Demodectic Rosacea

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

  Demodex Folliculorum [1]

"The Demodex mite is beginning to be accepted as one of the triggers of this inflammatory cascade, and its proliferation as a marker of rosacea; moreover, the papulopustules of rosacea can be effectively treated with topical acaricidal agents. Demodex proliferation appears to be a continuum process in rosacea, and may not be clinically visible at the onset of the disease." [2]

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." [3] This is referring to a paper published in 2014 "to classify human demodicosis into a primary form and a secondary form." [4] 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." [5] The RRDi has simplified this complicated issue by calling it demodectic rosacea, a variant of rosacea.

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 demodectic rosacea:

Controversy for Over a Hundred Years

Demodetic Rosacea has a long history of controversy which continues to this day. For example, note the following quote recorded more than 135 years ago:
"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

Rosacea Variant

Demodectic Rosacea is also known as, Demodex Dermatitis, Demodecidosis, Demodex Folliculorum, Demodicidosis, Demodicosis, Pityriasis Folliculorum, Rosacea-like Demodicidosis [8], Unilateral rosacea, Unilateral Demodicidosis, Unitaleral Demodex sp. folliculitis [7], and possibly other names for this variant of rosacea. 

"Granulomatous rosacea is a rare chronic inflammatory skin disease with an unknown origin. The role of Demodex follicularum in its pathogenesis is currently proved." [9]

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: 

Controversy Continues
The role of demodex in rosacea has a long history and continues to this day. [10] It should be ruled out in a diagnosis of rosacea or it is possible that your rosacea is, in fact, demodectic rosacea. 

If your dermatologist dismisses demodectic rosacea you might refer 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. Also we have an extensive category on demodectic rosacea in our member forum here: 

Forum Home >  Forums >  Public Forum >  Rosacea Topics > Demodectic Rosacea (Members Only)

Demodex Update • Soolantra • (Members Only)

Just think if 10K members of the RRDi each donated one dollar and insisted on supporting a reputable clinician to study what they wanted, supporting their own research, what might be discovered? This can only happen if enough rosaceans like you want it to happen. Or you can continue to do nothing and let the skin industry status quo research continue on. If you want independent rosacea research you can help. [6]

End Notes

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

[2] Dermatol Ther (Heidelb). 2020 Oct 23;:
The Pathogenic Role of Demodex Mites in Rosacea: A Potential Therapeutic Target Already in Erythematotelangiectatic Rosacea?
Forton FMN

[3] 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

[4] 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.

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

[6] Rosacea Research in Perspective of Idiopathic Diseases
Rosacea Research in Perspective of Funding

[7] PubMed RSS Feed - -Unilateral rosacea, unilateral demodicidosis, unitaleral Demodex sp. folliculitis: three names for the same disease

[8] Demodectic Rosacea (Variant) 

[9] J Med Case Rep. 2017; 11: 230. Published online 2017 Aug 20. doi:  10.1186/s13256-017-1401-5 PMCID: PMC5563383
Granulomatous rosacea: a case report
A. Kelati and F. Z. Mernissi

[10] The controversy is still acknowledged in the following paper published in 2022: 

"Rosacea and demodicosis are common facial conditions in dermatology practice. While demodicosis is clearly the result of Demodex mite infestation, the pathogenicity of rosacea is still not sufficiently explained, so that it is defined by its symptoms, and not by its cause. It is usually considered as a disease of the immune system associated with neurogenic inflammation triggered by various factors (ultraviolet light, heat, spicy food, alcohol, stress, microorganisms). Its links with demodicosis remain controversial, although there is increasing evidence that Demodex mites may play a key role in the inflammatory process."

PubMed RSS Feed - -Rosacea, an infectious disease: why rosacea with papulopustules should be considered a demodicosis. A narrative review