Demodecosis (demodex) is a widely spread chronic dermatitis. With the incidence ranging from 2 to 5%, demodex is the 7th among skin diseases. Esthetically, this is rather a severe disease, because it is mainly manifested on the face of young women.

The largest number of patients is observed at the age of 20-40 years.  Women to men ratio makes about 4:1. The causative agent of the disease is a tick-mite Demodex folliculorum. There are two types of this tick: Demodex folliculorum longus and Demodex folliculorum brevis parasitizing in people. They differ in the structure of adult ticks and in the cycle of their development. These two types are the most frequent. The ticks parasitize in hair follicles and sebaceous glands whose ducts are on the surface of the skin.  

According to different authors, 55-100% of the population is the carrier of the tick but without any clinical manifestations. Therefore, it is possible to state that demodex is a physiological representative of the skin microflora characterized by a progressing damage of hair follicles with years.  Since demodex is found on the healthy skin, it can be considered to be an opportunistic parasite. Usually, the ticks inhabit hair follicles, the ducts and secretion of the sebaceous glands of the face in an adult person. Sometimes, they can be found on the scalp, in the areas of eye-brows and eye-lashes. These ticks can preserve their activity outside the body. The disease can be transmitted directly from person to person (from a sick individual or from a carrier of the disease) and indirectly:  through underwear or bed-linen. Some authors do not exclude that the infection can be transmitted from domestic animals. In spring and summer, the ticks can be found on the skin more often. The cycle of the demodex development in the skin lasts 15 days. A fertilized female lays diamond-shaped eggs in the follicle orifice. When a large number of ticks appear, the first eruptions on the skin can be seen.

The main symptoms of the disease

  1. Redness, which is usually of short duration, is one of the first signs of demodex. It appears mainly on the face, though it may spread to the neck and the chest, and lasts several minutes. In some cases, it is accompanied by an unpleasant feeling of heat. This redness can often be caused by a certain irritant, such as the sun, hot drinks or physical exertion. 
  2. Persistent red spots, which can remain on the skin for a long time. This may be associated with alcohol abuse with red patches appearing on the cheeks, the nose and the chin, though they can also spread to the forehead, the neck and the chest.
  3. When the disease progresses, facial blood vessels can become wider and more noticeable with the formation of vascular “stars” on the face.
  4. Development of papules and pustules. They look like acne and may appear on the skin of the head and the body. The traces from papules/pustules can lead to the formation of scars.
  5. Induration of the skin in the form of rhinophyma, an infectious disease of the nasal skin (sometimes as a benign tumor). It is characterized by the hypertrophy of all skin elements: connective tissue, blood vessels and sebaceous glands, increase in the nose size and loss of its natural shape. This is a rare and severe symptom of demodex, which develops during several years. Rhinophyma is more often observed in men.
  6. Loss of hair is a typical symptom of the demodex of the scalp that can be accompanied by peeling and itching. At first, baldness is not so marked, but it can progress and become noticeable both for the patient and for other people. Seborrhea of the scalp can also be observed.
  7. Sensitivity of the skin (burning, itching, tingling, pain).
  8. Dryness, coarseness of the skin.
  9. Red patches above the skin surface.
  10. Facial edema (lymphatic edema).

In addition to the skin problems, many patients present with the eye (eye-lids) symptoms, such as:

  • the feeling of a foreign body in the eyes;
  • dryness;
  • redness and irritation;
  • inflammation of the eye-lids (blepharitis);
  • sticky eye-lashes, loss of eye-lashes;
  • tired eyes.

In some cases, cornea can be affected too, with the appearance of such symptoms as pain/sharp pain in the eyes, blurred vision and sensitivity to light (photophobia). Proper diagnosis and treatment for eye-lids demodex is determined by an ophthalmologist.

Demodex often occurs in combination with such diseases as acne and rosacea. In the first case, numerous asymmetric eruptions appear on the lateral surfaces of the face and the cheeks. In women, it may be a sign of hormonal disturbances. Combination of demodex with rosacea occurs quite often at the papule-pustule stage. The ticks can be found in the eruptions. This makes it possible to suppose that demodex contributes to the exacerbation of rosacea aggravating the redness, peeling, itching, burning, etc.

The disease is diagnosed by clinical manifestations and by detecting the ticks in the eruptions. It is important to determine the amount of ticks, because isolated ticks can be found in healthy people. If the number of ticks exceeds 5 per 1cm3, it is considered to be diagnostically significant. With a smaller concentration of parasites without clinical manifestations, the patient does not need any treatment and should be assessed as a carrier of the disease. Scales, crusts, the contents of the sebaceous gland ducts and eye-lashes serve the material for laboratory studies. Proper collection of the material is most important for the study results.

Treatment of demodex

Treatment of demodex should be administered by a specialist with consequent follow-up. Cutaneous form of demodex is diagnosed, as a rule, by a doctor-dermatologist; and the ophthalmological form is detected by an ophthalmologist. The drugs used for treating demodex should provide the following effects:

  • high anti-demodex activity;
  • disinfection of the skin;
  • anti-inflammatory effect;
  • decreased production of the cutaneous fat.

On average, treatment of demodex lasts from 2 to 3 months. In the majority of cases, the drugs are administered locally and are applied on the affected areas. In some cases, immune-stimulating preparations should be prescribed to improve the immune status of the patient. In hypo-vitaminosis, the patient’s condition is corrected, if necessary. In rare cases, when the patient presents with severe lesions of the skin and eyes with the presence of a concomitant infection, the doctor can administer anti-bacterial therapy.

It is very important to reveal a concomitant disease; otherwise, the patient may have a recurrence (repeated exacerbation). As a rule, cutaneous and ophthalmological forms are treated with various ointments, shampoos and gels producing a local effect. But it should be noted that the treatment scheme may differ depending on the form and severity of the disease. Usually, the doctor administers individual treatment in every case. 

In order to accelerate the process of treatment, the patients should take proper care of the skin. To clean the affected skin areas from the cutaneous fat, as well as from the tick and its waste products, soft scrubs and various peelings can be used. But it is necessary to consult a doctor before their application, because some of them can diminish the treatment effect and lead to the recurrence of the disease.

To fight the tick, folk-medicine can also be helpful. If used for a long time, folk-medicine remedies contribute to the reduction in the tick’s population in hair follicles and sebaceous glands. These remedies include wormwood, oak rind, castor oil, aloe sap and others. But in advances and complicated cases, they will hardly produce a proper effect.

During the treatment, it is not recommended to visit baths, saunas and solariums. Continuous sunbathing should be avoided too. The patients are advised to follow a special diet excluding spicy, salty and sweet food, as well as alcohol.

The following rules should be observed by the patients:

  • it is necessary to use disposable facial napkins (instead of a towel);
  • personal articles of clothing (hats, scarves, gloves, outdoor clothes) should be washed every second day;
  • bed linen should be changed every day;
  • it is advised to wipe regularly the glasses, razors and their cases with the spirit;
  • it is important to replace feather and downy pillows with synthetic ones (the tick cannot exist in the synthetic cloth);
  • it is not recommended to use make-up;
  • it is necessary to check your pets for demodex.

In conclusion, it should be noted that treatment of demodex and observance of all doctor’s recommendations concerning the diet and proper cosmetic care (home and professional) will help your skin to preserve its health and beauty.

E.V. Zhalovskaya, doctor-dermatovenerologist.