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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 Demodex Folliculorum [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

    • Prevalence of gastrointestinal comorbidities in rosacea: Comparison of subantimicrobial, modified release doxycycline versus conventional release doxycycline. J Am Acad Dermatol. 2018 Feb;78(2):417-419 Authors: Lim HG, Fischer A, Rueda MJ, Kendall J, Kang S, Chien AL PMID: 29332715 [PubMed - in process] {url} = URL to article
    • Prevalence of gastrointestinal comorbidities in rosacea: Comparison of subantimicrobial, modified release doxycycline versus conventional release doxycycline. J Am Acad Dermatol. 2018 Feb;78(2):417-419 Authors: Lim HG, Fischer A, Rueda MJ, Kendall J, Kang S, Chien AL PMID: 29332715 [PubMed - in process] {url} = URL to article
    • crawfish18 (at RF) reports mixing zinc oxide 20% and Sulfur 10% in a 50/50% mix which crawfish18 says works for rosacea. 
    • Related Articles Inate immunity in rosacea. Langerhans cells, plasmacytoid dentritic cells, Toll-like receptors and inducible oxide nitric synthase (iNOS) expression in skin specimens: case-control study. Arch Dermatol Res. 2018 Jan 12;: Authors: Moura AKA, Guedes F, Rivitti-Machado MC, Sotto MN Abstract
      Rosacea is a chronic inflammatory condition with predominant facial involvement. Because of that, many patients sense that rosacea affects quality of life. The etiology of rosacea remains unknown. Recent studies have suggested that aberrant innate immunity is central to this disease. The aim of this study was to examine the presence of Langerhans cells, plasmacytoid dentritic cells (PDC), the expression of Toll-like receptors (TLR) and inducible oxide nitric synthase (iNOS) in skin of patients with rosacea, to highlight the participation of innate immunity in its pathogenesis. 28 biopsy specimens were taken from patients with clinical and histopathological findings of rosacea. Immunohistochemical demonstration of Langerhans cells (anti-CD1a antibody), PDC (anti-CD 123 antibody), TLR2, TLR4 and iNOS was performed in skin samples and compared with normal skin controls. The expression of Langerhans cells was lower in rosacea group than in control group. PDC were found in skin samples of rosacea as isolated cells and forming small clusters. Expression of TLR2, TLR4 and iNOS was higher in rosacea samples than in normal skin controls. This research demonstrates early and late stage components of innate immunity in specimens of rosacea ratifying the existence of an altered innate immunity in its pathogenesis.
      PMID: 29330632 [PubMed - as supplied by publisher] {url} = URL to article
    • Pivotal Trial of the Efficacy and Safety of Oxymetazoline Cream 1.0% for the Treatment of Persistent Facial Erythema Associated With Rosacea: Findings from the First REVEAL Trial. J Drugs Dermatol. 2018 Jan 01;17(1):97-105 Authors: Kircik LH, DuBois J, Draelos ZD, Werschler P, Grande K, Cook-Bolden FE, Weng E, Berk DR, Ahluwalia G Abstract
      An unmet need exists for a safe, tolerable, effective treatment for moderate to severe persistent facial erythema in patients with rosacea. This pivotal phase 3, multicenter, double-blind study evaluated the efficacy and safety of topical oxymetazoline in patients with facial erythema associated with moderate to severe rosacea. Patients were randomly assigned to treatment with oxymetazoline hydrochloride cream 1.0% or vehicle applied once daily for 29 days, and were followed for 28 days posttreatment. The primary efficacy outcome was having at least a 2-grade decrease from baseline on both the Clinician Erythema Assessment (CEA) and the Subject Self-Assessment for rosacea facial redness (SSA) scales (composite success) at 3, 6, 9, and 12 hours postdose on day 29. Safety assessments included treatment-emergent adverse events (TEAEs) and posttreatment worsening of erythema (composite CEA/SSA increase of 1-grade severity from baseline; rebound effect). A total of 440 patients (mean age, 49.5 years; 78.9% females) were randomized (oxymetazoline, n=222; vehicle, n=218); most had moderate erythema. On day 29, significantly greater proportions of oxymetazoline recipients achieved the primary efficacy outcome at each time point (P less than 0.02) and overall (P less than 0.001) compared with vehicle recipients. The incidence of discontinuation due to TEAEs was low in both groups (oxymetazoline group, 1.8%; vehicle group, 0.5%). The most common TEAEs reported during the entire study period were application-site dermatitis, application-site erythema, and headache in the oxymetazoline group (1.4% each), and headache (0.9%) in the vehicle group. Following cessation of treatment, low proportions of patients experienced rebound effect (oxymetazoline group, 2.2%; vehicle group, 1.1%). Oxymetazoline applied to the face once daily for 29 days was effective, safe, and well tolerated in patients with moderate to severe persistent facial erythema of rosacea. <p><em>J Drugs Dermatol. 2018;17(1):97-105.</em></p>.
      PMID: 29320594 [PubMed - in process] {url} = URL to article
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