Abstract
Rosacea is a common dermatological condition that predominantly affects the central regions of the face. Rosacea affects up to 3 % of the world's population and a number of subtypes are recognized. Rosacea can be treated with a variety of antibiotics (e.g. tetracycline or metronidazole) yet no role for bacteria or microbes in its aetiology has been conclusively established. The density of Demodex mites in the skin of rosacea patients is higher than in controls, suggesting a possible role for these mites in the induction of this condition. In addition, Bacillus oleronius, known to be sensitive to the antibiotics used to treat rosacea, has been isolated from a Demodex mite from a patient with papulopustular rosacea and a potential role for this bacterium in the induction of rosacea has been proposed. Staphylococcus epidermidis has been isolated predominantly from the pustules of rosacea patients but not from unaffected skin and may be transported around the face by Demodex mites. These findings raise the possibility that rosacea is fundamentally a bacterial disease resulting from the over-proliferation of Demodex mites living in skin damaged as a result of adverse weathering, age or the production of sebum with an altered fatty acid content. This review surveys the literature relating to the role of Demodex mites and their associated bacteria in the induction and persistence of rosacea and highlights possible therapeutic options.
Highlights
Rosacea is a common chronic inflammatory dermatosis of the face that affects up to 3 % of the world’s population (Buechner, 2005)
Staphylococcus epidermidis has been isolated predominantly from the pustules of rosacea patients but not from unaffected skin and may be transported around the face by Demodex mites. These findings raise the possibility that rosacea is fundamentally a bacterial disease resulting from the over-proliferation of Demodex mites living in skin damaged as a result of adverse weathering, age or the production of sebum with an altered fatty acid content
The pathogenic role of Demodex mites is well-documented in dogs where Demodex canis causes demodicosis – a serious, potentially fatal disease connected with numerous skin and ocular symptoms (Gortel, 2006)
Summary
Disorders of the pilosebaceous unit, nutritional and chemical factors and infectious factors (Crawford et al, 2004, Yamasaki & Gallo, 2009). Over a significant period of time, there have been numerous attempts to connect the etiopathogenesis of rosacea with the presence of some micro-organisms on or within the skin (Lazaridou et al, 2011), including Demodex mites and bacteria. It is well established that there is a higher density of Demodex mites in the skin of rosacea patients than control patients but the significance of this has been disputed (Vance, 1986; Bonnar et al, 1993; Erbagci & Ozgoztasi, 1998). This review will explore the current understanding of the role of these organisms in the induction of rosacea
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