Demodex Research Articles

Demodex: The worst enemies are the ones that used to be friends.

Demodex mites are common ectoparasites of the human pilosebaceous units. Most adults are infested with Demodex mites without clinical symptoms. Demodex mite will only become a pathogenic organism when there is an abnormal increase in the number of Demodex mite density. This situation happens when the equilibrium between Demodex mites, skin microenvironment and human immunity system changes. Demodex infestation can cause multiple skin disorders, which are grouped under the term demodicosis or demodicidosis. Clinical manifestations of demodicosis can mimic other known skin diseases such as folliculitis, rosacea, perioral dermatitis, which is why it is often misdiagnosed. Diagnosis criteria consists of relevant correlation of suspected clinical skin lesions, confirmed by the presence of abnormal proliferation of Demodex mites and by clinical cure after acaricidal treatment together with normalization of Demodex mite density. Dermatologists should be aware that demodicosis is not an uncommon skin disease, and there are still many unknowns about it that should be researched further.

The Effect of Different Therapeutic Modalities on Demodex Densities and Clinical Symptoms of Patients with Demodicosis

Background: Demodicosis represents cutaneous diseases caused by cutaneous overpopulation of Demodex mites. The aim of this study was to evaluate the effect of different treatment options on Demodex densities (Dds) and clinical symptoms of patients with demodicosis.
 Methods: Patients with high Dds in two consecutive standardized skin surface biopsies (SSSB1>5 D/cm2 or SSSB2>10 D/cm²) and concomitant clinical symptoms were evaluated retrospectively. Measurements of treatment effectiveness included clinical improvement and normalization or reducing of Dds.
 Results: A total of 21 patients included in the study. Five patients received topical permethrin and crotamiton whereas 16 patients received systemic metronidazole in combination with topical permethrin and/or crotamiton. The treatment was continued with topical ivermectin in 2 patients who had failure with other treatments. The median treatment duration was 3 months (IQR 1-4). Pre- and post-treatment median Dds decreased 30 to 14 D/cm2 on SSSB1 whereas 81 to 80 D/cm2 on SSSB2, respectively. There was no statistically significant decrease in Dds on SSSB1 and SSSB2 after the treatment (p=0.173 and p=0.134, respectively). Clinical improvement was recorded in a total of 14 patients (66.6%) of whom only 2 patients (9.5%) had normalization on Dds. Additionally, topical ivermectin provided a rapid clinical improvement and normalization on Dds in both 2 patients.
 Conclusion: Irrespective of the treatment, more than two-thirds of the patients improved clinically without a significant change in Dds. This finding may suggest that the treatment response has been mostly associated with the anti-inflammatory properties of the agents. Topical ivermectin seems to be a more suitable treatment option for demodicosis with positive effects on both clinical findings and Dds.

The association of demodex infestation with pediatric chalazia

PurposeThis study aimed to investigate the association of Demodex infestation with pediatric chalazia.MethodsIn a prospective study, 446 children with chalazia and 50 children with non-inflammatory eye disease (controls) who underwent surgical treatment were enrolled from December 2018 to December 2019. Patient ages ranged from 7 months to 13 years old. All patients underwent eyelash sampling for light microscope examination, and statistical correlation analysis between Demodex infestation and chalazia, including the occurrence, recurrence, and course of disease, morphological characteristics, and meibomian gland dysfunction (MGD) in chalazia patients was performed.ResultsDemodex was found in 236 (52.91%) patients with chalazia and zero control patients. Demodicosis was significantly more prevalent in chalazia patients than the control group (P < 1 × 10− 14). Recurrent chalazia (P = 0.006) and skin surface involvement (P = 0.029) were highly correlated with Demodex infestation. Demodicosis was also associated with multiple chalazia (P = .023) and MGD(P = .024). However, Demodex infestation was comparable in the course of disease (P = 0.15), seasonal change (P = 0.68) and blepharitis subgroups (P = 0.15). Within the group of chalazia patients who underwent surgical removal of cysts, 4 (0.9%) patients with concurrent demodicosis experienced recurrence.ConclusionsDemodex infestation was more prevalent in pediatric chalazia patients than healthy children, and was associated with recurrent and multiple chalazia. Demodicosis should be considered as a risk factor of chalazia. In children with chalazia, Demodex examination and comprehensive treatment of Demodex mites should be applied to potentially prevent recurrence.

Comparison of the in vitro Demodex folliculorum killing activity of azelaic acid and permethrin

Aim: Demodex parasites have been linked to dermatological disorders, especially rosacea, without a proven mechanism. Moreover, some anti-Demodex agents demonstrate a dual therapeutic effect related to a direct effect on the skin disorder along with a decreased number of Demodex mites. Despite being considered a first-line treatment approach for rosacea, azelaic acid's efficacy against Demodex mites has not been investigated. In the current study, mites were continuously observed after exposure to the test agents to evaluate the potential anti-Demodex efficacy of azelaic acid. The efficacy of azelaic acid was compared to that of a positive control agent (permethrin).&#x0D; Material and Method: The wastes of diagnostic standardized skin surface biopsy samples of rosacea patients were collected for the trial. To four active treatment groups were administered 10% azelaic acid, 20% azelaic acid, 30% azelaic acid, and 5% permethrin. In addition, there was a control group, and 20 Demodex mites were included in each of the five groups. The authors conducted the real-time observation of the study groups through a digital microscope. The survival times of the mites were recorded and compared between the groups.&#x0D; Results: The mean survival time was 12.2±1.5 minutes in the 5% permethrin group. The mean survival times in the 10%, 20%, and 30% azelaic acid groups were 15.8±1.6, 14±1.5, and 12±1.2 minutes, respectively. The differences between the four active treatment groups did not reach statistical significance (p&gt;0.05).&#x0D; Discussion: The present study’s results revealed that all three concentrations of azelaic acid had anti-Demodex efficacy comparable to that of 5% permethrin.

Therapeutic efficacy of the drug Simparica® for demodicosis in dogs in the Kamianets-Podilskyi, Ukraine

The purpose of our research was to test the therapeutic efficacy of the acaricide «Simparica®» in combination with the biostimulator «Catosal» and the hepatoprotector «Tioprotectin» for demodicosis in dogs in the conditions of veterinary clinics in the Kamianets-Podilskyi, Ukraine. The study has been performed on dogs of different genders, ages and breeds that had a generalized form of demodicosis (affected at least 6 areas on the body of animals), to test the effectiveness of this drug in different treatment schemes. Acarological studies of scrapings from the skin of experimental animals for the presence of live or dead mites Demodex canis or their eggs have been carried out by the vital method according to D.O. Pryselkova. As a result of the conducted researches the choice of acaricidal drugs and development of complex therapeutic measures for demodicosis of dogs has been experimentally substantiated. The drug «Simparica®» has proved to be quite effective against demodicosis of dogs, even with a single use. The dependence of the effectiveness of the use of prolonged acaricide «Simparica®» on clinical forms of demodicosis has been shown. The absolute therapeutic effect of acaricide is obtained in the scaly form of demodicosis. However, in pustular and mixed clinical forms of demodicosis, its effectiveness decreased to 71.4 and 57.1%, respectively. In combination with the drug of pathogenetic therapy «Catosal» for pustular and mixed forms of demodicosis, the therapeutic efficacy of the drug «Simparica®» increases to 85.7%. When added to the scheme of hepatoprotector “Thioprotectin”, it is possible to achieve 100% therapeutic effect in pustular forms of demodicosis. However, in severe mixed form of demodicosis, the effectiveness was not absolute and was only 85.7%. In case of generalized demodicosis of dogs, regardless of clinical forms, it is recommended to use the acaricide «Simparica®» in combination with the drug «Catosal» and in the combination of «Catosal» and «Thioprotectin».

Revisiting standardized skin surface biopsy to demonstrate Demodex mite

Revisiting standardized skin surface biopsy to demonstrate Demodex mite

The comparative in vitro killing activity of tea tree oil versus permethrin on Demodex folliculorum of rosacea patients.

Demodex mites have been implicated in several cutaneous disorders compelling the research efforts for effective anti-Demodex therapy. Compare the survival time (ST) of Demodex folliculorum exposed to six different concentrations of tea tree oil (TTO) versus a positive control (permethrin 5%) and a negative control (immersion oil) group. The wastes of rosacea patients' standardized superficial skin biopsy samples were recruited for the trial. The primary outcome measure of this study was the survival time, defined as the period between the exposure of study agents to the complete cessation of Demodex movements. All differences between the mean survival times of 2.5% (54.0±6.1), 5% (39.0±3.9), 10% (22.0±2.5), 25% (13.0±2.5), 50% (7.8±0.6), and 100% TTO (3.3±1.3) were significant (p<0.05). The ST of the negative control group was 196.0±23.6min. The ST of permethrin 5% was 12.5±1.9 that did not show a statistically significant difference from the ST of TTO 25% (p=0.628). The survival times of the six different TTO groups confirmed a dose-related pattern, all of which had survival times shorter than the negative control (immersion oil). TTO 25% had comparable efficacy to the positive control agent (permethrin 5%).

Hypochlorous Acid Can Be the Novel Option for the Meibomian Gland Dysfunction Dry Eye through Ultrasonic Atomization.

Background Dry eye is a multifactor disease which needs comprehensive treatments to keep the homeostasis of ocular surface. Objective To explore the effect of hypochlorous acid on the meibomian gland dysfunction dry eye through ultrasonic atomization. Methods We set this study of 0.01% HOCL and 0.1% hyaluronate by ultrasonic atomization. All the data was recorded at the 1st, 15th, 30th, and 55th days. The patients' complains, the meibum analysis, conjunctive congestion, corneal staining, Schirmer's I test, and NIBUT were recorded by K5M, the MMP-9, and IL-2 of tear by inflammation kit; the Demodex was recorded by microscopy. Results 53 patients have joined this study. There is no statistic difference between them on OSDI (day 15: p = 0.061, 30: p = 0.055, 55: p = 0.052); results show the 10.57 ± 0.13 and 12.54 ± 0.17 reduction on OSDI; the differences of both treatments are significant (∗∗p < 0.01). Increased Schirmer's and TBUT are 3.27 ± 0.10 and 6.29 ± 0.10 (∗∗p < 0.01) or 7.32 ± 1.72 s and 9.22 ± 1.41 s (∗p < 0.05); the decreased conjunctive and corneal staining are 0.23 ± 0.07 and 0.45 ± 0.06 (∗∗p < 0.01) or 0.42 ± 0.03 and 0.37 ± 0.02 (∗p < 0.05) at both groups. The differences of MMP-9 and IL-2 negative rate are significant (Z = 0.896, ∗∗p = 0.002 < 0.01; Z = 0.659, ∗∗p = 0.001 < 0.01); the number of Demodex mites at first is 10 or 11, while the last is 2 or 6 (Z = −4.642, ∗∗p < 0.01; Z = 2.742, p > 0.05). The Demodex count between them is significant (Z = −2.310, ∗p = 0.032 < 0.05). The survival times (ST) of each stage at the HOCL are 110.75 (108.50 ± 24.50), 95.50 (90.25 ± 14.50), and 75.25 (73.48 ± 8.50) min which are shorter than those of control which are 155.50 (160.10 ± 21.50), 130.25 (128.25 ± 16.50), and 105.75 (102.50 ± 14.50) min (∗∗p < 0.01). The Demodex eradication rate of HOCL is statistic significant (∗p15th vs. 1stday = 0.028 < 0.05; ∗∗p30th vs. 1stday = 0.002 < 0.01; ∗∗p55th vs. 1stday = 0.0018 < 0.01). Conclusions 0.01% HOCL improves the Demodex eradication by shortening the survival time; the HOCL acts on the ocular surface by reducing the inflammation. The ultrasonic atomization helps for the drug usage.

Perioral pigmentation

Perioral pigmentation is a commonly encountered condition in the skin Out Patient Department (OPD), occurring due to a variety of primary as well as secondary causes. The affection of the perioral skin being readily visible negatively impacts the patient’s quality of life. As the etiology of perioral pigmentation is multifactorial, treatment modalities vary according to the cause. The perioral skin, because of its location close to the mouth, is exposed to various allergens associated with food, saliva, toothpaste, cosmetics, etc., which can all lead to allergic manifestations resolving with pigmentation. Certain other dermatoses like melasma can first present with pigmentation over the perioral region. Infections like chikungunya and dengue and infestation with Demodex mite can also lead to pigmentation at this site. Perioral pigmentation can also be a marker of underlying systemic disease. Localized lentigines-like pigmentation can be associated with various cancer predisposition syndromes like Peutz-Jeghers syndrome. Diffuse pigmentation can occur due to Addison disease, vitamin deficiencies, or can be drug-induced. All these causes of pigmentation are seen more commonly in type IV and V skin. Currently, very little literature is available elucidating the cause of perioral pigmentation and the diagnostic approach. This article reviews the causes of perioral pigmentation and highlights their important features.

Demodicosis among immunocompromised patients: a review.

Demodex mites (DM) are the most common ectoparasites of humans. Demodex folliculorum and Demodex brevis are the two species we are hosts for. Through the years there have been more data proving DM to be a pathogenic parasite. To this date it has not clear which groups of patients are clearly prone to develop demodicosis. To present a literature review in order to analyse and establish whether immunosuppressed patients are prone to develop demodicosis. Data were collected mostly from the PubMed database and through citation searching of the articles. A total amount of 23 case reports and 13 original works were included. Out of them, 4 original works deny the correlation between demodicosis and immunosuppression whereas 9 original works suggest that correlation. Demodicosis seems to be correlated with immunosuppression, but it requires more study in the future.

Prevalence and Clinico-Pathological Studies of Inflammatory Canine Skin Infections in Mumbai

Skin is largest organ of the body and forms a physical barrier between the animal and its environment. Thus, it is constantly exposed to variety of possible harmful agents. A soft lustrous coat and healthy skin not only is marker for overall well-being of any animal but also has an aesthetic value. The present study reviews prevalence and clinico-pathology of inflammatory skin infections of canines in Mumbai region. Out of 50 cases, 38 dogs were presented with inflammatory lesion. Out of these, highest occurrence observed was that of fungal dermatitis (15/38) followed by bacterial dermatitis (12/38), Malassezia (06/38) and demodicosis (05/38). Non-descript breed was most commonly affected. Highest occurrence was noticed in dogs under the age of 3 years. Male dogs were found to be overrepresented. Cytological examination revealed corneocytes, squamous cells, fungal hyphae, intracellular cocci bacteria, demodex mites, malassezia yeast and inflammatory cells. Histopathology revealed mainly acanthosis, parakeratosis, spongiosis and inflammatory cell infiltration.

Maintenance of Remission after Oral Metronidazole Add-on Therapy in Rosacea Treatment: A Retrospective, Comparative Study.

Rosacea is a chronic inflammatory disease which requires treatment to maintain remission. Recently, the effect of Demodex mites in recurrence of rosacea has been described. Although there is limited data, previous reports have suggested that oral metronidazole demonstrated efficacy in treatment of rosacea. Fifty-eight Korean patients with rosacea who received treatment with oral minocycline (50 mg twice daily) only or with two-week of oral metronidazole (250 mg thrice daily) were evaluated retrospectively. Their responses were evaluated by Investigator's Global Assessment (IGA), Clinician's Erythema Assessment (CEA), and patient's Global Assessment. The recurrence rate and odds ratio of risk factors for recurrence were also estimated. The combination treatment group reported earlier clinical improvement and lower mean IGA and CEA than the monotherapy group. Approximately 48% of patients with combination treatment did not show relapse within 24 weeks, which is significantly higher than that in the monotherapy group (p=0.042). Add-on therapy of oral metronidazole appeared to be a significant protective factor for recurrence of rosacea (p<0.05). This study suggests that oral metronidazole can be added to oral minocycline to reduce relapses in rosacea patients with tolerable safety.

Effect of ocular demodicosis on the stability of the tear film and the tear break up time

The aim of the study was to analyze the correlation between the presence of Demodex mites in the hair follicles of patients' eyelashes and the stability and break up time of the tear film assessed with the Non-Invasive Tear Break Up Times (NIBUT) method. 319 patients were included in the study (195 women, 124 men). The patients were divided into two groups: those with Demodex infestation and without visible symptoms of eyelid or eye surface diseases, and asymptomatic non-infested patients. The NIBUT analysis was performed with a 5 M keratograph (oculus). Non-invasive tests were performed to identify the first and mean values of the tear break up time. The first and mean tear break up time in the Demodex-infested group was lower than in the non-infested subjects. The difference was a highly statistically significant. There was a significant correlation with the age of the patients for the first break up time. The first break up time in both eyes decreased with the age of the Demodex-infested and non-infested patients. The NIBUT analyses indicate the impact of Demodex mites on the tear film stability. This may suggest possible association of demodicosis with dry eye syndrome.

A Survey of Human Face Mites Demodex (Acari, Demodicidae) in Patients with Dermatological Symptoms in Baghdad, Iraq

Demodex spp. mites are external obligate parasites; they are transmitted between hosts through direct contact, and may induce several dermatological symptoms when found in large numbers. However, these symptoms may be similar to other commonly known diseases; this often leads dermatologists to neglect the pathogenic role of these mites. Therefore, a better diagnosis is recommended in order to avoid mistreatment. The aim of this study was to investigate the correlation between Demodex mites and dermatological diseases. Infestation rates in patients suffering from acne, rosacea, folliculitis, and psoriasis were compared with asymptomatic patients, along with the mites’ relation to gender, age, personal hygiene, time of year, and residency. These mites were mainly found in patients with rosacea (66.67%) followed by acne (64.41%), while they were only observed in 48.15% of asymptomatic patients, 40.00% in folliculitis, and 0.00% in psoriasis. The statistical analysis showed a significant relationship between infestation and the previously mentioned dermatological diseases (P&lt;0.01). The infestation rates increased significantly with age, reaching 83.33% in patients above 60 years old, and especially during cold months with higher humidity rates. These mites were also more predominantly found in urban areas (56.10%), followed by rural areas (48.45%). However, there was no significant relationship according to gender or personal hygiene.

Persistent Facial and Chest Papular and Pustular Eruption in a Stem Cell Transplant Patient.

Demodex folliculitis is a condition caused by inflammation of the pilosebaceous unit due to the Demodex folliculorum mite.1 The mite is a normal inhabitant of the human hair follicle and though they have been found in all areas of human skin, they predominate on the face. The face, with a high density of active sebaceous glands is a desirable home for demodex mites who feed on exfoliated epidermal cells and sebaceous gland secretions. The eruption of demodex folliculitis can mimic many common skin pathologies such as rosacea, acne vulgaris, and bacterial folliculitis.2 When demodex folliculitis occurs with immunocompromised patients, the clinical presentation can be atypical and severe.3 Herein, we report a case of severe demodex folliculitis and review of the literature.

Clinical characteristics of Demodex-associated recurrent hordeola: an observational, comparative study

Our study evaluated the association between Demodex infestation and recurrent hordeola and examined the clinical features associated with these eyelid lesions. This was an observational, comparative study. We reviewed 250 patients and divided them into the recurrent hordeolum (n = 153) and control (n = 97) groups. Demodex infestation was detected by epilating eyelashes around the lesion/s and viewing them under a light microscope. Patient medical records and photographs were retrospectively analyzed to identify the clinical characteristics of Demodex-associated recurrent hordeola. Demodex was detected in 91 (59.5%) and 17 (17.5%) patients in the recurrent hordeolum and control groups (p < 0.001), respectively. In the recurrent hordeolum group, Demodex mites were found in 74 (68.5%) and 17 (37.8%) of the adult and pediatric patients (p < 0.001), respectively. Among patients with recurrent hordeola, patients in their 20s were most likely to have concomitant Demodex infestation. Patients with Demodex infestations were also more likely to develop recurrent lesions within a shorter period of time from the primary incision and curettage. The most common presentation of Demodex-associated recurrent lesions was external hordeola (67%) (p = 0.002). Demodex infestation may cause recurrent hordeola in adults and children. These mites may play a greater role in the development of lesions in adult patients. The strongest association between Demodex infestation and recurrent lesions was seen in patients in their 20s. Our results suggest that if the hordeola recur within a short period of time with the clinical characteristics of external location of eyelid, multiple numbers of lesions, or anterior blepharitis, eyelash epilation should be performed to identify the presence of Demodex mites.

Mast Cell Stabilizers in the Treatment of Rosacea: A Review of Existing and Emerging Therapies.

Rosacea is a chronic inflammatory skin disease characterized by centrofacial erythema, papules, pustules, and telangiectasias. The onset of rosacea typically occurs after 30 years of age. It is estimated that approximately 2–5% of adults worldwide are affected. While the exact etiology of rosacea remains unknown, its pathogenesis is thought to be multifactorial with both environmental and genetic factors implicated. Ultraviolet radiation, heat, steam, ingested agents, including spicy foods and alcohol, host vasculature, dermal matrix degeneration, genetic susceptibility, and microbial organisms, including Demodex mites and Heliobacter pylori, have been implicated in the development of rosacea. Recently, mast cells (MCs) have emerged as key players in the pathogenesis of rosacea through the release of pro-inflammatory cytokines, chemokines, proteases, and antimicrobial peptides leading to cutaneous vasodilation, angiogenesis, and tissue fibrosis. Several existing and emerging topical, oral, and injectable therapeutics have been associated with improvement of rosacea symptoms based on their ability to stabilize and downregulate activated MCs. Herein, we review the data implicating MCs in the pathogenesis of rosacea and discuss interventions that may stabilize this pathway.

A clinical study on the correlation between demodex infestation and ocular surface changes in patients with meibomian gland dysfunction.

Purpose:To observe the effect of demodex infection on the ocular surface changes of patients with meibomian gland dysfunction (MGD) and analyze the correlation between the number of demodex and the changes of the ocular surface.Methods:Hundred patients with MGD aged 18–70 years who visited the dry eye center of Shanghai Aier Eye Hospital were recruited. All patients were examined with in vivo confocal microscopy to quantify the demodex and divided them into two groups (demodex negative group and demodex positive group) according to the number of demodex mites. The subjects underwent questionnaires of ocular surface disease index (OSDI) and a series of examinations. Parameters including the OSDI score, fluorescein tear film break-up time (FBUT), meibum quality, meibum gland expressibility, meibomian gland dropout (MG dropout), and ocular redness were recorded and compared between the two groups. The correlation between the number of demodex and the ocular surface changes was further analyzed.Results:Among 100 patients, 51 were positive for demodex. The demodex-positive group showed significantly increased scores of OSDI (24.41 ± 3.43 vs 20.98 ± 2.31, P = 0.00), ocular redness score (1.38 ± 0.46 vs 1.00 ± 0.30, P = 0.00), and MG dropout (3.00 ± 1.13 vs 2.18 ± 0.64, P = 0.00) and decreased FBUT (6.40 ± 1.63 vs 6.54 ± 1.83, P = 0.00), compared to the demodex-negative group. A significant correlation was noted between the number of demodex and OSDI, ocular redness, and FBUT.Conclusion:Ocular demodex infestation might play a role in the ocular surface discomfort, inflammation, and meibomian gland dropout in MGD patients. It is necessary to pay attention to the examination and treatment of demodex mite in patients with MGD.

Evaluation of the sexual and age structure of infestation by the &lt;i&gt;Demodex&lt;/i&gt; mite and percentage of complications of acne-related dermatoses with secondary demodicosis, depending on their severity

Background. The article provides a detailed review of the etiopathogenetic, clinical and diagnostic aspects of demodectic skin of the face, considers the modern classification of this pathological condition, provides statistical data on the sex and age structure of population invasion by a tick of the genus Demodex, as well as the percentage of complications with secondary demodicosis of acneform dermatoses (rosacea and perioral dermatitis).&#x0D; Aim. To reveal the percentage of complications of the course of acneform dermatoses (perioral dermatitis and rosacea) with demodicosis, depending on the severity of the underlying disease, as well as the sex and age structure of the invasion among the patients of the study group.&#x0D; Materials and methods. In our own study, we assessed the sex and age structure of the Demodex mite infestation and the percentage of complications of rosacea and perioral dermatitis with secondary demodicosis, depending on their severity. The severity of clinical manifestations of rosacea was assessed using the rosacea diagnostic assessment scale; the PODSI index was used for perioral dermatitis. Before the start of the course of therapy and after its completion, all patients underwent a microscopic examination of scrapings from the skin of the face in order to detect a diagnostically significant number of individuals of the Demodex genus tick (5 or more). If a tick was found in scrapings, along with standard therapy drugs, patients were locally prescribed 1% ivermectin cream once a day for a course of 2 to 4 months, depending on the severity of the clinical manifestations of dermatosis.&#x0D; Results. It was found that the incidence of Demodex invasion in the study group increased in direct proportion to the severity of the clinical manifestations of dermatoses and the age of the patients. It was also found that among the patients of the study group, demodicosis was registered in women almost twice as often as in men. Topical use of 1% ivermectin cream has shown a high profile of the efficacy and safety of this drug.&#x0D; Conclusion. After the completing the treatment course, complete elimination of Demodex, confirmed by laboratory, was achieved in 100% of patients with demodicosis in the study group. There were no adverse events or side effects while taking the drug.

The Effectiveness of Topical Tea Tree Oil (Terpinen-4-Ol) in Human Demodicosis: A Literature Review

Demodecosis is a skin disorder caused by parasites with the demodicosis type. The primary cause of this condition in humans is two kinds of Demodex mites, D.folliculorum and D.brevis. Demodicosis are usually treated with TTO, but the effectiveness is not well documented. To evaluate the effects of topical Tea Tree Oil on demodicosis infestation in people. We use the following string in Google Scholar; PubMed; Science Directs with keywords (“Demodicosis”iORi“demodex”iORD.folliculorumiORiiD.Brevis) ANDi (TTOiORiT4OiOR tea tree oil). The articles compatible with the restriction criteria then screened using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) method. The quality of the articles is tested using GRADE method. A total of 4 of 1949 articles recorded according to the inclusion criteria, all three articles were randomized clinical trials. 351 patients were treated with topical Tea Tree Oil (TTO) scrub with eyelash shampoo, the most common ocular symtomps is ocular dryness. The treatment is provided on a scale 18 to 35 years of age, topical TTO scrub with consentrated persentation 5-50% with eyelash shampoo was at twice-daily treament for 4 weeks. No serious side effect. Topical administration of Tea Tree Oil has shown a reduction in human demodicosis.