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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

    • Related Articles Psychosocial aspects of rosacea with a focus on anxiety and depression. Clin Cosmet Investig Dermatol. 2018;11:103-107 Authors: Heisig M, Reich A Abstract
      Background: Rosacea is a common, chronic skin condition characterized by facial redness and inflammatory lesions. The disease can lead to social stigmatization and may significantly reduce the quality of life of patients. Psychosocial impact of rosacea can be severe and debilitating; however, it is still underestimated.
      Objective: This paper provides a literature review focused on depression and anxiety in patients with rosacea.
      Conclusion: Rosacea patients have an increased risk of developing depression and anxiety and tend to avoid social situations. However, there are still limited data on this condition. Effective treatment of clinical symptoms brings significant improvement in psychological symptoms. Further studies should be conducted to investigate in more detail the psychological impact of rosacea. In addition, improvement of the efficacy of rosacea treatment is still needed.
      PMID: 29551906 [PubMed] {url} = URL to article
    • Related Articles Genome-Wide Analysis Characterization and Evolution of SBP Genes in Fragaria vesca, Pyrus bretschneideri, Prunus persica and Prunus mume. Front Genet. 2018;9:64 Authors: Abdullah M, Cao Y, Cheng X, Shakoor A, Su X, Gao J, Cai Y Abstract
      The SQUAMOSA promoter binding protein (SBP)-box proteins are plant-specific transcriptional factors in plants. SBP TFs are known to play important functions in a diverse development process and also related in the process of evolutionary novelties. SBP gene family has been characterized in several plant species, but little is known about molecular evolution, functional divergence and comprehensive study of SBP gene family in Rosacea. We carried out genome-wide investigations and identified 14, 32, 17, and 17 SBP genes from four Rosacea species (Fragaria vesca, Pyrus bretschneideri, Prunus persica and Prunus mume, respectively). According to phylogenetic analysis arranged the SBP protein sequences in seven groups. Localization of SBP genes presented an uneven distribution on corresponding chromosomes of Rosacea species. Our analyses designated that the SBP genes duplication events (segmental and tandem) and divergence. In addition, due to highly conserved structure pattern of SBP genes, recommended that highly conserved region of microsyneteny in the Rosacea species. Type I and II functional divergence was detected among various amino acids in SBP proteins, while there was no positive selection according to substitutional model analysis using PMAL software. These results recommended that the purifying selection might be leading force during the evolution process and dominate conservation of SBP genes in Rosacea species according to environmental selection pressure analysis. Our results will provide basic understanding and foundation for future research insights on the evolution of the SBP genes in Rosacea.
      PMID: 29552026 [PubMed] {url} = URL to article
    • Related Articles Quality of Life in Individuals with Erythematotelangiectatic and Papulopustular Rosacea: Findings From a Web-based Survey. J Clin Aesthet Dermatol. 2018 Feb;11(2):47-52 Authors: Zeichner JA, Eichenfield LF, Feldman SR, Kasteler JS, Ferrusi IL Abstract
      OBJECTIVE: The objective of the study was to evaluate the impact of rosacea on self-perception, emotional, social, and overall well-being and quality of life in individuals with erythematotelangiectatic rosacea (ETR) and papulopustular rosacea (PPR). DESIGN: We distributed a cross-sectional email invitation for participants in the United States to fill out a web-based survey. PARTICIPANTS: We included adults who reported having previously received a diagnosis of erythematotelangiectatic rosacea or papulopustular rosacea. MEASUREMENTS: Questionnaires measured the psychosocial aspects of rosacea, including the Satisfaction With Appearance Scale and modified Satisfaction With Appearance Scale questionnaires, Impact Assessment for Rosacea Facial Redness, Rosacea-Specific Quality-of-Life questionnaire, and RAND 36-Item Short Form Health Survey. The Impact Assessment for Rosacea Facial Bumps or Pimples was administered to the papulopustular rosacea cohort. RESULTS: Six hundred participants enrolled and completed the survey, with most rating their rosacea as mild or moderate (ETR: 95.6%; PPR: 93.7%). In the erythematotelangiectatic rosacea and papulopustular rosacea cohorts, respectively, 45 and 53 percent disagreed/strongly disagreed that they were satisfied with their appearance due to rosacea; 42 and 27 percent agreed/strongly agreed that they "worry how people will react when they see my rosacea"; and 43 and 59 percent agreed/strongly agreed that they feel their rosacea is unattractive to others. Rosacea-Specific Quality-of-Life total and domain scores indicated negative impact of rosacea for both cohorts. Both cohorts reported worse 36-item Short Form Health Survey overall and domain scores than population norms in the United States. CONCLUSION: Rosacea had wide-ranging, negative effects on self-perceptions and emotional, social, and overall well-being as well as rosacea-specific quality of life. Overall, both erythematotelangiectatic rosacea and papulopustular rosacea cohorts reported a substantial negative impact of rosacea on quality of life on a range of instruments.
      PMID: 29552276 [PubMed] {url} = URL to article
    • "Acne rosacea, or more commonly called just rosacea, affects 14 million people in the U.S., or five percent of the population, and is sometimes said to be an adult version of acne vulgaris." Rosacea affects 5 percent of population, Richard P. Holm, Medical Doctor, Argus Leader, Part of the USA Network, Dec 11, 2017
    • Martin Schaller, MD, from the Department of Dermatology, Eberhard Karls University Tuebingen in Germany has co-wrote a paper that proposes using topical Ivermectin (Soolantra) to treat ocular rosacea. Dr. Schaller is a member of the RRDi MAC.  Br J Dermatol. 2018 Mar 12. doi: 10.1111/bjd.16534. 
      Successful therapy of ocular rosacea with topical ivermectin.
      Schaller M, Pietschke K. This was first announced by David Pascoe at RSG.