Standardized Skin Surface Biopsy Research Articles

Demodex folliculorum (Trombidiformes: Demodecidae) infestation in medical students with facial dermatoses and healthy groups.

Demodex folliculorum (Simon, 1842) has been associated with various dermatological conditions. This study aimed to assess the prevalence of Demodex infestation in medical students with facial dermatoses compared with healthy medical students serving as controls. A total of 250 participants were enrolled, including 150 individuals with facial dermatoses and 100 healthy controls. Sampling was performed based on the standardized skin surface biopsy method. Demographic characteristics, specifically gender and age, were not statistically different between the patient and control groups. Among the facial dermatosis patients, 25 out of 150 (16.6%) were found to have Demodex infestation, while only three out of the 100 healthy controls (3%) exhibited infestations. The only identified species was D. folliculorum. The rates of Demodex infestation were significantly higher in the patients compared to the control groups. These findings indicate a higher prevalence of Demodex infestation among medical students with facial dermatosis, particularly in those diagnosed with folliculitis, acne vulgaris, and inflammatory papule, when compared to healthy controls. A better understanding of the relationship between D. folliculorum infestation and these dermatological conditions may lead to improved diagnostic and treatment strategies in the future.

Evaluation of Demodex mite in chronic urticaria

Objective: Determining the possible role of Demodex mites in patients with chronic urticaria Methods: Demodex screening results in 49 patients with chronic urticaria were evaluated retrospectively. Results: The mean number of Demodex mites per 1 cm2 measured with standardized skin-surface biopsy (SSSB) was 0.89 which was at a similar level as control groups in the literature. Conclusion: Demodex mites seemed not to play a role in patients with chronic urticaria who had no facial eruptions. Patients with skin eruptions with the possible contribution of Demodex as rosacea could be investigated for chronic urticaria in other studies.

Biologic therapy increases Demodex density in psoriasis patients.

Demodex density is known to increase in various immunosuppressive conditions. The relationship between biologic therapy and Demodex density remains unknown. We aimed to investigate whether the density of Demodex mites is higher in psoriasis patients treated with biologic agents compared to treatment-naive or topically treated patients. A cross-sectional study was conducted, comparing psoriasis patients receiving biologic therapy (n = 34) with controls (n = 33). Demodex density was assessed using the standardized skin surface biopsy technique (SSSB). Statistical analysis was performed to compare the densities and prevalence of demodicosis between the two groups. Demodex density was significantly higher in the biologic therapy group compared to the control group on the right cheek (7.29 vs. 0.12/cm2; P = 0.001), left cheek (8.15 vs. 0.24/cm2; P = 0.002), and whole face (average of all four regions: 5.50 vs. 0.80/cm2; P = 0.001). The prevalence of demodicosis was significantly higher in the biologic therapy group on the forehead (35.3% vs. 12.1%; P = 0.043), right cheek (41.2% vs. 0%; P < 0.001), and left cheek (44.1% vs. 0%; P < 0.001). The frequency of cases with demodicosis in at least one localization was higher in the biological therapy group compared to the control group (61.8% vs. 15.2%; P < 0.001). Psoriasis patients receiving biologic therapy had a higher Demodex density and prevalence of demodicosis compared to controls. Biologics may lead to an increase in Demodex density by blocking specific cytokines, such as interleukin-17 and tumor necrosis factor-α, which play a role in immunity against Demodex. Further research is needed to explore the impact of different biological agents on Demodex density.

The effect of phototherapy on Demodex density: acase-control study.

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.

Has the Use of the Mask Exacerbated Rosacea During the Pandemic?

During the COVID-19 pandemic, personal protective equipment, particularly face masks, became an essential requirement to engage in various activities. Several articles reported an increase of recurrences of dermatologic facial diseases (ie, acne, rosacea) related to mask use. To evaluate the number of recurrences of rosacea related to face mask use. This prospective study was conducted on adult patients with a pre-pandemic diagnosis of mild and moderate papulopustular rosacea. All patients had previously achieved either partial or complete remission after a 4-month treatment with topical ivermectin in 2019. We collected data in two different phases characterized by different intensity of mask use during the pandemic and post-pandemic period. We collected data through clinical assessment of the disease, questionnaires on personal habits and standardized skin surface biopsy to study the Demodex mites count. We enrolled a total of 30 patients. In the pandemic period, 5/30 patients had a relapse of mild papulopustular rosacea; the Demodex sample resulted positive in 4/5 relapsed patients. In the post-pandemic period, 4/30 patients reported a relapse of mild rosacea (3 patients) and moderate papulopustular rosacea (1 patient). At the Demodex exam, 1/4 relapsed patients resulted positive. We did not find a significant increase in relapses of papulopustular rosacea during the pandemic. An appropriate anti-parasitic treatment may reduce the number of recurrences due to mask use.

Characteristics of Biofilm-Forming Ability and Antibiotic Resistance of Cutibacterium acnes and Staphylococcus epidermidis from Acne Vulgaris Patients.

Acne vulgaris (AV) is a common and chronic disorder of the pilosebaceous unit and has a multifactorial pathology, including activities of Cutibacterium acnes (C. acnes) and Staphylococcus epidermidis (S. epidermidis). Antibiotic resistance has become a major concern in dermatology daily practice, and the ability of biofilm formation by both bacteria is suggested to increase antibiotic resistance in acne. Our aim was to analyze the comparison of antibiotic resistance between biofilm-forming (BF) and non-biofilm-forming (NBF) strains of C. acnes and S. epidermidis towards seven antibiotics commonly used for acne. This is a cross-sectional analytical study involving 60 patients with AV. Samples were obtained from closed comedones on the forehead using the standardized skin surface biopsy (SSSB) method at the Cosmetic Dermatology Clinic Dr. Hasan Sadikin in Bandung, Indonesia. Isolates were cultured and identified before undergoing the biofilm-forming test using the tissue culture plate method. Antibiotic susceptibility testing for each antibiotic was then performed using the disc diffusion method. The incidence of antibiotic resistance to clindamycin in BF and NBF C. acnes isolates was 54.5% (p=1.00), while in BF and NBF S. epidermidis isolates, it was 54.5% and 45.5% respectively (p=0.67). The incidence of antibiotic resistance to erythromycin and azithromycin in BF and NBF C. acnes isolates was 54.5% and 63.6% respectively (p=1.00), whereas for S. epidermidis BF and NBF isolates, it was 54.5% (p=1.00). There was no resistance observed to tetracycline, doxycycline, levofloxacin, and cotrimoxazole in all groups. There were no significant differences in resistance against seven antibiotics between the C. acnes and S. epidermidis in BF and NBF groups. Furthermore, although statistically not significant, some resistances were observed against clindamycin, erythromycin, and azithromycin. Consequently, the use of these three antibiotics should be judiciously regulated.

The Possible Relation of Demodex and Facial Erythema in Connective Tissue Diseases.

We aimed to investigate the frequency of Demodex infestation and clinical implications in connective tissue disease patients with facial erythema. Patients diagnosed with a connective tissue disease and had facial erythema were consecutively enrolled in the study from 2019-2020. An age and gender matched control group was formed from healthy volunteers. Presence of Demodex was investigated by standardized skin surface biopsy. Number of Demodex mites over 5 per centimeter square was considered meaningful for infestation. Topical or systemic metronidazole treatment was given to the connective tissue disease patients with Demodex infestation. Facial erythema visual analog scale was questioned in patients at treatment onset and one month after. A total of 31 connective tissue disease patients with facial erythema were enrolled. Control group included 31 healthy volunteers. Demographics and comorbidities were similar between groups. Demodex infestation was present in 58.1% of the disease group and in 25.8% of the control group (P=0.01). Pruritus was the most common symptom in patients with infestation. Median (IQR) facial erythema visual analog scale score was 6 (3) at treatment onset and was 2 (2.5) one month later (P<0.001). When evaluating facial cutaneous lesions, Demodex infestation should not be overlooked in a patient group like connective tissue diseases with dysfunctional immune system.

STANDARDIZED SKIN SURFACE BIOPSY - A BETTER DIAGNOSTIC OPTION FOR DEMODICOSIS IN MACULAR ROSACEA IN VIETNAMESE PATIENTS

Introduction: Demodicidosis is a chronic skin disease, caused by two species of Demodex (D. folliculorum and D. brevis). Demodex infected individuals are mainly symptomless and may have pathogenic symptom only when mite density is high within the skin.Objectives: To compare the value of the Standardized skin surface biopsy (SSSB) and direct microscopic examination with KOH (DME) for assessing Demodex density.Methods: Fifty patients with demodicosis were determined Demodex by SSSB and DME. Comparision of the similarity of test results between the two methods was conducted by Cohen’s Kappa statistic.Results: The positive test rate of SSSB is 90.0%, of DME is 82.0%. The percentage of patients who tested positive for both methods was 76.0%, and the negative for both methods was 4.0%. Demodexdensity &gt; 5/cm2of SSSB was 47.9% higher than DME of 29.2%. There was quite similarity of Demodexdensity between SSSB and DME with coefficient kappa = 0.62. Conclusion: SSSB is more sensitive method for detecting Demodex than DME, particularly in patients with macular lesions, vasodilatation, U-shaped distribution, located on the nose and nasolabial sulcus.

Comparison of in vitro Killing Effect of Thai Herbal Essential Oils, Tea Tree Oil, and Metronidazole 0.75% versus Ivermectin 1% on Demodex folliculorum.

Abnormal proliferation of Demodex mites causes a skin disorder called demodicosis and has been linked to rosacea. The development of alternative therapy against Demodex mites is currently required. The ability to kill Demodex mites of Thai herbal essential oils has never been explored. This study aimed to study and compare the in vitro killing effect of Thai herbal essential oils, tea tree oil, and metronidazole 0.75% with ivermectin 1% on D. folliculorum. D. folliculorum mites were collected from the wastes of diagnostic standardized skin surface biopsy samples of demodicosis and rosacea patients for the trial. The microscopic evaluation started immediately after the mites were exposed to immersion oil (negative control), Thai herbal essential oils, tea tree oil, metronidazole 0.75%, and ivermectin 1% (positive control). The survival times of ten mites from each test agent were compared. The efficacy of Thai herbal essential oils and other test agents can be arranged in order as follows: lemongrass oil > sweet basil oil > clove oil > tea tree oil > lesser galangal oil > ginger oil, kaffir lime oil, peppermint oil > citronella oil > galangal oil > cajeput oil > ivermectin 1% > metronidazole 0.75%. This current study demonstrated the in vitro killing efficacy on D. folliculorum: Thai herbal essential oils, Tea tree oil > ivermectin 1% > metronidazole 0.75%. Thai herbal essential oils have the potential to be an adjuvant or alternative therapy against Demodex mites. Further in vivo studies are necessary to determine the treatment efficacy and side effects.

Papulopustular periorbital demodicosis: A diagnosis often overlooked

Demodicosis is the term given for cutaneous diseases caused by the human ectoparasitic mites Demodex folliculorum and Demodex brevis which are common commensals of the pilosebaceous units in human beings. We report a 72-year-old female who presented with erythematous papulopustular lesions over both upper and lower eyelids and a few similar lesions on the cheeks of 2 weeks duration with one similar episode in the past. A cyanoacrylate standardized skin surface biopsy showed increased mite density and the patient was successfully treated with acaricides. Demodicosis is often misdiagnosed as contact dermatitis, papulopustular rosacea, or seborrheic dermatitis. A high index of suspicion of demodicosis is needed to arrive at an accurate diagnosis.

Comparison of in vitro Killing Effect of N, N-Diethyl-Meta-Toluamide (DEET) versus Permethrin on Demodex folliculorum

BackgroundThere is no single effective treatment for demodicosis; successful treatment requires a multimodal approach. Relapse or recurrence of demodicosis is relatively high, making the therapy challenging. Several reports have documented the successful treatment of demodicosis with acaricidal agents, which aimed at reducing the excessive number of Demodex mites and improving the patients’ symptoms. Reports of irritation and resistance to topical acaricidal agents have led to the search for effective alternative treatments.Materials and MethodsA total of 100 standardized skin surface biopsy (SSSB) biopsy slides from 100 patients with demodicosis were randomly divided into five groups, each with 20 slides exposed to immersion oil, N, N-diethyl-meta-toluamide (DEET) 5%, 10%, 20%, and permethrin 1%, respectively. The microscopic evaluation started immediately after the test agents exposed the mites. The survival time (ST) was defined as the interval between the first exposure of Demodex folliculorum to the test agents to the time the movements ceased.ResultsThe differences between the median ST of DEET 5% (44 min), 10% (22 min), and 20% (14 min) were significant when compared to the negative control group (240 min) with p<0.001, <0.001, <0.001, respectively. While the median ST of permethrin 1% (42 min) was not significantly different from the median ST of DEET 5% (p=0.7395).ConclusionThis study demonstrated the dose-related acaricidal effect of DEET on D. folliculorum. The survival times of DEET 5%, 10%, and 20% were significantly shorter than the negative control (immersion oil). DEET 5% had a comparable in vitro killing effect as permethrin 1%. Further in vivo studies are necessary to determine the clinical efficacy in patients with demodicosis.

COMPARATION OF THE EFFICACY OF ORAL IVERMECTIN COMBINED TOPICAL METRONIDAZOL 1% WITH ORAL AND TOPICAL METRONIDAZOL IN THE TREATMENT OF DEMODICOSIS

Objectives: To compare the treatment outcomes of pityriasis folliculitis by combining oral ivermectin with topical metronidazol 1% and combining oral with topical metronidazol therapy.&#x0D; Method: 70 patients with pityriasis folliculitis were randomly divided into 2 groups: 35 patients in group one were treated with oral ivermectin (one dose of 200 µg/kg) and topical metronidazol 1%. 35 patients in group two were treated with oral metronidazol (doses 500 mg per day for 2 weeks) and topical metronidazol 1%. Demodex was detected by standardized skin surface biopsy. The subjects were followed-up at week 2 and 4 after the treatment.&#x0D; Result: After 2 and 4 weeks of the treatment, pruritus, red papules, red patchs and skin scabs in both groups reduced. There was no differences between the two groups regarding age, sex and duration of the condition (p&gt; 0.05). Group one had greater reductions in Demodex density than those in the group two (p &lt; 0.05). Moreover, at week 4, the group one treated with oral ivermectin and topical metronidazol, 80% had good improvement, 14.3%:moderate improvement and 5.7%: mild improvement. Meanwhile, in the group treated by combining oral and topical metronidazol, the rates were 71.4%, 22.9% and 5.7%, respectively. The outcomes of the treatment in both groups had no significant difference (p &gt; 0.05). Side effects including pruritus, burning in group one were lower than that of group two (p &lt; 0.05).&#x0D; Conclusion: There were no differences in clinical improvement in the two groups treated by two different therapies. However, the reductions of the number of Demodex in the group one were higher than those in the group two. On the other hand, the side effects in the group one were less than those in the group two

Could there be an association between Hashimoto's thyroiditis and demodex infestation?

Human demodex mites are parasites that live in the pilosebaceous unit and can result in the disease demodicosis. While demodicosis may occur as a primary skin disease; immunosuppression, and topical or systemic immunosuppressive treatments can cause secondary demodicosis. It is known that thyroid hormones may cause skin changes, such as xerosis, and thereby may also modulate immune responses in the skin. The aim of this study is to investigate whether or not that the changes occurring in the skin of patients with Hashimoto's Thyroiditis (HT) predispose to demodex infestation. Seventy-eight patients being followed for a diagnosis of HT at Kocaeli University Endocrinology Outpatient Clinic, between January 2019 and March 2020, constituted the patient group. The control group consisted of 41 patients who did not have any chronic systemic or dermatological disease and were shown to have no thyroid disease by laboratory tests. Demodex intensity in the malar regions of the patient and control groups was determined using the standardized skin surface biopsy (SSSB) method and compared with each other. HT patients were significantly more likely to have increased demodex density and suggestive SSSB results than the controls (p<0.001, p=0.012, respectively). A significant correlation was found between demodex intensity and the findings of xerosis (p=0.010, p=0.011) and spiny follicular papules (p=0.008, p=0.008) in the patient or control groups, respectively. However, a significant correlation was identified between the demodex density and the symptoms of burning-stinging (p=0.028), and feelings of dryness (p=0.018) roughness (p=0.028) only in the control group. Xerotic skin and/or impaired immune responses as a result of autoimmune changes in patients with HT may lead to secondary demodicosis.

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.&#x0D; Methods: Patients with high Dds in two consecutive standardized skin surface biopsies (SSSB1&gt;5 D/cm2 or SSSB2&gt;10 D/cm²) and concomitant clinical symptoms were evaluated retrospectively. Measurements of treatment effectiveness included clinical improvement and normalization or reducing of Dds.&#x0D; 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.&#x0D; 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.

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.

Effect of Phototherapy on Demodex Parasıte Densıty.

Demodex parasites are the most common ectoparasites in humans. One of the factors in the pathogenesis of an increase in parasite density is immunosuppression. In this prospective study, we aimed to evaluate the effect of phototherapy-induced immunosuppression on Demodex density. Thirty-five patients receiving phototherapy were included in the study. The number of parasites in the samples taken from the right cheek, left cheek, forehead, nose and chin of the patients, by standardized skin surface biopsy method, were recorded before phototherapy and in the third month of treatment. Of the 35 patients, the female-to-male ratio was found to be 2.1:1. There was no statistically significant difference between the ages of the male and female patients. The increase in the number of parasites in the right cheek, left cheek, nose and chin in the third month was statistically significant; whereas the increase in the forehead was not. The results of our study showed that phototherapy can cause an increase in Demodex density, and these findings are compatible with those of other studies in the literature. Since our study aims to evaluate density at the beginning and the end of the third month of phototherapy, it differs from other studies by indicating the effect of phototherapy more accurately.

Revisiting standardized skin surface biopsy to demonstrate Demodex mite

Revisiting standardized skin surface biopsy to demonstrate Demodex mite

The therapeutic effects in patients with rosacea: how do we evaluate them?

Rosacea is a common, chronic skin disorder with negative impacts on physical health and social function. The response to therapy plays a critical factor in determining the duration of treatment and developing new medicines. However, it is challenging to assess the efficacy due to its complicated clinical characteristics and nonspecific histopathological findings. This study aims to review the efficacy evaluation tools for rosacea. An extensive literature search was conducted using PubMed, Web of Science, and other databases for articles on efficacy evaluation methods for rosacea from 1995 to 2021. In clinical practice and scientificresearch, various methods are available for assessing the curative effect. Evaluation tools based on phenotypes are the most commonly used because they are cheap and straightforward. Various questionnaires also exist to evaluate health-related quality of life. However, the inevitable subjectivity makes it challenging to comparethecurative effect among different studies. By contrast, objective assessment tools are more precise and repeatable, such as consecutive standardized skin surface biopsies, computer-aided image analysis, and biophysical parameter assessments. No single assessment method could balance convenience and accuracy. For improving outcomes and facilitating academic exchanges, a well-validated gold standard evaluation tool is still needed. This review provides an overview of the existing efficacy evaluation methods for rosacea and discusses the relevant details.

Dermoscopy of papulopustular rosacea and comparison of dermoscopic features in patients with or without concomitant Demodex folliculorum.

The dermoscopic findings of papulopustular rosacea include tiny papules and pustules, follicular plugs and follicular dilatation. Demodex tails and Demodex follicular openings are dermoscopic indicators that are mainly found in primary demodicosis and, less frequently, in rosacea. To describe the dermoscopic features of papulopustular rosacea and to investigate the differential dermoscopic features between patients with and without concomitant Demodex infestation. We conducted a prospective study of patients with almost-clear, mild or moderate papulopustular rosacea. For each patient, dermoscopic images were taken and a standardized skin surface biopsy was performed. In this group of 60 patients, the most frequent dermoscopic findings were yellow dots, vascular polygons and follicular scales. Patients with moderate rosacea had more Demodex follicular openings compared with patients with mild rosacea (P = 0.02), while patients with mild rosacea had a higher frequency of follicular scales than did patients with almost-clear rosacea (P = 0.01). Patients with moderate rosacea had higher rates of Demodex follicular openings (P = 0.02), follicular scales (P < 0.001), follicular annular pigmentation (P = 0.001) and follicular pustules (P < 0.001) compared with patients with almost-clear rosacea. No significant dermoscopic differences were observed between patients with and without concomitant Demodex infestation. Papulopustular rosacea has specific dermoscopic findings. In our opinion, dermoscopy is not sufficient by itself for the diagnosis of Demodex proliferation in rosacea.

Demodex infestation as a cause of sensitive skin in a dermatology outpatient clinic.

Sensitive skin is subjective cutaneous hyperreactivity to environmental factors. Demodicosis is a skin disorder caused by Demodex mites. There may be a link between demodicosis and sensitive skin. This study aimed to examine facial Demodex mites density and other factors associated with sensitive skin in patients. A total of 349 randomly selected patients presented to the dermatology department. The research data were collected using a questionnaire form that included the participants' sociodemographic and lifestyle characteristics, a sensitive skin questionnaire, the Dermatology Life Quality Index (DLQI), and European Health Interview Survey (EHIS). Patients underwent standardized superficial skin surface biopsy of 4 areas of the face. D.folliculorum count greater than 5mites/cm2 was considered positive. In relation to Demodex, there was an increase in skin sensitivity with higher Demodex density (p=0.04). There was a statistically significant, weak positive correlation between skin sensitivity and DLQI score (r=0.33, p=0.00), and there was also a significant but very weak negative correlation between skin sensitivity and EUROHIS (r=-0.164, p=0.002). Skin sensitivity was more common in patients with a concomitant dermatological disease (p=0.01) and increased with more frequent cosmetic use (p=0.00). Alongside other risk factors, for the patients presenting with complaints of sensitive skin, investigating Demodex population density may help alleviate sensitive skin symptoms with appropriate therapies and preventive measures.