr; 27(1): 183-95, Journal of the Egyptian Society of Parasitology, Author Affiliation: Department of Dermatology, Faculty of Medicine, Al-Azhar University, Nasr City, Cairo.Authors: Abd-El-Al AM; Bayoumy AM; Abou Salem EA

A random sample of 16 female patients suffering from papulopustular rosacea (PPR) as well as (16) normal female healthy subjects as control group were adopted in this study to assess of Demodex folliculorum pathogenesis. It was done through determination of mite density using a standard skin surface biopsy 10.5 cm2 from different designated 6 areas on the face, and scanning electron microscopic study (SEM) as well as total IgE estimation. A trial of treatment using Crotamiton 10% cream with special program was also attempted. All subjects ranged between 35-55 years old. All patients with rosacea and 15 of the control group i.e. 75.93% were found to harbour mites. The mean mite counts by site distribution were 28.6 & 6.9 on the cheeks, followed by 14.5 & 3.0 on the forehead and lastly 6.8 & 0.8 on the chin in PPR and control groups respectively. The total mean mite count in patients was 49.9 initially and 7.9 after treatment. In the control group it was 10.7 & 10.6 respectively. The mean total IgE was 169.4 & 168.4 and 96.3 & 98.4 in PPR and control groups respectively Light and scanning electron microscopy revealed that all mites were pointing in one direction. Some of them were containing bacteria inside their gut and on their skin. After treatment 3 cases (18.75%) were completely cured, 10 cases (62.5%) gave moderate response while 3 cases (18.75) have no response. In conclusion, this study supports the pathogenic role of D. folliculorum in rosacea.

Major Subjects:
.. Acne Rosacea / Drug Therapy / * Parasitology
.. Mite Infestations / * Complications / Drug Therapy
.. Mites / * Growth & Development / Ultrastructure

Additional Subjects:
.. Adult, Animal, Antipruritics / Therapeutic Use, Female
.. Hair Follicle / Parasitology / Ultrastructure, Human, .. IgE / Analysis
.. Insecticides / Therapeutic Use, Microscopy, Electron, Scanning
.. Middle Age, Toluidines / Therapeutic Use

Chemical Compound Name:
(Antipruritics); (Insecticides); (Toluidines); 37341-29-0 (IgE); 483-63-6 (crotamiton)

Demodicidosis in childhood acute lymphoblastic leukemia; an opportunistic infection occurring with immunosuppression. Ivy SP – J Pediatr – 1995 Nov; 127(5): 751-4, Author Affiliation: Department of Pediatrics, Children’s National Medical Center, Washington, DC 20010, USA.Authors: Ivy SP; Mackall CL; Gore L; Gress RE; Hartley AH

We report demodicidosis in 11 children with acute lymphoblastic leukemia and a mildly pruritic, erythematous papular dermatitis that developed in areas rich in sebaceous glands. Dermodex eruptions were safely and effectively treated with 5% permethrin. Proliferation of commensal parasites of the skin, Dermodex folliculorum and Dermodex brevis may be an opportunistic infection of the skin in the immunocompromised host; the expected abrogation of cell-mediated immunity secondary to lymphocyte depletion predisposes some children given chemotherapy for leukemia to mite proliferation.

1. Bonnar E, Ophth MC, Eustace P, et al. The Demodex mite population in rosacea. J Am Acad Dermatol 1993;28:443-8.
2. Hoekzema R, Hulsebosch HJ, Bos JD. Demodicidosis or rosacea: What did we treat? Br J Dermatol 1995;133:294-9.
3. Shelley WB, Shelley ED, Burmeister V. Unilateral demodectic rosacea. J Am Acad Dermatol 1989;20:915-7.
4. Forton F, Seys B. Density of Demodex folliculorum in rosacea: a case-control study using standardized skin-surface biopsy. Br J Dermatol 1993;128:650-9.
5. Mateo JR, Guzman OS, Rubio EF, et al. Demodex- attributed rosacea-like lesions in AIDS. Acta Derm Venereol 1993;73:437.
6. Ashack RJ, Frost ML, Norins AL. Papular pruritic eruption of Demodex folliculitis in patients with acquired immunodeficiency syndrome. J Am AcadDermatol 1989;21:306-7.
7. Dominey A, Rosen T, Tschen J. Papulonodular demodicidosis associated with acquired immunodeficiency syndrome. J Am Acad Dermatol 1989;20:197-201.
8. Banuls J, Ramon D, Aniz E, et al. Papular pruritic eruption with human immunodeficiency virus infection. Int J Dermatol 1991;30:801-3.
9. Sahn EE, Sheridan DM. Demodicidosis in a child with leukemia. J Am Acad Dermatol 1992;27:799-801.
10. Dominey A, Rschen J, Rosen T, et al. Pityriasis folliculorum revisited. J Am Acad Dermatol 1989;21:81-4.
11. Jimenez-Acosta F, Planas L, Penneys N. Demodex mites contain immunoreactivelipase. Arch Dermatol 1989;125:1436-7.

Demodex and Eye Disease

Blepharitis. Demodex folliculorum, associated pathogen spectrum and specific therapy, Demmler M – Ophthalmologe – 1997 Mar; 94(3): 191-6, Augenklinik, Universitat Munchen., Demmler M; de Kaspar HM; Mohring C; Klauss V

Original Title: Blepharitis. Demodex folliculorum, assoziiertes Erregerspektrum und spezifische Therapie.

Demodex folliculorum has been demonstrated with an elevated frequency in patients with blepharitis, and is thought to cause therapy-resistant blepharitis. This paper presents the germ spectrum of patients with blepharitis and demodex and discusses the efficiency of a specific therapy.

METHODS: In all, 3152 cilia from 139 patients with blepharitis (38% blepharitis, 44% blepharoconjunctivitis, others) and 108 persons with quiet eyes were examined for demodex. Smears n = 125, from the conjunctive of symptomatic patients were investigated for bacteria, 3 weeks of therapy with mercury ointment, 2%: Lindan, cortisone (prednisolone, dexamethasone, hydrocortisone, fluorometholone) or antibiotics after antibiogram (gentamicin, kanamicin, neomicin, erythromicin, ofloxacin, polymyxin-B, colistin) followed in all Demodex-positive blepharitis patients (n = 41).

RESULTS: Demodex was found in 52% (62/139) of patients with chronic blepharitis, as against 20% (3/15) of those with acute blepharitis (statistically significant difference, chi 2-test, alpha = 2.5%) and in 29% of quiet eyes (statistically significantly less, alpha = 2.5%, chi 2-test). Gram-positive cocci were isolated from 79% of 57 Demodex-positive patients with blepharitis and 72% of 68 Demodex-negative patients anaerobes in 39% and 37%, gram-negative rods in 11% and 3% (statistically significant difference for gram-negative rods, alpha = 5%, chi 2-test). Of the patients with Demodex, 25% apparently had no more parasites after mercury ointment, 2% (n = 8 ) and lindan (n = 5) and 15% after cortisone and antibiotics (n = 13). (The best and statistically very significant results (alpha = 1%) were those obtained with mercury ointment, 2%, and lindan: t-test for connected spot checks).

CONCLUSIONS: Gram-positive and gram-negative bacteria grew more often in patients with Demodex. Demodex seems to be a mediator of chronic blepharitis; we recommend that mites be sought in cilia of chronic blepharitis patients. Mercury ointment, 2% and lindan proved efficient for specific therapy, the main problem being the laborious application and toxicity.

Major Subjects:
.. Blepharitis / * Diagnosis / Drug Therapy / Etiology
.. Mite Infestations / Complications / * Diagnosis / Drug Therapy

Additional Subjects:
.. Administration, Topical,
.. Anti-Inflammatory Agents, Steroidal / Administration & Dosage
.. English Abstract, Female, Human, Lindane / Administration & Dosage
.. Male, Mercury Compounds / Administration & Dosage, Middle Age
.. Prospective Studies

Chemical Compound Name:
(Anti-Inflammatory Agents, Steroidal); (Mercury Compounds); 58-89-9 (Lindane)

Okay, that’s enough for today. Please let me know what you think about this.
Annie

Followup Email

From: “Annette Anderson” <andersona@telus.net>
To: “Rosacea-Support” <rosacea-support@egroups.com>
Subject: Unsubscribe please/Bye
Date: Fri, 1 Dec 2000 11:53:17 -0800

Hi,
I’ve enjoyed my stay here.

I was very sorry, though, that Rachelle had a very bad reaction to the
treatment I proposed, although she did say she’s very sensitive to start with.
Something good may have come out of this as she found a wonderful protocol of
natural ingredients to attack the mite. If one has a choice, of course, natural
treatments are always preferable.

Unfortunately I can’t keep up with reading all my messages from you and others,
so I’ve done “my hit and run “. As I am free of any and all rosacea symptoms
now, I’m concentrating on my other area of interest, insulin resistance.
If any of you would like to write to me about my area of special interest,
Demodex folliculorum and rosacea, please write to
andersona@telus.net

Good luck to all of you and thanks for the great ideas.
Annie

More Information

For more information see how to kill demodex mites and also ocular demodex, tea tree oil as a treatment.

For those interested in eliminating Demodex, do check out Soolantra – a recently approved topical treatment for rosacea that contains 1% ivermectin.

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