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Demodex Mites & Rosacea: The Microbes Linked To Rosacea 

What is the connection between Demodex mites and rosacea? In this article, we detail everything you need to know.

Read on

Thoughts of microbial life don’t immediately come to mind when thinking about flushing rosacea. But, there’s a mounting body of research to suggest Demodex mites might play an important role in the exacerbation of this common condition. Thinking of tiny bug life wreaking havoc on your skin might not be the most pleasant image, but if it’s any consolation, these mites live on almost all humans. It’s estimated that between 23% to 100% of all people play host to two types of Demodex face mites -- Demodex folliculorum and Demodex brevis. 

In most cases, these mites don’t pose any issues at all. But, it’s all a little different when it comes to rosacea. 

In this article, we’ll go over how these mites have been associated with rosacea, and what you can do to treat it. Here at Strut Health, our custom rosacea formulated creams may contain Metronidazole or Ivermectin (the active ingredient in Soolantra) which help to quickly target Demodex mites. 

What are Demodex mites?

All humans play host to many microorganisms which comprise normal skin flora. One microbe is the Demodex mite. Out of 65 types of Demodex, only two are found to live on humans: Demodex folliculorum and Demodex brevis. 

These tiny parasitic organisms can’t be seen with the naked eye and can only be observed via a microscope. They live in or near the follicles or sebaceous glands on the face.

Demodex folliculorum primarily lives in the follicles of the face and eyelids.  While Demodex brevis live in the sebaceous glands of the skin. Both mites feed on the facial oil known as sebum and shed dead skin cells.

These tiny mites do not pose an issue to most of us. Having these mites on our skin is most often asymptomatic and part in parcel of being a mammal. 

However, studies have found a link between abnormal Demodex populations and rosacea. 

How are Demodex mites linked to rosacea?

It’s well established that those with rosacea have been found to have higher numbers of Demodex mites. Research has shown that Demodex mites have been found in numbers 15 to 18 times greater in rosacea patients than in those without rosacea. 

For a while, the connection wasn’t well understood (and research is still ongoing).

Researchers were puzzled when antibiotics seemed to improve inflammatory rosacea symptoms -- they hypothesized the anti-inflammatory properties of the antibiotics must be the cause of improvement. But, when they tested anti-inflammatory agents only, rosacea did not improve in the same way. This led them to believe bacteria might be a cause. 

Now, it’s hypothesized that the bacteria living on the mites, Bacillus oleronius, is what causes an inflammatory response in rosacea patients. 

Dr. Kevin Kavanagh of the University of Ireland has researched this inflammatory response caused by Demodex infestation in rosacea patients. He says “When each of those [mites] dies, they release bacteria into the skin,” which triggers an immune response. 

So, the overpopulation of Demodex might not be the cause of inflammation, but rather the bacteria these mites leave behind. 

Many experts consider rosacea as a disease of the immune system which proliferates an abnormal immune response causing vascular, and inflammatory symptoms. While Demodex mites in high numbers might not be the cause of rosacea, it is, however, considered a significant trigger of rosacea inflammation.   

What are the symptoms of Demodex mites?

Most people will not experience any symptoms from having Demodex mites on their skin. But, some will. Even so, those with Demodex mites might present with non-specific symptoms.

Demodex mite overpopulation can be diagnosed by your doctor via a noninvasive skin biopsy (scraping follicular tissues and oils from your face). However, there are also other ways to diagnose an overpopulation of Demodex mites. 

Here are some of the most common signs and symptoms caused by Demodex mites:

  • Itchy skin
  • Rough skin
  • Sandpaper-like texture to the skin
  • Follicular scales 
  • Pustules and papules 
  • Redness
  • Burning sensation
  • Increased sensitivity
  • Macules, eczema, folliculitis, granulomas, and pigmentation have also been described

How to get rid of Demodex 

The most common treatment of Demodex overpopulation is the topical antibiotic metronidazole. This can be administered alongside prescription azelaic acid and other oral antibiotics. 

Learn more about Metronidazole for rosacea.

More recently, antiparasitic Ivermectin cream has been used to great success to kill Demodex mites and the associated bacteria. 

Learn more about Ivermectin for rosacea. 

Besides prescription topical creams to kill the Demodex mites, there are other things you can do:

  • Avoid oily skincare products as this can offer a food source to the mites
  • Washing the face with gentle cleansers twice a day
  • If your skin is not overly sensitive, try exfoliations a few times a week to remove dead skin cells

Article Summary 

Demodex mites are microorganisms that live on most humans and are a part of our normal skin flora. They cannot be seen with the naked eye and often cause no harm or symptoms in humans. However, research has shown, those with rosacea tend to have 15 to 18 times the average amount of Demodex mites. The mites and their associated bacteria are hypothesized as an inflammatory trigger for those with rosacea. You can treat this Demodex overpopulation with topical antibiotics and antiparasitics. 

Strut Health prescribes custom rosacea cream online

Our custom rosacea creams take Demodex mites into account. Among other possible ingredient additions, we use Metronidazole or Ivermectin for their anti-inflammatory, antibacterial and antimicrobial properties. 

To see if you’d benefit from Metronidazole or Ivermectin, simply complete a questionnaire-based online doctor's consultation to see if our rosacea treatments are right for you. 

If our doctors find this is a good fit for you, we’ll ship your custom prescription to your doorstep.

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