Demodex and the Gut?

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Nadine, at the Rosacea Forum, found an interesting article, Belly Health, Rosacea, and A Starring Role for Mites, David Edelberg, MD, WholeHealth Chicago,  which I have put in this post for consideration.  

A couple of points in the article are not accurate. For example, the author, David Edelberg, MD, writes, "Here’s why: like all of us, the Demodex mite has its own wee digestive system. After it eats (a teeny little bit of you), just like you it needs to empty its intestines." Not true, demodex have no anus so cannot eliminate waste. Technically what happens is “Their abdomen just gets bigger and bigger, and when they die and decompose they release their faeces all at once in the pore,” says Kavanagh. When the mites are numerous, he believes that the material is enough to trigger an immune reaction, inflammation and tissue damage." Rosacea may be caused by mite faeces in your pores, Debora MacKenzie, New Scientist 

So since this little technicality is missing from the article, there may be more inaccuracies. The article says that metronidazole is an "anti-parasite drug" however, technically it is an antibiotic and antiprotozoal medication, so it does kill parasites, therefore, that is no real inaccuracy.  

The author states, "Scientists recently discovered that the rosacea-linked B. oleronius is one of several bacteria responsible for a not-uncommon digestive condition called “small bowel intestinal overgrowth,” SIBO for short." Aside from putting the words in the wrong order for SIBO, there is no citation for this and I have never read that B. Oleronius is 'one of several bacteria responsible' for SIBO. The gut has a huge number of types of bacteria (the microbiome) and probably includes B. Olernonius, but whether it is one of the key ones in SIBO hasn't been established in any article I have read. Maybe Dr. Edleberg has some paper to substantiate this, but it is not cited. There are now at least five known bacteria associated with demodex and list keeps growing. These little buggers carry a host of different types of bacteria. 

You have brought up a twist or a third factor in the old Rosacea or Demodex, Which Came First? quandary. Adding the gut into the quandary question may be part of the solution equation. As I have said repeatedly, antibiotics do indeed clear rosacea and this is done systemically. However, the long term side effects and risks with antibiotics are wanting. Probiotics have now been clearly shown to improve rosacea. Hopefully the cure for rosacea will be found in untangling this mystery.

You may also want to read, Why do demodex mites like human skin?

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On the other side of the coin is the which came first, the bacteria or the rosacea (the old chicken or egg quandary)? Further, does it matter which came first? To some, this is a very important question to answer. The evidence is that the bacteria in the mites may be first, rather than pre-existing rosacea. Now that at least five types of bacteria have been associated with demodex and rosacea, the evidence is mounting. 

Another question is why do mites on normal skin people (everyone has them) who die not cause any issues? Is it because there is no bacteria in their dead bodies? That doesn't seem likely. What is it that causes the mites to increase on rosacea sufferers? The evidence is that mites are in greater numbers on rosacea patients over the normal population. There is evidence that reducing the count of demodex clears rosacea. 

I think the best evidence that killing mites helps rosacea patients is the success Galderma has had with Soolantra, and the overwhelming evidence is that "Annual market sales for the last 12 months were approximately $120 million, according to IMS Health." Source.