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Thread: Demodex Mites and Elastotic Degeneration

  1. #61
    Senior Member Brady Barrows's Avatar
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    Default demodex density tests have shown something is amuck

    Quote Originally Posted by Michael_V View Post
    Yes, it is fairly well established that demodex populations are increased in rosaceans, so I am not sure what would be gained through skin scrapings.

    A skin biopsy, on the other hand, while mildly invasive, could be useful in distinguishing rosacea from rosacea-like demodicidosis because we should expect to see mite-filled follicles with perifollicular inflammation in the latter.

    Still, I think the previous poster made a better point: it doesn't greatly matter what percentage of rosaceans have increased demodex densities (presumably, we all do), but what percentage improve after treatment with acaricidals. This empirical approach makes more sense to me, and gives better information.

    One more point: why are demodex increased in rosaceans, even if the mites are not responsible for our disease in most cases? Two good reasons: (1) the compromised structural integrity and altered blood flow to our faces makes our skin a more hospitable environment for them and (2) per Gallo's theory, we have altered dermal immunity that makes us susceptible to opportunistic infections with pathogens that are normally commensal in immunocompetent individuals (like demodex and malassezia).

    So, yes, it is worthwhile to screen rosaceans for treatable causes like demodex (but not with a skin scraping: too many false positives). But spending too much time thinking about and attempting to eradicate what amounts to normal skin flora is (in my view) trying to treat the smoke without first putting out the fire.
    You do make a lot of practical sense. Just remember though, if they hadn't been taking demodex density tests we wouldn't even know about these buggers. I think it will boil down to how much time it takes and how much it costs to test for demodex or to just treat the demodex. Now what do you think the physicians will do? Write a prescription for demodex treatment or perform a test that likely costs less?
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  2. #62
    Senior Member Michael_V's Avatar
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    Default

    Quote Originally Posted by Brady Barrows View Post
    You do make a lot of practical sense. Just remember though, if they hadn't been taking demodex density tests we wouldn't even know about these buggers. I think it will boil down to how much time it takes and how much it costs to test for demodex or to just treat the demodex. Now what do you think the physicians will do? Write a prescription for demodex treatment or perform a test that likely costs less?
    I don't think it comes down to cost.

    If there were a good test (few false positives or false negatives) that predicted treatment success, it would make sense to implement it wholesale throughout the rosacea community. But so far, the mere presence of demodex in a skin scraping
    from a rosacean does not predict remission with acaricidals. On the other hand, remission after an empirical trial of acaricidals does happen to tell us perfectly which patients will improve with treatment (!). And this is really what we want to know, isn't it? Not "do I have high numbers of demodex?" because we already know we do, but "will acaricidals cure me?"

  3. #63
    Senior Member Brady Barrows's Avatar
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    Default data is all we get

    Quote Originally Posted by Michael_V View Post
    I don't think it comes down to cost.

    If there were a good test (few false positives or false negatives) that predicted treatment success, it would make sense to implement it wholesale throughout the rosacea community. But so far, the mere presence of demodex in a skin scraping
    from a rosacean does not predict remission with acaricidals. On the other hand, remission after an empirical trial of acaricidals does happen to tell us perfectly which patients will improve with treatment (!). And this is really what we want to know, isn't it? Not "do I have high numbers of demodex?" because we already know we do, but "will acaricidals cure me?"
    You are right practically speaking. Comparing the demodex density count with a huge number of rosaceans simply gets us data. If the data is useful depends on points of view and comparisons. Most of the demodex density counts that are in the clinical studies are on so few cases that it would be interesting at least to compare with a huge rosacea population, but as you have pointed out, their is no motive for physicians and rosaceans to do these tests. Clearing rosacea with treatment is more important and understandably so as you distinctly point out.
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  4. #64
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    Thumbs up Best acaricides for treating demodex

    Quote Originally Posted by Brady Barrows View Post
    And what acaricide are you recommending?
    Benzyl Benzoate 25% lotion was the last acaricide I used. I was very impressed with the results. It worked so well I stopped all treatment after just 6 days of use. That was about 4 weeks ago. I have not relapsed so far and remain clear of papules.

    I have been using various acaricides for about 20 months in total. Previously permethrin 5% cream was my favourite, but my recent experience with BB has moved it right up to the top of my list for efficacy.

    In order of efficacy from my personal experience at clearing demodicosis/papulopustular rosacea:

    1. Benzyl Benzoate 25% lotion
    2. Permethrin 5% cream
    3. Ivermectin 1% (best for eye area, cleared mite induced blepharitis in one dose)
    4. Crotamiton 10% (Eurax cream or lotion) (lotion good for use in ears for otitis externa)
    forget about sulphur, nasty stuff

  5. #65
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    Default Counting mites

    Quote Originally Posted by Brady Barrows View Post
    Comparing the demodex density count with a huge number of rosaceans simply gets us data. If the data is useful depends on points of view and comparisons.
    With so many different ways of collecting the mites from the skin, it is unlikely to be comparable. However it might be useful to know which exact species of mite is involved. Is it always the demodex folliculorum or are other species involved? Some methods of counting mites are mentioned here:

    The diagnosis of Demodex infestation can be easily confirmed by direct microscopic examination of skin scrapings, expressed follicular contents, adhesive tape, cyanoacrylate glue (skin surface biopsy) and skin biopsy specimens. Interestingly, the number of mites varies greatly with the site examined and the method employed (3, 9). A classical skin biopsy shows a perifollicular infiltrate with the presence of numerous Demodex in the dilated ostium of hyperkeratotic follicles (10). One could also observe dilated vessels and extrafollicular granulomatous reactions to Demodex in the dermis. Recently, a noninvasive sampling method, a so-called standardized skin surface biopsy (SSSB), has been successfully employed (9). However, SSSB can fail to reflect the complete biotope of the Demodex, which can be much higher, since it collects only the superficial part of the skin (11).source

  6. #66
    Senior Member Mistica's Avatar
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    Quote Originally Posted by Brady Barrows View Post
    I keep a large file of research papers listed at this url. It has been fairly well established that the density is high in a significant number of cases of rosacea, enough to warrant a large number of clinical studies. Obviously there could be more research on how to accurately test for demodex density since there doesn't seem to be a standardized test for this mentioned anywhere. You have a point that needs to be further substantiated with further trials if we could find the article.
    Here it is.

    http://findarticles.com/p/articles/m.../ai_n29204472/

    In hyperkeratotic skin, experience has shown that even if numerous mites are present in the first biopsy, they represent a small portion of the mites present. Mites congregate on various levels in elongated and hyperkeratotic follicles.

    Dr. Forton explained that in one of her patients with erythema telangiectatic rosacea, the initial skin biopsy resulted in a Demodex density (Dd) of 24 D/[cm.sup.2]. However, four subsequent biopsies performed on the same area of the patient's cheek on the same day resulted in a total Dd of 1,154 mites/[cm.sup.2] (24 269 499 317 45).
    Previous Numerous IPL, ZZ cream.
    Supplements: Vit K2, High Dose Vit C, BHCL, Digestive Enzymes, Ionic trace mineral drops, low dose iodine to correct deficiency.
    Skin Care: Cetaphil Gentle Cleanser, or ZZ soap.

    Treating for gut infections under specialist care. (This is helping).
    GAPS diet foods/no probiotics.

  7. #67
    Senior Member Mistica's Avatar
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    Quote Originally Posted by Wistar View Post
    Benzyl Benzoate 25% lotion was the last acaricide I used. I was very impressed with the results. It worked so well I stopped all treatment after just 6 days of use. That was about 4 weeks ago. I have not relapsed so far and remain clear of papules.

    I have been using various acaricides for about 20 months in total. Previously permethrin 5% cream was my favourite, but my recent experience with BB has moved it right up to the top of my list for efficacy.

    In order of efficacy from my personal experience at clearing demodicosis/papulopustular rosacea:

    1. Benzyl Benzoate 25% lotion
    2. Permethrin 5% cream
    3. Ivermectin 1% (best for eye area, cleared mite induced blepharitis in one dose)
    4. Crotamiton 10% (Eurax cream or lotion) (lotion good for use in ears for otitis externa)
    forget about sulphur, nasty stuff
    Hi Wistar,

    You recently attributed your ability to remain clear of P&P's following use of acaricides, to high doses of vitamin D3.
    Could you please elaborate on this?

    Thanks!
    Previous Numerous IPL, ZZ cream.
    Supplements: Vit K2, High Dose Vit C, BHCL, Digestive Enzymes, Ionic trace mineral drops, low dose iodine to correct deficiency.
    Skin Care: Cetaphil Gentle Cleanser, or ZZ soap.

    Treating for gut infections under specialist care. (This is helping).
    GAPS diet foods/no probiotics.

  8. #68
    Senior Member Michael_V's Avatar
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    Default

    Quote Originally Posted by Mistica View Post
    However, four subsequent biopsies performed on the same area of the patient's cheek on the same day resulted in a total Dd of 1,154 mites/cm2.
    OMG, that just gave me the heebie-jeebies!

  9. #69
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    Default Still doing the D3

    Quote Originally Posted by Mistica View Post
    Hi Wistar,

    You recently attributed your ability to remain clear of P&P's following use of acaricides, to high doses of vitamin D3.
    Could you please elaborate on this?

    Thanks!
    I started D3 at 10,000 iu/d at beginning of October. Right at the time I stopped using the acaricides. It could be the D3 is helping keep me clear. Not sure how I can know if D3 is working or not.

    On the first day, after taking the D3, I had a hot head, like a fever that lasted about 6 hours with intense tingling in my cheeks and ears. My forehead was really hot. After the second dose of D3, it came back but less intense. It certainly felt like something was happening.

    I am still taking the D3 everyday at the same dose. I don't get the hot head effect any more. Something is definitely working as no relapse for 4 weeks is a new record for me.

  10. #70
    Senior Member Michael_V's Avatar
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    ... and now I'm motivated for another round of acaricidals!

    I just ordered some Origins Youthtopia Skin Firming Lotion that contains benzyl benzoate (and some other interesting ingredients), although I'm not sure in what concentration.

    Wistar, where does one obtain benzyl benzoate 25% lotion?

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