A new report says, “Because Demodex mites are ubiquitous, their potential as human pathogens has often been ignored. This contribution focuses on the growing body of evidence linking Demodex mites with various skin disorders. Histologically, spongiosis and lymphoid inflammation are regularly seen in follicles containing Demodex mites. In animals, they are well established as a cause of mange, and a human counterpart-demodectic alopecia-appears to exist. There is also a statistical association between Demodex mite density and rosacea, facial itching, and chronic blepharitis. Papulovesicular rosacealike lesions and spiny blepharitis often respond to agents that reduce Demodex numbers. Although these observations are not sufficient to fulfill Koch’s postulates, Koch’s postulates are also not fulfilled for the association between brown recluse spiders and dermal necrosis or the association between streptococci and guttate psoriasis. The evidence linking Demodex mites to human disease has implications regarding treatment.”  [1]

Demodex and its connection with rosacea is probably the most researched and reported topic other than reports on metronidazole. [2] Yet demodex remains a hot topic that is debated and discussed not only by rosaceans but also in the medical community. For example, a couple of noted rosacea online gurus have dismissed the role of demodex in rosacea. One such rosacea guru said, “Rosacea experts all agree that this mite plays no real role in the development of progression of rosacea (except for the odd pustule).”  [3] The other rosacea guru says, “I have always pushed the line that demodex mites have thus far only been proven to be innocent bystanders in rosacea symptoms.” [4]

While demodectic rosacea remains a controversy, it will continue to play a significant role in more research and discussion and the list of articles written on this subject by researchers all over the world will continue to grow.  [5]

Sources

For a high res image of Demodex Folliculorum click here.

A February 2010 study in the British Journal of Dermatology that “many dermatologists do not include demodicosis in their differential diagnoses, or the diagnosis of demodicosis is frequently masked by other skin diseases such as papulopustular or erythematotelangiectatic rosacea, seborrhoeic dermatitis, perioral dermatitis and contact dermatitis.”  I have been saying this since 2007 when I wrote my book on rosacea 101.  I have been encouraging all rosaceans to insist that their dermatologist rule out demedectic rosacea by obtaining a skin biopsy.  This same report concluded that the authors “recommend the use of SSSB for the measurement of Dd as more patients with demodicosis can be diagnosed with this method compared with the DME method.”

Another study also concluded what I wrote in my 2007 book that a skin biopsy should be done to determine demodex density to rule out Demodectic Rosacea. Here is the conclusion:

“Demodicosis should be considered in the differential diagnosis of recurrent or recalcitrant rosacea-like, granulomatous rosacea-like, and perioral dermatitis-like eruptions of the face. Potassium hydroxide examination, standardized skin surface biopsy, skin biopsy, or a combination of these are essential to establish the diagnosis.”
Source

Dr. Frank Powell wrote in his new book, Rosacea Diagnosis and Management, the following:

“There is no laboratory test or investigation that will confirm the diagnosis of PPR. Specific investigations may be required to rule out similar appearing conditions (many of which will be identified by listening carefully to the patient’s medical history and examining the skin lesions). These include skin swabs for bacterial culture, skin scrapings for the presence of demodex mites, scrapings for fungal KOH and fungal culture, skin biopsy for histologic examination, (and rarely culture) skin surface biopsy for demodex mite quantification, patch tests, photopatch tests, and very rarely systemic workup wih appropriate blood tests and radiological examinations.”

Did your dermatologist do any of the above tests including a skin biopsy to rule out Demodectic Rosacea?

“It is when the first diagnosis and treatment don’t work that dermatologists look deeper and often discover something called demodex.”

Microscopic menace may be cause of skin trouble, Jennifer Van Vrancken, Reporter,
FOX 8 News: WVUE Live Stream

More info on Demodex