Demodex Mites and Elastotic Degeneration

[Brady Barrows]

Originally Posted by Michael_V

That aside, I am far more interested in the collagen aspect of the disease, which seems to me a novel way of looking at it.

Here is what Food for Appearance
Which Foods Have a Direct Impact on Your Looks?
by Ankie Renique says:

Collagen is a natural protein in your skin and muscles that provides resiliency, shape and texture. Unfortunately, collagen production decreases with age but you can fight back with dark fruit. Blood oranges, cherries and blueberries are full of antioxidants, which decrease aging and disease by lowering inflammation. Antioxidants also increase collagen production and thicken the skin, making you look younger and healthier. The severity of rosacea has also been shown to decrease with antioxidants. Blackberries, raspberries, plums, pomegranates, cranberries, asian dragon fruit and kiwis also contain antioxidants. Source

[GJ]

Originally Posted by leesah

Does rosacea inflammation break down collogen, change the dermis and fibrillar structure and weaken the connective tissue?

This doesn't answer that but hints at answers. A nice article. With photos!

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1602424/

Complex business. Unending questions. My spidey sense tells me there's something not quite right with the novel theory Michael has happened upon.

Do unusually volatile blood vessels, or vessels that are dilated for long periods, affect the surrounding tissue? There are suggestions that they might. And so on...

Given the uhelpfully broad defintion of rosacea the amateur researcher will always encounter difficulties when trying to reconcile his theories with such a broad church of symptoms. (The professional might encounter fewer difficulties: you may imagine that when a cure, or something near to a cure, is found, the person who finds his condition unchanged will be told he doesn't have rosacea after all..)

[Mistica]

Originally Posted by leesah

I am new to researching Rosacea and learning that not all people suffering have had U.V damage.

So please excuse my ignorance with this question, but could those histologic studies have wrongly revealed the presence of significant solar elastotic degeneration because the rosacea inflammation itself actually degrades the skin in a similar manner as long term U.V exposure.

Does rosacea inflammation break down collogen, change the dermis and fibrillar structure and weaken the connective tissue?

Thanks, Leesah

This is what I was suggesting in a post near the beginning of this thread. I had suggested excessive levels of ATP as this can cause trauma to surrounding tissue.
Cryptic bacteria also cause damage to surrounding tissue. (Both of these processes have been proven in general).
Any inflammation from any cause can result in this.
I am certain that UV exposure is not a primary cause. It may be a secondary player in some people.

[Melissa W]

I tend to agree with the thought that UV exposure is not a major factor for some (if not many) of us. I cannot recall any major sunburns, unprotected sun etc. My dad was vigilant about us being protected all through our childhood as he is extremely fair skinned as am I. I also lean towards the cpn explanation as part of the issue but in truth we probably won't know the whole truth for quite a while if at all in our lifetime. In the meantime it is good to share ideas as you never know who will crack the secret of rosacea

[college_senior]

I have been looking at the epidermis skin layer on charts and graphs. It looks like for rosaceans, our skin has become victim to NOT being able to contain or hold our blushing and flushing.

Everybody gets hot, humind, etc., but their skin has the ability to "mask" (if you will) the appearance of it.

Am I way off here?

[Wistar]

Originally Posted by Brady Barrows

I don't know why getting a physician to take a demodex mite density test is such a big deal, but it may be due to the prevailing view because of misinformation on the subject that demodex is not a big player in rosacea. We know that it is not a major player, but relegating demodex to a minor player seems to be the reason physicians dismiss demodex and not take a skin scraping and examine in a microscope a demodex density count. If rosaceans would insist on such a test and find a physician willing to do this test, in time, probably years, there would be enough data available for clinicians to do some clinical studies on this subject to evaluate what role demodex has in rosacea, substantiating whether it truly is a minor player or what per cent of the rosacea population demodex is a major factor. Currently there are very few physicians encouraging demodex density counts. Powell is one of the few physicians encouraging demodex density counts and taking skin scrapings. Whether demodex is a factor in your rosacea only a test can confirm. Treating for demodex might indicate that is the problem if you get relief from the treatment but it would not confirm demodex unless you test for it.

I think a skin biopsy test is not necessary. An emperical test approach is more effective. If an acaricide clears the skin, therefore it must be mites causing the symptoms. The density of mites in a patch of skin is irrelevant and merely a statistic of interest to a medical researcher writing a paper. A GP seeing a patient with papulopustular rosacea, should just try an acaricide for a few weeks. The number of patients that respond to an acaricide would be much more interesting than counting mites in a random column of skin extracted from a patient, which in itself seems a highly dodgy way of determining a mite density.

[Brady Barrows]

Originally Posted by Wistar

I think a skin biopsy test is not necessary. An emperical test approach is more effective. If an acaricide clears the skin, therefore it must be mites causing the symptoms. The density of mites in a patch of skin is irrelevant and merely a statistic of interest to a medical researcher writing a paper. A GP seeing a patient with papulopustular rosacea, should just try an acaricide for a few weeks. The number of patients that respond to an acaricide would be much more interesting than counting mites in a random column of skin extracted from a patient, which in itself seems a highly dodgy way of determining a mite density.

This sounds logical and may be the reason why physicians don't perform mite density tests. Do you have some sort of background knowing these things or do you have something to back this up? I am impressed by your presentation. And what acaricide are you recommending?

Actually, doesn't it take about five minutes to ten minutes to perform a skin scraping and examination under a microscope for a demodex density count? That is what I have been told. I suppose it only takes a couple of minutes to just write a prescription and ask the patient to return in a few weeks for another examination to see if it worked. I can see why most physicians wouldn't want to waste time counting mites.

[Mistica]

With regard to the following:

The number of patients that respond to an acaricide would be much more interesting than counting mites in a random column of skin extracted from a patient, which in itself seems a highly dodgy way of determining a mite density.

There is a study floating around the net which determined that testing of mite populations was difficult and produced different results when performed at varying intervals during the day.
From memory, one doctor did a skin scraping on the cheek of a rosacean and found an average amount of demodex. Hours later she redid the test only to find an enormous density of mites in exactly the same area.
This would suggest that testing is an unreliable method of determining if demodex have proliferated or not, especially if the physican only performs one test. This could lead him/her to inaccurate conclusions.

I don't have the study bookmarked as I lost interest in demodex a long time ago.
Some googling will be necessary.
Perhaps it has already been posted on this forum at some point?

[Brady Barrows]

Originally Posted by Mistica

With regard to the following:
There is a study floating around the net which determined that testing of mite populations was difficult and produced different results when performed at varying intervals during the day.
From memory, one doctor did a skin scraping on the cheek of a rosacean and found an average amount of demodex. Hours later she redid the test only to find an enormous density of mites in exactly the same area.
This would suggest that testing is an unreliable method of determining if demodex have proliferated or not, especially if the physican only performs one test. This could lead him/her to inaccurate conclusions.

I don't have the study bookmarked as I lost interest in demodex a long time ago.
Some googling will be necessary.
Perhaps it has already been posted on this forum at some point?

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.

[Michael_V]

Originally Posted by Brady Barrows

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.

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.