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

Accutane is being prescribed for rosacea more than ever according to anecdotal reports. More reports of accutane treatment for rosacea in low dose prescriptions seem to be the current popular treatment without much discussion on the risks and side effects.  Accutane was initially used to treat acne but has become quite common to hear of physicians prescribing it for rosacea. Particularly pregnant women should be warned clearly of the risks associated with accutane. A rosacean should ask his doctor what are the risks associated with taking accuatane, including the side effects and determine if the risks are worth the benefits. This what is called the risk-benefit analysis. If you decide to accept risks of this treatment,  you will discover later what these risks are for yourself but at least you were warned. Taking Accutane without considering the risks is like jumping into a dark deep hole blind folded. What you land on could hurt later.

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In recent years oral antibiotics are now given by dermatologists as a first line treatment for rosacea along with topical metronidazole.  Oracea has become the most recent popular antibiotic because it is low dose and touted as an anti-inflammatory rather than antibiotic, but nevertheless, is still an antibiotic. Generally speaking, taking these antibiotics for rosacea is long term since after short term use rosacea comes right back. Why is long term use of antibiotics the treatment?  According to Dr. James Del Rosso, professor of dermatology at the University of Nevada, says, ”We know that it’s best, in an ideal world, that patients are not on long-term antibiotic therapy. The reality is that patients are there for treatment, and part of the effective treatment that we have to date is giving them antibiotics. And so we’re caught in the middle until we have some better, definitive ways to solve the problem.” [1]  So what doctors are trying to do is reduce the dosage to a minimal amount that still treats the rosacea effectively, hence low dose tetracycline, Oracea. We have no idea what the long term effects of taking Oracea are since the safety of using Oracea hasn’t been established beyond nine months. All we do know is the long term effects of antibiotics since they have been used for a long time. What are the long term risks and side effects of antibiotic use?

Long Term Risks

There are many risks associated with long term antibiotic treatment and probably the foremost concern is antibiotic resistance which is is a type of drug resistance where a microorganism is able to survive exposure to an antibiotic. This problem is aggravated when “the greater the duration of exposure the greater the risk of the development of resistance irrespective of the severity of the need for antibiotics.” [2] There are, of course, other risks associated with long term antibiotic resistance including bacterial overgrowth, digestive problems usually due to changes in gut microflora, lower levels of phytoestrogens and compromising the immune system. [3] This doesn’t even take into account the many side effects of antibiotic treatment which are too many to list here. [4]

So a rosacean should ask his doctor what are the long term risks associated with taking an antibiotic, including Oracea, including the side effects and determine if the risks are worth the benefits.  This what is called the risk-benefit analysis. If you decide to accept long term antibiotic treatment, including Oracea, you will discover later what these risks are for yourself but at least you were warned.

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Sources

[1] NPR
Doubts Raised Over Antibiotic Use for Acne by Allison Aubrey

[2] Wikipedia

[3] The Long-Term Effects of Antibiotics on Health and Immunity

[4] Antibiotics
The Merck Manuals