Clinical picture, diagnosis and treatment of rosacea, complicated by Demodex mites. Dermatol Reports. 2019 Jan 23;11(1):7675 Authors: Kubanov A, Gallyamova Y, Kravchenko A Abstract The article analyzes the clinical picture and course of rosacea in patients with Demodex mites. It presents the advantages of using the method of confocal laser scanning microscopy over the method of light microscopy of facial skin scrapes. The aimes were to study the influence of Demodex mites on the clinical picture and course of rosacea; to compare laboratory and instrumental diagnostic methods for detecting Demodex mites; to evaluate the effectiveness of external therapy aimed at eliminating Demodex mites. 212 people were examined. The study included healthy patients, patients with a diagnosis of rosacea with the presence and absence of Demodex. The presence of Demodex mites was confirmed by two methods of study (light microscopy of skin scrapes and confocal laser scanning in vivo microscopy). Demodex mites promote the development of acute-inflammatory morphological elements, increase the duration of the condition (more than 5 years, P<0.01) and the probability of recurrence (from 1 to 3 relapses in 39.5% of patients, P<0.05), resulting in a decrease in the quality of life of patients (dermatology life quality index is 12.5±4.5, P<0.05). Antiparasitic drug ivermectin, in the form of an external form, at a concentration of 1% has a high therapeutic efficacy (in 93.3% of cases). Demodex folliculorum shows signs of parasitism, while Demodex folliculorum brevis is a saprophyte. The severity of the condition does not depend on the quantitative load of the mites in the scrape. As an antiparasitic drug, it is recommended to use 1% ivertmectin. PMID: 31007879 [PubMed] {url} = URL to article URL to Review and to full article

The Russian Ministry of Health conducted a detailed study of demodex mites and rosacea on 212 men and women which is illuminating and confirms the effectiveness of using 1% ivermectin in treating rosacea is just as effective as using metronidazole combined therapy. Further, some new information about detecting a demodex mite density count is revealed that is significant news. While the paper is difficult to read, probably due to the translation, here are some of the jewels found in the report:  (1) Light Microscopy Skin Scraping Not Reliable According to the report,  if you use a skin scraping with a light microscope, there may be no reliable data on demodex density counts, which says, "The severity of the condition does not depend on the quantitative load of the mites in the scrape." The report states that "in the light microscopy of scrapes of Demodex mites in the number of 5 individuals per 1 cm2, only 6 healthy persons (n=6; 2.8%); in the remaining 66 healthy people (31.2%), the light microscopy of the scrapes was negative." "As a result of the study, we found that it is difficult to detect the mite by light microscopy of scrape per 1 cm2 of skin." However when using a 'Confocal laser scanning in vivo microscopy', there is a significantly more reliable data to count on, which this same report concludes, "Confocal laser scanning in vivo microscopy is an effective diagnostic method to detect Demodex mites that does not require preliminary preparation for analysis and allows detecting Demodex mites at the level of the spiky epidermis layer, which is not accessible for scarification, to identify the species belonging to the size of Demodex mites (from 100 up to 200 μm - Demodex brevis, 200 to 400 μm – Demodex folliculorum)." "Comparing the results obtained by light microscopy and confocal laser scanning in vivo microscopy in patients with rosacea and healthy people, in more cases Demodex mites are detected by confocal laser scanning in vivo microscopy, whereas scrape in these patients were negative." (2) The report confirms the size and movement of demodex  "Using a confocal laser scanning in vivo microscope allowed determining the average size of Demodex mites. When determining the size of mites from 100 to 200 μm, it was believed that in this case Demodex brevis was observed, while the average length of the mite was 125 μm; from 200 to 400 μm – Demodex folliculorum with an average length of 293 μm. The average size of the width of Demodex mites was 24 μm." More information on the size of demodex. "In the examination of healthy people by light microscopy, Demodex mites were detected in 6 cases (2.8%). Given the ability of the mites to move over the surface of the skin at a speed of 8-16 mm/h, as well as random selection of the study site, this fact does not prove the absence of mites." The method of scattered light intensity (SLI) is used as a new quantitative method of evaluating the viability of Demodex mites.  (3) Topical 1% Ivermectin Just as Effective as Metronidazole "Antiparasitic drug ivermectin, in the form of an external form (cream), at a concentration of 1% (1 time per day, the general course of 30 days) has a high therapeutic efficacy in patients with associated with Demodex mites (in 93.3% of cases). The effectiveness of external therapy with a drug containing 1% ivermectin (course of 30 days) is comparable to the combined treatment with the systemic drug metronidazole 250 mg per os 2 times a day and the external application of 1% metronidazole (gel) 1 time per day for 30 days." "Thus, clinical observations demonstrated a lack of superiority in combined antiparasitic therapy using a systemic drug compared to external therapy using a preparation containing 1% ivertmectin as a cream, as confirmed by statistical analysis. Stein et al. showed that after 12 weeks of ivermectin treatment, the skin of patients was defined as clean or almost clean. There was a significant reduction in the percentage of inflammatory lesions in the ivermectin treatment group. The results of the study showed that 1% ivermectin is an effective and safe treatment for inflammatory lesions in patients with rosacea." (4) No Demodex Mites Detected in Some Patients This paper reveals that in some humans there are no demodex detected. The report states, "the fact that in 55-100% of cases, mites are detected, both in patients with face dermatosis and with patients having no clinical signs of dermatological illnesses......II group is a comparison group, which was composed of patients with a diagnosis of rosacea with no Demodex mites. In Group II patients, two methods of study of Demodex mites were not found." What this means is the second comparison group demodex mites were not detected by two methods, light microscope by skin scraping and Confocal laser scanning in vivo microscopy. The study concluded that those in group two had no demodex mites. If this is true, then this is illuminating and definitely  news since most literature says demodex mites are on all humans except new born babies.  "In 80 patients with rosacea (37.8%) with Demodex mites were detected in an amount of less than 5 individuals per 1 cm2 or were absent altogether with a developed clinical picture of the condition." However, because of the ability of the mites to move, the report adds this caution:  "In the examination of healthy people by light microscopy, Demodex mites were detected in 6 cases (2.8%). Given the ability of the mites to move over the surface of the skin at a speed of 8-16 mm/h, as well as random selection of the study site, this fact does not prove the absence of mites." (5) Role of Demodex on Humans "Demodex folliculorum shows signs of parasitism, while Demodex folliculorum brevis is a saprophyte." Most papers state that the role of demodex is not known. This is illuminating and definitely news.  (6) Demodex Mites are Significantly Higher in Rosacea "Our findings confirm the hypothesis of Turgut Erdemir et al., that the Demodex mites affect the severity of the disease and contribute to the progression of the pathological process. In addition, the authors have proved that the density of mites increases depending on the severity of the disease." "The detection of Demodex mites is not only statistically more significant in patients with rosacea than in the rest of the population, but also as can be seen from the Table 2, Demodex mites were more often found in patients with more severe clinical forms of rosacea (pustulous, infiltrative- productive forms)." (7) Demodex brevis not as significant as Demodex Folliculorum "In patients with severe manifestations of the condition (pustulous and infiltrative- productive forms of rosacea), the species of the mites Demodex folliculorum (P<0.01) is more often detected. Demodex brevis is found in mild forms of the condition and in healthy people, without showing signs of parasitism." "When Demodex brevis is found, given its weak possibility of parasitism, treatment with antiparasitic drugs is not indicated." (8) After 30 days of Ivermectin Treatment there is an INCREASE of demodex mites "Patients enrolled in subgroup A received only external therapy with a drug containing 1% ivermectin in the form of a cream 1 time per day for 30 days. Patients enrolled in subgroup B received a drug containing 250 mg of metronidazole systemically 2 times a day, externally 1% metronidazole in the form of a gel 1 time per day for 30 days. A repeat visit of the patients took place after 30 days of continuous therapy. Subjectively, treatment regimens of patients were well tolerated, no side effects were noted, no patient was excluded from the study. When comparing the efficacy of the therapy, it was found that statistically significantly more Demodex mites were found after treatment with confocal laser scanning in vivo microscopy (P≤0.05) (Table 7).  The above is significant news. However, the patients nevertheless improved their rosacea in 30 days and the report concluded:  "Analysis of the clinical picture showed a positive dynamics of therapy, which manifested itself in a significant decrease in the number of morphological elements characterizing the severity of inflammation (P≤0.05). The effectiveness of the therapy was confirmed by a reduction in subjective complaints of patients after the treatment, and patients who received only external therapy had no complaints of a feeling of lusters of skin and the appearance of greasy lusters, which is an additional advantage." You can read the entire Russian paper yourself here:  Dermatol Reports. 2019 Jan 23; 11(1): 7675.Clinical picture, diagnosis and treatment of rosacea, complicated by Demodex mitesAlexey Kubanov, Yuliya Gallyamova, and Anzhela Kravchenko

The gold standard treatment for rosacea includes Soolantra (1% ivermectin) along with Oracea. Learn more. 

Nanoemulsion strategy of pioglitazone for the treatment of skin inflammatory diseases. Nanomedicine. 2019 Apr 17;: Authors: Espinoza LC, Silva-Abreu M, Calpena AC, Rodríguez-Lagunas MJ, Fábrega MJ, Garduño-Ramírez ML, Clares B Abstract Pioglitazone (PGZ) is a peroxisome proliferator-activated receptor agonist. Its role in the inflammatory response modulation opens the door for additional therapeutic applications. The purpose of this study was to develop a pioglitazone nanoemulsion (PGZ-NE) to investigate its anti-inflammatory efficacy on the skin. For that a NE vehicle aimed for skin delivery was optimized and characterized. The resulting PGZ-NE showed a good anti-inflammatory efficacy by decreasing the expression of adipose inflammatory cytokines IL-6, IL-1β and TNF-α. The properties of the developed nanocarrier allowed achieving a high permeation flux of PGZ through the skin as well as high retained amount in the skin, probably due to the depot effect of ingredients, which assured a prolonged local action, with good skin tolerability among participating individuals. Consequently, these results suggest that PGZ-NE may be used as an alternative treatment for inflammatory skin diseases such as rosacea, atopic dermatitis or psoriasis. PMID: 31004811 [PubMed - as supplied by publisher] {url} = URL to article

Related Articles Evaluation of Demodex mite viability using motility and scattered light intensity. Exp Appl Acarol. 2019 Apr 19;: Authors: Gatault S, Foley R, Shiels L, Powell FC Abstract Demodex mites have been suggested to have a role in various cutaneous and ocular disorders pathogenesis, such as rosacea or blepharitis. Evaluation of potential treatments with anti-Demodex effects is difficult because the viability of living mites needs to be evaluated during their exposure to the agent being tested. Mite viability is currently based solely on their observed movement. However, this method of assessing viability has significant limitations as mites may be resting, immobile or paralysed at any given observation point giving the observer a false impression of the organism's death. To overcome this limitation we evaluated a new quantitative method of evaluating the viability of Demodex mites by using scattered light intensity (SLI). We demonstrated that when combined with observation of mite motility, SLI provided increased accuracy of the evaluation of viability of mites being studied. This new viability assay will help address the technical challenges of mite viability experiments. Accurate evaluation of mite viability will enhance mite biology research and allow for more accurate in vitro toxicity assays of proposed anti-mite agents. PMID: 31001698 [PubMed - as supplied by publisher] {url} = URL to article

Nonvascular uses of pulsed dye laser in clinical dermatology. J Cosmet Dermatol. 2019 Apr 19;: Authors: Forbat E, Al-Niaimi F Abstract Lasers are fast becoming the vogue of dermatology ranging from ablative, nonablative, fractional photothermolysis to vascular lasers. There are a range of vascular lasers including potassium titanyl phosphate (KTP 532 nm), pulsed dye laser (PDL -595 nm), diode (810 nm), and Nd:YAG (1064 nm). PDL is a laser that emits yellow light using Rhodamine dye as it is lasing medium. Typical vascular lesions which are treated by PDL include port wine stain, hemangioma, telangiectasia, spider angioma, and rosacea. This article focuses on the use of PDL beyond primary vascular conditions. We review the evidence, or lack thereof, of the use of PDL in acne vulgaris, scars, striae, warts, molluscum, psoriasis, rejuvenation, basal cell carcinoma (BCC), and miscellaneous dermatological sequelae. PMID: 31002479 [PubMed - as supplied by publisher] {url} = URL to article