Demodicosis: update and treatment with laser and other light sources.

Demodex blepharitis is aprevalent but often overlooked form of eyelid inflammation with significant impact on ocular surface health. Recent insights into the pathogenesis, especially the role of Demodex folliculorum and Demodex brevis, highlight its clinical relevance. The investigation and introduction of specifically efffective treatment approaches provide the prospect of expanded treatment options.

Demodex mites are believed to contribute to the pathogenesis of both rosacea and demodicosis. While standardized skin surface biopsy (SSSB) remains the gold standard for detecting Demodex density, it is invasive and time-consuming. Ultraviolet (UV) dermoscopy, a non-invasive technique that visualizes fluorescent structures, may offer a rapid alternative for identifying Demodex proliferation. To investigate the relationship between Demodex folliculorum (D. folliculorum) and Demodex brevis (D.brevis) counts obtained by SSSB and fluorescent dots detected under UV dermoscopy, and to evaluate the diagnostic value of these findings in rosacea and demodicosis. Fifty-four patients with rosacea or demodicosis were evaluated using both UV dermoscopy and SSSB from the same facial region. Orange and bright blue fluorescent dots were recorded dermoscopically, and mite density and species were quantified via SSSB. Correlation analyses and ROC curve analysis were performed to assess diagnostic performance. A significant positive correlation was found between total Demodex count and bright blue fluorescent dots (r = 0.343, p = 0.013), but not with orange dots (r = -0.065, p = 0.649). Only D. folliculorum showed significant correlation with blue and total fluorescent dots. ROC analysis identified >11 bright blue dots as the optimal threshold for predicting Demodex positivity, with a sensitivity of 82.1% and specificity of 71.4% (AUC = 0.793, p = 0.003). Bright blue fluorescent dots observed under UV dermoscopy significantly correlate with Demodex density, particularly D. folliculorum. A threshold of >11 blue dots demonstrated good diagnostic accuracy and may serve as a practical, non-invasive alternative or adjunct to SSSB in clinical settings. Orange fluorescence was not associated with Demodex density and likely reflects unrelated sebaceous or microbial activity.

Demodex mites, particularly Demodex folliculorum and Demodex brevis, are common ectoparasites residing in human pilosebaceous units, often implicated in dermatological and ocular conditions such as rosacea, blepharitis, and demodicosis. Conventional treatments include topical acaricides such as ivermectin, permethrin, and metronidazole; however, these agents may be associated with limited efficacy, resistance, and adverse effects. Consequently, there has been growing scientific interest in exploring alternative therapies derived from natural sources, particularly essential oils and herbal extracts with known acaricidal, anti-inflammatory, and antimicrobial properties. The goal of this review was to investigate the effects of herbal extracts and essential oils on Demodex spp. Mites in skin and hair, as well as how these parasites operate and what impact they have on people's health. Demodex parasites are small arthropods that reside on the outer surface of the skin and often have no specific clinical symptoms. The main cause of disease in humans is two types of Demodex mites, Demodex folliculorum and brevis. Currently, chemical drugs that target Demodex usually have side effects and low efficacy. However, research has shown that plant extracts and essential oils such as tea tree oil have acceptable effects on the treatment of Demodex parasites and have fewer side effects. Therefore, applying these techniques may be a more suitable choice for treating demodicosis.

Rosacea is a chronic inflammatory skin disease affecting approximately 5.4% of the world population. Among its pathogenic factors is infestation by Demodex spp. Standardized skin surface biopsy (SSSB) and direct microscopic examination (DME) are widely used methods to measure Demodex spp density (Dd); however, there is no agreement on the method of choice, nor the prevalence of infestation in rosacea patients. This study compared both techniques in rosacea patients. A prospective study was conducted with 61 patients diagnosed with rosacea by dermatologists from two dermatology centres. Dd was evaluated using SSSB and DME in each patient. Results, median sampling time and reported pain were analyzed using appropriate statistical methods. The median Dd was significantly higher with SSSB (11 mites/cm2) compared to DME (1 mites/cm2; P < 0.001). Infestation (>5 mites/cm2) was detected in 64% of patients with SSSB and in 28% with DME (P < 0.001). The median sampling time was longer for SSSB (60 s) than for DME (30 s; P < 0.001). Both methods were associated with mild pain, slightly lower with DME (P = 0.033). SSSB proved more effective than DME for detecting Demodex spp. in rosacea, identifying a greater total number of mites and a higher percentage of infestation. Up to 64% of rosacea patients showed infestation with Demodex spp. using the SSSB technique. The results reinforce the use of SSSB as the standard technique for diagnosing Demodex spp. infestation in rosacea patients.

Objectives: Demodicosis results from the overgrowth of Demodex mites, Demodex folliculorum, and Demodex brevis, which are normally present on human skin. Overpopulation of these mites can cause skin manifestations ranging from erythema and scaling to papules, pustules, and nodules, mimicking other dermatoses such as rosacea and seborrheic dermatitis. This study was planned to assess the clinical and dermoscopic features of patients with demodicosis by retrospectively analyzing cases suspected and confirmed of having the condition. Materials and Methods: A retrospective analysis was conducted on clinically suspected demodicosis cases from January to December 2023, using standardized skin surface biopsies to quantify Demodex mites. Patient data, including age, gender, disease duration, lesion morphology, comorbidities, and topical corticosteroid use, were collected from records. Dermoscopic images retrieved from the database were analyzed. Results: Of the 25 suspected cases, 11 tested positive on standardized skin surface biopsy, with a mean age of 27.4 years. The clinical spectrum included cases of sensitive skin (2), pityriasis folliculorum (3), perioral/orbital dermatitis (3), papulopustular demodicosis (2), and nodulocystic demodicosis (1). Six patients had a history of corticosteroid abuse. Dermoscopy findings included Demodex tails (63.6%) and Demodex follicular openings (72.7%). Patients with primary demodicosis showed a significant improvement with topical ivermectin monotherapy. Limitations: Limitations of the study are its retrospective nature and small sample size. Conclusion: Demodicosis should be considered in cases of facial skin lesions, particularly with a history of corticosteroid use. The addition of dermoscopy can significantly aid in the correct diagnosis of demodicosis. Proper diagnosis and treatment, including acaricides like ivermectin, can significantly improve patient outcomes.

Demodex species in the family Demodicidae are hair follicle scabies agents. Demodex species are transmitted from person to person through close contact, shared towels, make-up materials, etc. This study was conducted to obtain data on the relationship between mandatory mask use and demodicosis during the Coronavirus disease-2019 (COVID-19) period. The study included 510 students who used masks in necessary environments since the beginning of the pandemic and participated in the study voluntarily. Cellophane tapes were applied to the relevant areas three times. In addition, both eye lashes were pulled from both eyes and adhered to the cellophane tapes. The samples were examined under light microscope at different magnifications (x10, x40). Demodex folliculorum and Demodex brevis were detected in 38 (7.5%) of 510 students. D. folliculorum was detected in 33 of the positive students and both D. folliculorum and D. brevis were detected in 5 students, 2 of whom were male and 3 of whom were female. Demodex spp. was found in 12 (4.9%) of 245 students who answered "no" to the question "Do you have acne or skin complaints on your face?" and in 26 (9.8%) of 265 students who answered "yes". While this parameter was statistically significant, the other parameters were not statistically significant. The COVID-19 period has changed people's lifestyles and habits in many ways. It has made the use of masks obligatory. During mandatory mask use, factors that may increase the presence of Demodex spp. should not be ignored.

In rosacea patients, the Demodex folliculorum was detected on the skin of the lesions in 68.1% of cases. According to the species identification, Demodex folliculorum longus was detected in 64.5%, and Demodex folliculorum brevis – in 35.4%. Taking into account the severity according to the Rosacea Diagnostic Assessment Scale, Demodex brevis was most often isolated in patients with a mild severity, and Demodex folliculorum longus – with moderate and high severity (55% and 93.5%, respectively). With increasing severity of the clinical course, the count of the Demodex folliculorum increased by 2.8, 5.1, and 7.8 times and on average amounted to 8.5+0.2, 15.3+0.2, and 23.5+0.2, respectively. The obtained data indicate the significance of the Demodex folliculorum mite and its quantitative characteristics in the clinical course of rosacea.

Demodex folliculorum and Demodex brevis are external parasites that reside in human hair follicles and sebaceous glands, most commonly on the cheeks, chin, nose, and eyelids, inhabiting the eyelash follicles. The prevalence of Demodex spp. varies with age. The highest concentration of mites is observed in older people, being almost 100%, and the lowest is found in children. Although the presence of parasites does not directly lead to the development of pathological symptoms, their high density is associated with diseases such as rosacea or blepharitis. This manuscript delves into the biological characteristics of Demodex folliculorum and Demodex brevis with consideration of current diagnostic techniques for detecting Demodex mites. It also aims to provide an in-depth analysis of the role Demodex mites play in the development of various dermatological conditions, with a review of the current therapeutic approaches for managing Demodex-related diseases.

Demodex galagoensis sp. nov. (Acariformes: Demodecidae) from the Senegal bushbaby Galago senegalensis in the light of the current understanding of the demodecid mite fauna of primates, with notes on a case report.

Background: Human demodicosis is a parasitic disease caused by two species of mites, Demodex folliculorum and Demodex brevis. Cutaneous and ocular demodicosis most often occurs in a situation of impaired immune response, where the attacked organism is weakened, has reduced immunity or metabolic disorders. The treatment of demodicosis can last up to several months and requires a lot of patience and regularity from the patient. Objective: The aim of this paper is to review the therapeutic options used in the treatment of the ocular and cutaneous human demodicosis. Materials and methods: This review was based on available data collected in the PubMed and Google Scholar databases, using the keywords: ‘Demodex brevis’, ‘Demodex folliculorum’, ‘Demodex mite’, ‘human demodicosis treatment’. Conclusions: Treatment of demodicosis based on the use of a single medicament has the lowest efficiency and effectiveness. In contrast, a combination therapies, in which oral and local applied medication are taken together or several types of local medication are combined have the best effect.

Identification of the enzyme activity of human Demodex aspartic protease and its function to hydrolyse host macromolecules and skin cell proteins

Epidemiological survey of two morphotypes of Demodex folliculorum (Prostigmata: Demodicidade) in young people from southern Spain

The increased proliferation of Demodex mites in the pilosebaceous unit can be the cause of rosacea flare-ups on the face. Signs and symptoms of the scalp (e.g., itching, dandruff) have sometimes been reported in patients with papulopustular rosacea of face; they may be due to a proliferation of Demodex mites on the scalp. To study the Demodex mites count, a standardized skin surface biopsy was performed on the cheek and on the scalp. Microscopic examination and molecular identification of Demodex were performed. Pearson's χ2 Test or Fisher's Exact Test were used to test for any association between categorical variables and outcome. Patients affected by papulopustular rosacea had a greater frequency of Demodex-positive standardized skin surface biopsy than controls at the scalp (35.0% vs. 0%, P=0.033), at the face and/or at the scalp (50% vs. 10%, P=0.032). Demodex positive patients with a Demodex-positive face sample were more frequently found to have a Demodex-positive scalp sample (P=0.035). The predominant species was found to be Demodex folliculorum (92.6% of samples); the species Demodex brevis was identified only in 7.4% of samples. Demodex folliculorum is more frequently found on the scalp and face of patients with rosacea than controls, even though it is not statistically associated with scalp symptoms. The scalp may be a reservoir area for Demodex mites which could migrate on the face again after an acaricidal treatment.

To study the demographic, clinical, and microbiological profile of Demodex-related blepharokeratoconjunctivitis (BKC) at a tertiary eye care hospital. This retrospective observational study was conducted from January 2016 to September 2022. It included 83 patients with microbiologically proven Demodex BKC who presented to the cornea department of our tertiary care eye center. The clinical, microbiological, and demographic data of the 83 cases were analyzed. Of the 83 cases, 57 (68.67%) were younger than 40 years, and 25 (30.12%) were below 20. Most patients presented with a good visual acuity of 20/40 or better (93 eyes; 84.55%). The disease was unilateral in 55 patients and bilateral in 28. Cylindrical dandruff was the predominant presentation noted in 61 eyes (54.95%), followed by corneal scarring in 47 eyes (42.34%) and corneal vascularization in 40 eyes (36.04%). On light microscopy, 87.95% of the positive samples were identified as Demodex folliculorum , 7.23% as Demodex brevis , and 6.02% remained unidentified. Tea tree oil and lid scrubs eradicated the disease in most patients clinically (75/83, 90.36%). The spectrum of BKC includes both lid signs and corneal involvement. It can be a cause of recurrent BKC and detection of the mite by microscopic evaluation of the lashes can confirm the diagnosis. In most cases, the tea tree oil can effectively manage this condition. However, low doses of topical steroids are needed to control the inflammation in patients with corneal involvement.

Human Demodex mites, Demodex folliculorum and Demodex brevis, are microorganisms that reside in the pilosebaceous units, usually without causing symptoms. Phototherapy has been linked to demodicosis in previous studies. We aimed to determine whether there was an increase in the frequency of demodicosis and Demodex density after 20 phototherapy sessions. A case-control study was conducted with 32 participants who received narrowband ultraviolet B or ultraviolet A-1 therapy for various dermatological indications. Standardized skin surface biopsies were performed before and after phototherapy to assess Demodex density. The presence of Demodex-related skin conditions was assessed before phototherapy. A statistical analysis was performed to compare the Demodex densities and prevalence of demodicosis between the baseline and 20th session of phototherapy. No significant change was observed in Demodex density after 20 sessions of phototherapy. The average Demodex density before treatment was 2.75 ± 4.48 (/cm2 ), and after treatment, it was 2.85 ± 4.81 (/cm2 ), indicating no significant difference (P = 0.879). The percentage of patients with demodicosis in at least one region of the face was 28.1% (9/32) before treatment, and after treatment, it was 31.3% (10/32), with no significant difference (P = 1.00). Our findings contradict previous studies that suggested an increased Demodex density and demodicosis prevalence after phototherapy. The data from previous studies are open to debate due to their selected samples, designs, and interpretations regarding the phototherapy-immunosuppression-Demodex relationship. Larger-scale longitudinal studies conducted on a homogeneous sample are warranted to better understand the relationship between phototherapy and demodicosis.

Demodex species are permanent parasites of pilosebaceous units infesting humans worldwide. Of the two species associated with the human host, Demodex folliculorum is much more commonly detected and occurs more abundantly in hair follicles and Zeiss glands. Demodex brevis, on the other hand, is mainly associated with the sebaceous and meibomian glands, all over the body. The infestation is usually chronic, and the troublesome ocular and skin symptoms often make it difficult for patients to function in both a social and professional context. Despite this, diagnostics for Demodex spp. are still not routinely performed during ophthalmological and dermatological examinations. We aimed to compare preparations of eyebrow hair, eyelashes, and skin scrapings, and to investigate the correlation with false negative results in the laboratory diagnosis of demodicosis. Direct microscopic examination was applied on 100 patients (81 women and 19 men). The most common ocular and skin symptoms reported by the study participants were eyelid itching and erythema, respectively. Significant differences were found between infested and uninfested patients with regard to the following symptoms: eyelid itching which was more common in infested patients (35.8%) (p = 0.0343) and chalazion occurring only in infested patients (13.2%) (p = 0.0285). The collection of diagnostic material from more than one site e.g. nasolabial folds, eyebrow hairs or eyelashes has a significant effect on the test result. Taking a single type of a sample from a single face zone can lead to false negative results.

&#x0D; &#x0D; &#x0D; The aim of the study was to identify the Demodex mites collected from the patients’ eyelashes from the X outpatient clinic in Lithuania and the bacteria they carry. A total of 62 mites were collected from 15 different patients who complained of redness and itchiness around the eyes, rubbing around the eye area. Morphological examination of mites was carried out with an optical microscope. The Mites’ DNA was isolated using a DNA isolation kit, bacterial amplification was performed using specific primers for amplification of the 16S RNA gene fragment. Demodex folliculiorum was identified in all the examined samples, Demodex brevis was detected in only one sample. No bacteria were detected in the analysed samples.&#x0D; &#x0D; &#x0D;

Few studies have evaluated the histopathological characteristics of clinical rosacea subtypes in detail. To assess rosacea histopathological features in correspondence to clinical subgroups. The histopathological findings of 204 rosacea patients were analyzed retrospectively and were compared among clinical subtypes. Thirt-Two Percent of patients were male and 68% were female. Seventy-three patients had erythematotelangiectatic rosacea (ETR) and 110 had papulopustular rosacea (PPR), 12 were ETR + PPR, 4 ocular, 2 phymatous, and 3 had Morbihan's edema. Perivascular and perifollicular lymphohistiocytic infiltration, perifollicular exocytosis, follicular spongiosis, and ectatic vessels were almost found in all subtypes. Solar elastosis was higher in ETR. Spongiosis, exocytosis of inflammatory cells into epidermis, acanthosis, and granulomatous reaction were higher in PPR. Inflammatory cells exocytosis was more in PPR and phymatous. Demodex folliculorum was identified in 27% of ETR, 33.6% of PPR, 50% of phymatous, one ocular patient, and none of Morbihan edema. Demodex brevis were found in 5% of ETR, 3% of PPR, and 50% of phymatous. Demodex brevis not folliculorum was more in phymatous. Spongiosis was the most common finding in ocular rosacea. Spongiosis, exocytosis of inflammatory cells, and granulomatous reactions were more in PPR. Solar elastosis was more in ETR. Histopathological findings were compatible with clinical subgroups.

Demodex folliculorum and Demodex brevis are commonly present on facial skin and frequently noted via Reflectance Confocal Microscopy (RCM) examination. These mites inhabit follicles and are often seen in groups of two or more, although D. brevis is usually found as a solitary mite. When observed through RCM, they are typically present as refractile, round groupings seen on a transverse image plane inside the sebaceous opening, as they are vertically oriented, and their exoskeletons refract under near-infrared light. Inflammation may occur, leading to a variety of skin disorders; nonetheless, these mites are considered to be part of normal skin flora. a 59-year-old woman presented to our dermatology clinic for confocal imaging (Vivascope 3000, Caliber ID, Rochester, NY, USA) of a previously excised skin cancer for margin evaluation. She did not exhibit symptoms of rosacea or active inflammation of the skin. Incidentally, a solitary demodex mite was noted in a milia cyst nearby the scar. The mite appeared to be trapped in the keratin-filled cyst and was positioned horizontally to the image plane such that its entire body was captured in a coronal orientation as a stack. Demodex identification using RCM can provide clinical diagnostic value in the context of rosacea or inflammation; in our case, this solitary mite was thought to be part of the patient's normal skin flora. Demodex are practically ubiquitous on the facial skin of older patients and are frequently noted during RCM examination; however, the orientation of the mite referenced herein is uncommon, allowing for a unique view of its anatomy. The use of RCM to identify demodex may become more routine as access to technology grows.