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  • Demodectic Rosacea

    Demodectic Rosacea is a rosacea variant, just as valid a variant as Granulomatous Rosacea.

    Image of Demodex Folliculorum courtesy of National Geographic Image [1]

    The RRDi is the only non profit organization for rosacea that has officially recognized Demodectic Rosacea as a variant of rosacea. "Recently human primary demodicosis has been recognized as a primary disease sui generis and a clinical classification has been proposed. A secondary form of human demodicosis is mainly associated with systemic or local immunosuppression." [2] This is referring to a paper published in 2014 "to classify human demodicosis into a primary form and a secondary form." [3] While acknowledging the work of Dr. Chen and Dr. Plewig, whether you refer to demodicosis or demodectic rosacea we are referring to the same condition. The term 'demodectic rosacea' was coined by Dr. Plewig in an email to the RRDi on March 2, 2007 where Dr. Plewig wrote, "Concerning your questiones, demodicosis can be a disease by itself and thus being independent of rosacea. Or demodex mites heavily colonize pre-existing rosacea and thus lead to demodectic rosacea ( rosaceiform dermatosis). This is a rather complicated issue. Rosacea is usually diagnosed by inspection [of] the eye. Laboratory tests are rarely needed, for instance in gram-negative rosacea, where one needs bacteriology. The same is true for demodectic rosacea, where one has to demonstrate the mites in great numbers." [4] 

    Current concepts on rosacea is a video presentation by the Charles Institute of Dermatology, University College Dublin with Frank Powell, MD who interviews Fabienne Fortan, MD, Université libre de Bruxelles, Belgium explaining the latest information on demodectic rosacea:

    Demodetic Rosacea has a long history of controversy which continues to this day. For example, note the following quote:
    "From these and other statements it is seen that in suggesting the thought that these minute forms of life are etiological factors in even some of the phases of acneform diseases, I shall be but little in accord with the highest authorities. In antagonism to these views, I may say that the results of my observations appear to indicate a close relationship of the parasites with the diseased condition."
    Demodex Folliculorum in Diseased Conditions of the Human Face
    Proceedings of the American Society of Microscopists, Vol. 8, 1886, page 123, Published by: Wiley-Blackwell

    For a comprehensive article on demodectic rosacea and why it is considered a rosacea variant click here.

    Dr. Leyda Bowes discusses demodectic rosacea (demodicosis) in this short video: 

     

    If your dermatologist dismisses demodectic rosacea you might refer him to this page, the Demodex Mite Videos available for viewing as well as this comprehensive article and comprehensive list of medical papers on this subject

    End Notes

    [1] Image of Demodex Folliculorum courtesy of National Geographic - by Darlyne A. Murawski

    [2] Iran J Parasitol. 2017 Jan-Mar; 12(1): 12–21.
    PMCID: PMC5522688
    Human Permanent Ectoparasites; Recent Advances on Biology and Clinical Significance of Demodex Mites: Narrative Review Article
    Dorota LITWIN,  WenChieh CHEN, Ewa DZIKA, and Joanna KORYCIŃSKA

    [3] Br J Dermatol. 2014 Jun;170(6):1219-25. doi: 10.1111/bjd.12850.
    Human demodicosis: revisit and a proposed classification.
    Chen W, Plewig G.

    [4] Read end note 7 in the article, Demodectic Rosacea [Variant]



  • Posts

    • Rod102988 reports, "A year ago this time I was diagnosed with Rosacea due to heavy drinking and long bouts in the sun. I was devastated, depressed and embarrassed. I quit several jobs, tried makeup, turmeric, eating healthy, water etc. You know name it. I spent hundreds on products for up to a year. I even tried Finacea which while it helped the bumps not so much with the redness plus my insurance didn't cover it and it cost $330 a tube. Finally, I did tons of research online and found two products which I use in combination and they only cost a combined $80 on Amazon.  1) La roche Posay Rosaliac AR Intense. It's a visible redness reducing serum made by scientists in France. It's light and has no smell. You apply twice a day after washing.  2) GIGI Bioplasma Azaleic Acid 15 percent cream. This stuff is better than Finacea IMO and much much cheaper. It tackles all the same things as Finacea; redness, blemishes, acne and hyperpigmenation. Now what I do is usually is place both on at the same time but always one significantly less than the other....only on the problems spots. For example, a full dot full of one and miniscule dot full of the other. But, some may get irritated by that I wouldn't suggest starting off like that. In would initially alternate with one each day and then maybe alternate throughout the day. With that said, this cream and serum has worked wonders and its only costing me $80 bucks a month but I could really stretch both to a month and a half of I want to. After using these for 3 months I am amazed and these combination have been a complete and utter life saver."
    • Found this post at healthboard.com:  "My husband and I both have rosacea. We have used Metrogel daily for years and sometimes it would keep the rosacea under control and other times it would not.
      I researched home remedies and this is what has worked for both of us. We no longer have to go to the dermatologist for an Rx for Metrogel. Please note that this is NOT a cure. We do this daily and then we have no recurrence of the rosacea. When I stopped using it, the rosacea would return after a few weeks. I purchased a 12 ounce bottle of baby shampoo. It doesn't matter what brand as long as it is not too runny like water. Then I bought a 1 ounce bottle of 100% tea tree oil at Trader Joes. It doesn't matter where you buy your bottle of 100% tea tree oil. I poured about 1/3 of the 1 ounce bottle of tea tree oil into the 12 ounce bottle of baby shampoo. I then closed the cap of the baby shampoo and shook it really well.  In the beginning when my rosacea was prevalent, every morning I would put some of the tea tree oil infused baby shampoo on those areas. I would leave it on while I brushed my teeth. I tried to keep it on for at least 5 minutes. Then I would rinse it off. That evening I would do it again and keep it on for at least 5 minutes. Then rinse off. After a few days I saw my rosacea disappear. When I stopped this treatment, the rosacea would ultimately return. So now to keep my rosacea from returning I put on the tea tree oil infused baby shampoo every morning while I brush my teeth. I no longer need to put it on at night as the once daily application has kept my rosacea from returning. It is has been well over a year since the rosacea has resurfaced.  My husband still continues to put his application of tea tree oil infused baby shampoo on twice a day because he gets good results and he doesn't want to chance it returning as his rosacea was far worse than mine. This daily regime has worked for both my husband and I. If you choose to try this, I hope it works for you as well." This probably would help improve demodectic rosacea. 
    • Related Articles An empirically generated responder definition for rosacea treatment. Clin Cosmet Investig Dermatol. 2017;10:347-352 Authors: Staedtler G, Shakery K, Endrikat J, Nkulikiyinka R, Gerlinger C Abstract
      OBJECTIVE: The aim of this study was to empirically generate a responder definition for the treatment of papulopustular rosacea.
      METHODS: A total of 8 multicenter clinical studies on patients with papulopustular facial rosacea were analyzed. All patients were treated with azelaic acid and/or comparator treatments. The severity of rosacea was described by the Investigator Global Assessment (IGA) and the number of lesions. Patients with the IGA score of "clear/minimal" were considered as responders, and those staying in the range of IGA "mild to severe" as nonresponders. The respective number of lesions was determined.
      RESULTS: A total of 2,748 patients providing 12,410 measurements were included. After treatment, responders showed 2.23±2.48 lesions (median 2 lesions [0-3]), and nonresponders showed 13.74±10.40 lesions (median 12 lesions [6-18]). The optimal cutoff point between both groups was 5.69 lesions.
      CONCLUSION: The calculated cutoff point of 5.69 lesions allows discrimination of responders (5 or less remaining lesions) and nonresponders (6 or more remaining lesions) of therapeutic interventions in rosacea.
      PMID: 28932125 [PubMed] {url} = URL to article
    • The relationship between migraine and rosacea: Systematic review and meta-analysis. Cephalalgia. 2017 Jan 01;:333102417731777 Authors: Christensen CE, Andersen FS, Wienholtz N, Egeberg A, Thyssen JP, Ashina M Abstract
      Objective To systematically review the association between migraine and rosacea. Background Migraine is a complex disorder with episodes of headache, nausea, photo- and phonophobia. Rosacea is an inflammatory skin condition with flushing, erythema, telangiectasia, papules, and pustules. Both are chronic disorders with exacerbations of symptoms almost exclusively in areas innervated by the trigeminal nerve. Previous studies found an association between these disorders. We review these findings, provide a meta-analysis, and discuss possible pathophysiological commonalities. Methods A search through PubMed and EMBASE was undertaken for studies investigating the association between all forms of migraine and rosacea published until November 2016, and meta-analysis of eligible studies. Results Nine studies on eight populations were identified. Studies differed in methodology and diagnostic process, but all investigated co-occurrence of migraine and rosacea. Four studies were eligible for meta-analysis, resulting in a pooled odds ratio of 1.96 (95% confidence interval 1.41-2.72) for migraine in a rosacea population compared to a non-rosacea population. Conclusion Our meta-analysis confirmed an association in occurrence of migraine and rosacea. Future studies should specifically investigate possible shared pathophysiological mechanisms between the two disorders.
      PMID: 28920449 [PubMed - as supplied by publisher] {url} = URL to article
    • A recently published paper concluded, "Expert groups and evidence-based guidelines agree that topical retinoids should be considered the foundation of acne therapy." So this article explains the increased use of retinoids by physicians over antibiotics since there is concern over antibiotic resistance. This article states, "The use of retinoids plus BPO targets multiple pathways and can often eliminate the need for antibiotics, reducing the likelihood of antibiotic resistance."

      Isotretinoin is just one of the several retinoids used to treat acne. The retinoids mentioned in the article are, "adapalene 0.1% and 0.3%; tazarotene 0.1%; tretinoin 0.01%, 0.025%, 0.038%, 0.04%, 0.05%, 0.08%, and 0.1% in the USA; isotretinoin 0.05% and 0.1% in other regions of the world" and reviews "the evidence supporting why retinoids should be considered the foundation of acne therapy (with a focus on topical retinoids)." The article states, "Both dermatologists and other physicians were less likely to prescribe a retinoid for patients aged 19 or older compared to those aged 10–19." The topical retinoids mentioned in this article are a "fixed combination adapalene 0.3%-benzoyl peroxide (BPO) 2.5% (0.3 A/BPO; Epiduo Forte®, Galderma Laboratories) and topical retinoids (adapalene, tazarotene, or tretinoin) and Retinoids are also available in fixed-combination formulations with BPO [adapalene-BPO 0.1%/2.5% and 0.3%/2.5% (Epiduo® and Epiduo Forte®, Galderma Laboratories)] and clindamycin [tretinoin 0.025%/clindamycin phosphate 1.2% (Veltin, Aqua Pharmaceuticals; Ziana®, Valeant Pharmaceuticals)]."

      The article does address the concern of "retinoid irritation" and offers "Strategies to minimize tolerability issues" in Table 1 but does not mention anything about long term risks of 'accutane induced rosacea' which many in RF and other anecdotal reports have confirmed happens to some.  Dermatol Ther (Heidelb). 2017 Sep; 7(3): 293–304.
      Published online 2017 Jun 5. doi:  10.1007/s13555-017-0185-2
      PMCID: PMC5574737
      Why Topical Retinoids Are Mainstay of Therapy for Acne
      James Leyden, Linda Stein-Gold, and Jonathan Weiss
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