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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 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

    • Comparative effectiveness of purpuragenic 595 nm pulsed dye laser versus sequential emission of 595 nm pulsed dye laser and 1,064 nm Nd:YAG laser: a double-blind randomized controlled study. Acta Dermatovenerol Alp Pannonica Adriat. 2019 Mar;28(1):1-5 Authors: Campos MA, Sousa AC, Varela P, Baptista A, Menezes N Abstract INTRODUCTION: Erythematotelangiectatic rosacea is a common condition in Caucasians. The most frequently used lasers to treat this condition are pulsed dye laser (PDL) and neodymium:yttrium-aluminum-garnet laser (Nd:YAG). This study compares the treatment efficacy of purpuragenic PDL with that of sequential emission of 595 nm PDL and 1,064 nm Nd:YAG (multiplexed PDL/Nd:YAG). METHODS: We performed a prospective, randomized, and controlled split-face study. Both cheeks were treated, with side randomization to receive treatment with PDL or multiplexed PDL/Nd:YAG. Efficacy was evaluated by spectrophotometric measurement, visual photograph evaluation, the Dermatology Quality of Life Index questionnaire, and a post-treatment questionnaire. RESULTS: Twenty-seven patients completed the study. Treatment was associated with a statistically significant improvement in quality of life (p < 0.001). PDL and multiplexed PDL/Nd:YAG modalities significantly reduced the erythema index (EI; p < 0.05). When comparing the degree of EI reduction, no differences were observed between the two treatment modalities. PDL was associated with a higher degree of pain and a higher percentage of purpura. Multiplexed PDL/Nd:YAG modality was associated with fewer side effects and greater global satisfaction, and 96.3% of the patients would recommend this treatment to a friend. CONCLUSIONS: Both laser modalities are efficacious in the treatment of erythematotelangiectatic rosacea. The multiplexed PDL/Nd:YAG modality was preferred by the patients. PMID: 30901061 [PubMed - in process] {url} = URL to article
    • Logo of the Human Microbiome Project, a program of the NIH Common Fund, National Institutes of Health, image courtesy of Wikimedia Commons This subject of microbiome-based therapeutic strategies for rosacea is one of my favorite subjects which I have done a great deal of research on. You may want to read the latest article I have written on this subject of the human microbiome. 
    • Related Articles Skin diseases are more common than we think: screening results of an unreferred population at the Munich Oktoberfest. J Eur Acad Dermatol Venereol. 2019 Mar 19;: Authors: Tizek L, Schielein MC, Seifert F, Biedermann T, Böhner A, Zink A Abstract BACKGROUND: Skin diseases are ranked as the fourth most common cause of human illness, resulting in an enormous non-fatal burden. Despite this, many affected people do not consult a physician. Accordingly, the actual skin disease burden might be even higher since reported prevalence rates are typically based on secondary data that exclude individuals who do not seek medical care. OBJECTIVE: The aim of the study was to investigate the prevalence of skin diseases in an unreferred population in a real-life setting. METHODS: A cross-sectional study of 9 days duration was performed in 2016 at the 'Bavarian Central Agricultural Festival', which is part of the Munich Oktoberfest. As part of a public health check-up, screening examinations were performed randomly on participating visitors. All participants were 18 years or older and provided written informed consent. RESULTS: A total of 2701 individuals (53.5% women, 46.2% men; mean age 51.9 ± 15.3 years) participated in the study. At least one skin abnormality was observed in 1662 of the participants (64.5%). The most common diagnoses were actinic keratosis (26.6%), rosacea (25.5%) and eczema (11.7%). Skin diseases increased with age and were more frequent in men (72.3%) than in women (58.0%). Clinical examinations showed that nearly two-thirds of the affected participants were unaware of their abnormal skin findings. CONCLUSION: Skin diseases might be more common than previously estimated based on the secondary data of some sub-populations. Further information and awareness campaigns are needed to improve people's knowledge and reduce the global burden associated with skin diseases. PMID: 30891839 [PubMed - as supplied by publisher] {url} = URL to article
    • Fractionated Carbon Dioxide Laser Resurfacing as an Ideal Treatment Option for Severe Rhinophyma: A Case Report and Discussion. J Clin Aesthet Dermatol. 2019 Jan;12(1):24-27 Authors: Comeau V, Goodman M, Kober MM, Buckley C Abstract Rhinophyma is a progressive, disfiguring condition that affects the nose and is caused by the hypertrophy of sebaceous glands and connective tissue. Although its exact pathogenesis remains unclear, it is generally thought to be a subtype of the chronic, inflammatory condition rosacea. To date, oral and topical treatments have been largely ineffective at treating rhinophyma. Laser resurfacing is an emerging treatment modality that offers hope for patients with severe rhinophyma. We present a case of rhinophyma treated via fractionated carbon dioxide laser resurfacing with impressive results, excellent tolerability, and minimal downtime. PMID: 30881573 [PubMed] {url} = URL to article
    • Effective Treatment of Morbihan's Disease with Long-term Isotretinoin: A Report of Three Cases. J Clin Aesthet Dermatol. 2019 Jan;12(1):32-34 Authors: Olvera-Cortés V, Pulido-Díaz N Abstract Morbihan's disease is characterized by the presence of chronic and persistent edema of the periorbital tissue, forehead, glabella, nose, and cheeks. In some cases, it is related to acne and rosacea, but its exact etiology remains unknown. A defined therapeutic approach has yet to be established for the treatment of Morbihan's disease. To date, the systemic and surgical options attempted have not been very successful and/or do not yield sustained results. Isotretinoin is a key systemic treatment used for the treatment of various skin conditions. However, there are few reports of isotretinoin being used to treat Morbihan's disease. Here, we present the details of three patients with Morbihan's disease who were successfully treated long-term with isotretinoin. PMID: 30881575 [PubMed] {url} = URL to article
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