The NRS recently highlighted a paper speculating that demodex mites are the missing link in papulopustular rosacea, or as they characterised the mites are the “chicken coming first before the egg”. It is a cute headline but the article and paper quoted are pretty lightweight.
The Chicken, Not the Egg
Thursday, July 5, 2012
Demodex mites, the microscopic parasites that are normal inhabitants of facial skin, have long raised the question, “Which comes first, Demodex or rosacea?” as medical experts debate whether their increased numbers on rosacea patients are a cause or a result of the disorder, and now there may be some evidence that the “chicken” — Demodex mites — and not the “egg” comes first, according to a recent scientific report.
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The link between mites and infection may be suggested by evidence that the complaint of sensitive skin in rosacea patients disappears when the number of Demodex mites is brought back to normal, he said. Disruption of the skin barrier may also occur as the mites erode the skin surface, penetrating into the lower dermis skin layer.
Furthermore, Dr. Forton suggested the Demodex mites themselves may be responsible for the bumps and pimples of subtype 2. Biopsies have shown that the presence of Demodex mites inside facial follicles consistently corresponds with the immune response in the skin as the body protects itself against invaders.
The NRS blog entry highlights the work of, 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.
Dreaming
As Rosacea News noted in October last year in Demodex Infestation: the Missing Link?, this theory is pretty far fetched.
Better Research
There is a more detailed and proven theory already emerging that tries to link demodex mites with rosacea symptoms. A particular theory centres around the body’s immune response to 2 proteins that have been isolated from demodex bacteria.
The National Rosacea Society has in fact sponsored some of the research seeking to prove this strong link with rosacea and demodex bacteria.
David,
I grant you that all this is still theory, yet, as more evidence emerges about demodex which apparently is where a lot of research money is being spent, more rosacea authorities are suggesting that the evidence points to the mites including the NRS.
“In other words, which came first: the mites or the rosacea?” study author Frank Powell, M.D., consultant dermatologist at Mater Misericordiae Hospital in Dublin, Ireland, was quoted as saying. “And now there is evidence that it might be the mites.”
http://www.ivanhoe.com/channels/p_channelstory.cfm?storyid=17692
The article you say is dreaming says, “there may be some evidence that the “chicken” — Demodex mites — and not the “egg” comes first, according to a recent scientific report.”
Neither of these articles are dogmatic about which comes first, they are merely saying the evidence points to the mites. Whether the mites comes first or the rosacea comes first the point is that mites have a role whether primarily or secondarily. When it comes to demodex density counts this is another matter that to me needs to be cleared up. Is it really so that having a higher demodex density count on rosacea sufferers is the problem? There really is no data on this. We keep hearing that there is higher demodex density counts on some rosacea patients. We need to establish demodex density counts on 10,000 rosacea patients and compare that to a control group of equal size to really understand if a higher counts is related to rosacea flare ups. How many have higher demodex density counts without any rosacea symptoms? How many have rosacea flareups with low demodex density counts. Does it even matter what the demodex density count is?
As to the theory regarding the body’s immune response to 2 proteins that have been isolated from demodex bacteria causing an inflammatory response you seem to agree that this has some merit. Kudos to you for mentioning it.
As I have repeated before, demodectic rosacea is a variant of rosacea. Not all rosacea cases are demodectic. That is why ruling out demodectic rosacea is important in a differential diagnosis. Dismissing the role of demodex in rosacea by not ruling it out is a disservice to rosacea patients and more dermatologists in the future will without a doubt pay attention to articles like what the NRS is publishing and the findings of Forton , Powell, and many others.
Any work on galdermas phase 3 for ivermectin? It started in January 2012. This whole mite to debate will come to a conclusion one way or the other when that finally comes out.
No, there are no updates available yet from the CD5024 trials.
Whether it is down to density count or an allergy to the mites themselves in whatever number, or their bacteria, I am personally convinced that demodex mites play a vital role in my own (papulopustular) rosacea.
I have been using tea tree oil for 12 days now and the results are fantastic compared to what my dermatologist, my laser guy and the dermatology department at my states big time hospital have prescribed, I am convinced they are all getting kickbacks from the pharmaceutical companies for prescribing garbage that is potentially harmful with long term use but matter of factly just does not work, when I mention mites as a possible cause I get the you don’t know what you are talking about speech, we are the experts not you. I have spent thousands of dollars with little or no results that lead back to square one every time from these self proclaimed experts, big time drug companies have spent hundreds of millions of dollars on their failures so you know they will not admit a $10.00 bottle of tea tree oil is the answer.., well in my case it has their stuff beat hands down with no side effects and it’s all natural. I am expecting big money to try and ban tea tree oil if they can not capitalize from it. I stocked up just in case.