Simply No Proof that Demodex Mites cause Rosacea

Written by on February 16, 2015 in Demodex Mites with 31 Comments

Now you are talking !

Finally a paper that comes right out and says in a clear way that there is simply no proof that demodex mites cause rosacea.

OK, they don’t say it quite so succintly as that – here is the conclusion;

Demodex mites can be regarded as a non-necessary, non-sufficient causal factor for certain forms of rosacea.

There you go – after decades of extensive research that is the best that can be said about the link between demodex and rosacea.

I just love the title of this paper – all rosacea sufferers would love to know, once and for all if demodex mites are principal, conspirator, accomplice, witness or bystander in the cause of rosacea?

The paper’s abstract ends with the common cry that more research is needed here, confirming that there is just no proof available.

Are you satisfied?

What do you think – are you frustrated that the demodex question never quite seems to be answered? Is the lack of proof simply just lack of luck in finding?

Article Abstract

Are Demodex Mites Principal, Conspirator, Accomplice, Witness or Bystander in the Cause of Rosacea?

Am J Clin Dermatol. 2015 Feb 11., Chen W, Plewig G.

As the only permanent human ectoparasite, the role of human Demodex mites in health and diseases remains largely unclarified.

In view of the ecological interaction between organisms of two different species, a type of commensalism between Demodex mites and humans (the former benefit, the latter unaffected) is most likely, while parasitism occurs temporarily and spatially in the diseased state (the former benefit, the latter harmed).

As part of normal skin microbiota, the causal role of Demodex mites in the initiation of rosacea can neither fulfill the classical Henle-Koch’s principal nor the advanced criteria proposed by Fredericks and Relman for molecular detection of non-cultivatable microorganisms.

Epidemiological analysis using Hill’s criteria fails to support the causative role of Demodex mites in rosacea regarding the strength of association, specificity and temporality of association, biological gradient and plausibility as well as clinical coherence, therapeutic experimentation and medical analogy.

In application of Rothman’s sufficient cause model to evaluate the contribution of Demodex mites to rosacea on a population basis, Demodex mites can be regarded as a non-necessary, non-sufficient causal factor for certain forms of rosacea.

Further strategies to dissect the association between Demodex mites and rosacea may include studying the possible existence of more virulent forms of mites with a higher pathogenicity, the endosymbiotic bacteria in certain life periods of mites, the interactions between mites and human hosts or between mites and environment, and to set up ex vivo culture models for Demodex mites.

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

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31 Reader Comments

  1. Mary Burnette says:

    Cliradex T4O Wipes have worked for me!

    • Ryan Carr says:

      Yep they should help with Ocular Rosacea. Ocular Rosacea can appear in tandem with Papulopustular Rosacea. If untreated or undertreated can develop into Phymatous Rosacea, Papulopustular Rosacea can. Demodex have a field day on the nose.

  2. Laura says:

    Seizing to eat or dring any dairy has worked for me.

  3. Ann says:

    Then why has treatment with Eurax lotion 2/Day given me practically symptom free skin? After 40 years of multiple Rosacea medicines which never worked I finally have something that does and it targets the mites! The only other treatment that helped was tea tree oil which was too harsh for my skin.

  4. Shelia Butts says:

    Does this mean the new Soolantra won’t help?

    • Soolantra seems to work quite well for the papules and pustules of rosacea. Galderma admits that they don’t really know how Soolantra works. This research indicates that we cannot prove that it is because Soolantra eradicates demodex and demodex causes rosacea. It isn’t that simple. Just what the relationship is, remains unknown.

      • Shelia Butts says:

        That’s very good to know as I get my first tube of Soolantra tomorrow.

      • Ryan Carr says:

        haha They obviously know how it works its an antiparasitic that kills parasites (Demodex) they just cant say cause the science hasnt caught up with the evidence. They will say it looks as if demodex are involved. If you truly have Papulopustular Rosacea its fairly obvious mites are involved because thats exactly what it feels like crawling over your skin. The excess cylindrical dandruff is a big clue to the culprit. Demodex cause this in Ocular Rosacea. You get this too in Papulopustular Rosacea and Demodicidosis but over your face, scalp and body. I think they are sebum plugs but I’m not completely certain either way the demodex create them because they create them in ocular rosacea as well.

      • Ryan Carr says:

        For the papules and pustules it will help. For the flushing it may help but possibly not.

  5. Ryan Carr says:

    The bacteria in the demodex stomach causes the spots, there’s been a paper written in the UK about this. Demodex are the culprit thats why ivermectin works so well coz its an anti-parasite treatment. I have Papulopustular Rosacea which is a type of autoimmune disease caused in long term acid suppressed people. I know this because this is how I got it. H Pylori may be involved in alot of the people because H Pylori causes acid suppression. Other treatments that may help manage the issue are crotamiton, permethrin and benzyl benzoate. Plexion (Sodium sulfacetamide 9.8% & Sulfur 4.8) is another option. Or the ZZ cream. The range of options on the NHS is quite frankly pathetic. There are more complex less understood reasons why the flushing happens but some researchers are gettin closer to understanding that. The cause tends to be a period of low stomach acid in the person’s stomach accompanied by a lack of certain pancreatic enzymes needed to digest food also small intestinal bacterial overgrowth which will happen after a prolonged period of bad digestion of food. Carbs are the big culprit here as well. Leaky Gut may be an issue as well, treat this with Zinc L-Carnosine or L-Glutamine or better both. The company Natural Enzymes make a pretty good shampoo and conditioner for Acne Rosacea. Their star ingredients are wait for it (protease, amylase, cellulose, lipase) and where are they normally created. sell some good Acne Rosacea products as well. Anybody who has Acne Rosacea should go to the doctors and get a serum test for H Pylori erradicate that if they have it because that causes, 1. gastritis, 2. low stomach acid, can also cause MALT Lymphoma and Stomach Cancer and a whole host of other symptoms/conditions. 2 months of Matula Herbal Formula tea, they claim 1 month can eradicate but Id really go through 2 boxes of it and go with 2 months to be sure. Pyloricil is another gr8 product for H Pylori, needs to be taken 3 months that one though. You could go down the antibiotic route but they give you so many antibiotics in a week course that it almost kills you. Why they try to fit it into a week is beyond me ? Alot of people will not be able to finish the course because its so extreme that strength of antibiotics. Why people get better getting rid of H Pylori is because their stomach acid levels return to normal mostly after the treatment ? Supplement with HCL Acid and Digestive Enzymes before eating is the best way to combat Acne Rosacea or go on a carb free diet or low carb diet or go get a hydrogen breath test and a methane breath test and treat a positive on the Hydrogen test with Rifaximin antibiotic or a positive on the Methane breath test with Metronidazole to clear the small intestinal bacterial overgrowth. BEST WAY TO COMBAT Papulopustular ROSACEA right there. If you on Proton Pump Inhibitors or H2 Antagonists go get the operation and come off them because these will be adding to the problem. Why doesnt everybody on long term acid suppression develop Acne Rosacea is a harder one to understand ? Maybe these other people dont have a leaky gut also. It’s a hard one to get ya head around. Autoimmune diseases dont happen to everyone is my only answer.

    • Shelia says:

      Just got my first tube of Soolantra today and am very excited to use it. I am 61 yrs old and have suffered with the breakout of rosacea since I was 18. I am happy to know there is a medication that focuses on Demodex because I fully believe they are a large part of the problem.

    • Evie Fishkin says:

      Loved what you wrote. It makes sense. I once was treated for H pylori. I had the whole antibiotic treatment that I thought would do me in. I was re-checked for H pylori a few years later, It did not return but the antibodies will always be positive through blood work. The biopsies showed negative for H pylori yet blood always be positive. Could the antibodies in the blood be the cause for rosacea? Although dx with rosacea years later.

      I do think I have a leaky gut problem and I believe most diseases begins in the gut. I also have gastric Pharsis…not sure if I spelled it right, where you stomach doesn’t break down food so I depend on the acid. I don’t think I have enough gastric acids.

      I also wondered if raw milk is okay if you are lactose intolerant?

      I also have stage iv breast cancer although against odds I’m surviving way beyond date for me to die. I recently also was dx with shingles. I wondered if rosacea is somewhat related to the herpie family in that they all have the tingling sensation. I cured shingles in two weeks using medicine I used for cold sores.

      I’m trying to find the cause and solution for rosacea as I don’t need another disease to fight right now 🙂

      I wonder if drinking too much water at a meal dilutes the gases in the stomach?

      I do believe it all begins in the gut. Amazing that chocolate is a trigger for canker sores, cold sores and rosacea. Super Lyzine taken in mass amounts also is what took care of shingles, canker sores, cold sores and now rosacea.

      It seems to be an immune subpressant problem.

      Thanks for what you wrote…very encouraging and educational.

      I’m on top of the rosacea…although it is frustrating…itchy, burning and red spots.

  6. Ryan Carr says:

    All rosacea sufferers would love to know, once and for all if demodex mites are principal, conspirator, accomplice, witness or bystander in the cause of rosacea? haha Interesting title They are the principle agitating factor but not the cause. The bacteria in their stomach does cause the spots. Its an autoimmune type thing. Your immune system is not doing its job on them. Trying to remove everyone of the fuckers from your skin is near impossible. You need to turn your immune system back on in relation to what is needed to keep them at bay and they will drop like flies.

  7. Patchouli says:

    I believe that the mites cause rosacea. This article appears to be very careful in its wording. Too careful. Like many other studies, questionable. And I am putting that, mildly. That’s my 5 cents.

  8. Rob says:

    I too am a believer in the demodex theory, in my other posts I state I can feel a crawly sensation at times. I have tried dozens of products over the past 2 to 3 years including v-beam (short term results for $160.00 a whack, maybe a couple weeks). I have been on soolantra for 2 weeks now. I have noticed the raised rutty looking area on the top of my nose has receded to almost nothing and skin texture is almost normal with less redness but I am still seeing the little round blemishes here and there, much better than anything else with no dryness or stinging so far. Like other reviews with Soolantra the key ingredient is ivermectin which is anti-parasitic so DUH! Demodex are definitely my main issue. I think this will only keep improving over time so my fingers are crossed and if I make it through one month that will be a first for me in years. Good luck to all and dont give up.

    • Shelia Butts says:

      I have been on Soolantra two weeks and my face seems to be getting worse. I am worried that my skin is reacting poorly to the extra ingredients in the medication. I have more breakout, many more of the whitehead areas, and more splotchy redness. I am not sure I will be able to continue using it. I see my dermatologist on the 18th but have many concerns that this new medication may either be too strong for me or some of the sub ingredients are causing this reaction. Has anyone else been using and not had the best results? I am disappointed. I was hoping this was my miracle medication.

      • Ann says:

        I have been using Eurax 10% lotion (crotamiton) for about 2 years and the results have been excellent. I do have sensitive skin, but it was much more sensitive before the Eurax. I feel that was because of the mite infestation. Good luck and know there is an alternative for you with the Eurax.

      • Ryan Carr says:

        try sulphur + zinc oxide or something like plexion

    • Ryan Carr says:

      Demodex are involved. If you feel the crawling, itchy sensation then put permethrin on. The crawling itchy sensation disappears thats prove positive that the demodex are involved. What more prove does someone want ? Changes in the skin are the problem and the cause of this is goings on and the reaction to digestion of food from the stomach and small intestine. Bacteria and yeast in the small intestine also probably have a connection as well. Pancreas tends to be involved in autoimmune diseases and rosacea seems to be one from what I can see. Low stomach acid is a common theme also.

  9. Davem81 says:

    Sheila, I think some short-term deterioration is expected in this treatment – the theory being that a ‘die-off’ occurs in the mite population leading to a short-term increase in symptoms. Try to ride it out and see if it clears. Unfortunately in my own case I never got past that stage – the flare ups kept coming – but I was self-treating, not using soolantra. When it becomes available in Europe I’ll be giving it another go.

    Best wishes


  10. Evie Fishkin says:

    I recently dx with rosacea have done a lot of research looking for the best treatment and or cure. What I hate is the itch and burning. I need answers.

    In my research and reading many blogs, and forums I’ve developed a theory that rosacea at least the phrase 2-4 is contagious. I also don’t think all dermodex mites are the same. This is why I believe the more severe rosacea is contagious.

    1. It is interesting that I have no one from about 3 generations down that I know of who have rosacea. At age 70 I suddenly dx with rosacea. My daughter just happened after two weeks of my dx come down with it as well. What are the odds? One of my employees has rosacea and I noticed adult acne on her face. I asked if she had rosacea. She said yes. Is it possible that a good by hug, face to face that I inherited one of her mites? Did my daughter catch it from me? We are both olive skin color. My immune system is compromised, and hers is not. Why did we get it about the same time; she is young, and I’m older?

    I read one study where it said that deromex mites crawl, not fly or jump and can crawl onto someone else. Is it possible they can crawl from one person to another?

    2. Also, from what I read, and my Derm- you are not to touch your face as you can spread the infection or mites else where. I had one spot only on my face. It looked like a pimple. My face wasn’t read. Just a pimple. Then another pimple. In a few days I had several pimples. My face wasn’t red. My face became itchy and burned. I woke up with swollen eye lids. I went to see my Derm and she dx me rosacea. My face a few days earlier turned red.

    My theory is one mite from possible a too close hug found home, hatched and more and more so within a week I have rosacea. I scratched them because at first I had no idea it was mites.

    Why do people talk about washing bedding and pillowcases if mites don’t spread? Although, I’m not sure they make their way into our bedding as I heard they can’t live off of human skin.

    3. I am around a lot of people and noticed quite a few with red faces or cheeks. I asked if they have rosacea. All said yes. I asked if it itches or burns. They said no. I asked if they had pimples. They said no. Thus, I’ve wonder if their rosacea is more of an inflammation disease, where the mites that cause pimples, and rhino nose are infectious types mites traveling from one person to the next and to why they spread elsewhere on the body. The latter rosacea, more serious, spreads by touch and scratching. The mites breeding and or death cause the inflammation. If you leave it alone without treatment it worsens. The people who only have blushing do little for their face and it doesn’t spread. Although, a few said there is slight burning but no itch.

    4. Some believe rosacea is fungal related. It might be related as the skin environment must be favorable for its existence. I do believe our immune system can keep mites in control, but if this is a different breed of mites then who knows. Perhaps it can be put into remission. Maybe there are different types of dermonex mites. What the mites feed on or hormones in the skin might effect where they find home such as the nose.

    I also wonder if the heat hatches the mites eggs as to why our face suddenly reddens. I don’t know. My imagination has just crossed the line 🙂

    It is interesting some people talk about washing sheets probably fearing of mites being in the sheets. If that be the case is it possible for others sleeping with you to get mites?

    We are all looking for answers. I believe there is a cause, and solution. I’m trying to put the pieces of the puzzle together because I can’t accept there aren’t answers. What I have is theory only, but it is a starting place for me.

  11. joeyr says:

    I’ve tried combining Soolantra with my Mirvaso and applying it together. Its very soothing and the redness still goes away.

  12. Liv says:

    The report says for ‘ certain types of Rosacea ‘ which leaves the door wide open . It also indicates that there is plenty more research that needs to be done and gives specific examples. The writer just seems to be saying that in the studies he quotes he does not think the conclusions reached re dermadex mites are well supported by the evidence. This is fairly standard in scientific circles and it is only his opinion!

  13. David, demodectic rosacea is a variant of rosacea and the success of Soolantra with improving rosacea is the evidence. Not all cases of rosacea are demodectic since some say Soolantra does nothing for them (my dermatologist says about one in four of his patients have success with Soolantra). The article you have cited says, “According to Rothman’s model of causality, Demodex mites are probably a non-necessary and non-sufficient cause of rosacea.” The key word is ‘probably.’ While this paper does indeed substantiate your feelings that these little critters are a ‘bystander’ with rosacea, the evidence that demodectic rosacea is a rosacea variant has become quite accepted with more dermatologists today than ever before. I mentioned the term demodectic rosacea to my new dermatologist who acknowledged it as acceptable term to use. He readily gave me a Rx for Soolantra. Galderma has spent a lot of money on making ivermectin into a very expensive treatment for rosacea which has turned out to be a winner based on ‘probably a non-necessary and non-sufficient cause of rosacea.’ And now there are a number of over-the-counter treatments for demodex added to the list. In conclusion, we will without a doubt have more papers written on this controversy which has been going on for well over a hundred years, and more anti-demodex treatments down the pipeline ‘probably.’

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