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Gets Worse Before It Gets Better

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

There are substantial anecdotal reports that treatment for demodectic rosacea gets worse before it gets better. Galderma reports that treatment with Soolantra improves rosacea. This is usually the same with treatment using the ZZ cream

The logic behind this is that killing the demodex mites causes a die-off of the mites that takes weeks to accomplish since new eggs are being hatched each day and the "life cycle of demodex mites consists of five phases of development and lasts from 14 to 18 days". [1] Furthermore because the movement of the mites has been shown to be "at a speed of 8-16 mm/h" [2] they may leave the area being treated and return later while planting eggs along the route. During the initial treatment which may take weeks some of the mites are reported to be killed which may cause inflammation and worsen the skin. One explanation of this is the "Jarisch–Herxheimer reaction" (JHR) which has been "traditionally associated with antimicrobial treatment of syphilis." [3] The principle of JHR may indicate a reason why it gets worse before it gets better. One source comments on this by stating, "And while the JHR only technically relates to spirochetal infections (spiral-shaped bacteria) and antibiotics, the concept of symptom-onset or worsening after starting treatment with antimicrobials has been seen to apply more broadly in clinical practice. This is why you’ll often hear practitioners talk about a Herx-reaction, even if it isn’t scientifically accurate. But, what we call ‘die-off symptoms’ is certainly something we see commonly when clients begin addressing bacteria, parasites and yeast pathogens using natural antimicrobials." [4]

One article explains, how this might happen: 

"Rosacea often improves with antibacterial drugs that don’t affect the mites, such as tetracyclines. Kavanagh thinks this is because rosacea is caused by a reaction to bacteria in the mite’s faeces." [5]

Furthermore, there are at least six types of bacteria that have been associated with demodex mites, and bacteria has been implicated for a long time with rosacea. [6] At least one fungus has been associated with rosacea [7]. Viruses have not been ruled out in rosacea. There are very little, if any, clinical studies done on virus and rosacea. Viruses are in bacteria and throughout the human body and comprise more weight in the human body than bacteria by a factor of ten times. [8] For that matter, other microbes haven't been studied either, such as protozoa or archea. There is much to learn about the human microbiome and as more research is done, new insights are learned. 

More study should be done on why treatment for demodectic rosacea seems in many cases to get worse before it gets better.

Nevertheless, reducing demodex density counts in rosacea improves the patient with rosacea. [9] 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 you want it to happen. Or you can continue to do nothing and let the status quo research continue on. [10]

End Notes

[1] Demodex Update
Subheading, The potential role of Demodex folliculorum mites and bacteria in the induction of rosacea, third paragraph 

[2] Russian Study on Demodex Mites and Rosacea Illuminating, (2) The report confirms the size and movement of demodex, second paragraph

[3] Jarisch–Herxheimer reaction, Wikipedia

[4] Pathogen & Parasite Die-Off Symptoms: How to manage detox side-effects, Bella Lindemann, June 24, 2019

[5] Rosacea may be caused by mite faeces in your pores, Debora MacKenzie, New Scientist

[6] Bacteria Associated with Rosacea and Demodex Mites

Bacteria Theory

[7] Candida Albicans

[8] Human Microbiome, Brady Barrows 

[9] Decreasing Demodex Density Count Improves Rosacea

What are the numbers?

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


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Very good post. I also have been researching and trying to find out the ways in which mite-bacterial interaction as well as viral interaction in rosacea exacerbate the condition of inflammation.

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