High-Definition Optical Coherence Tomography for the in vivo Detection of Demodex Mites

Background: Demodex mites are involved in different skin diseases and are commonly detected by skin scrape tests or superficial biopsies. A new high-definition optical coherence tomography (HD-OCT) with high lateral and axial resolution in a horizontal (en-face) and vertical (slice) imaging mode might offer the possibility of noninvasive and fast in vivo examination of demodex mites. Methods: Twenty patients with demodex-related skin diseases and 20 age- and gender-matched healthy controls were examined by HD-OCT. Mites per follicle and follicles per field of view were counted and compared to skin scrape tests. Results: HD-OCT images depicted mites in the en-face mode as bright round dots in groups of 3-5 mites per hair follicle. In the patients with demodex-related disease, a mean number of 3.4 mites per follicle were detected with a mean number of 2.9 infested follicles per area of view compared to a mean of 0.6 mites in 0.4 infested follicles in the controls. The skin scrape tests were negative in 21% of the patients. Conclusion: The innovative HD-OCT enables fast and noninvasive in vivo recognition of demodex mites and might become a useful tool in the diagnosis and treatment monitoring of demodex-related skin diseases. Copyright (C) 2012 S. Karger AG, Base

The Modern Approach To The Complex Therapy Of Demodicosis

Demodicosis is one of the most common diseases of the skin. Despite the large number of scientific publications on this issue the question of the etiology and pathogenesis of this disease still remains unresolved and the development of more effective methods of treatment and prevention has not only medical but also social significance as patients preserving the working ability have actually long enough to be on outpatient and even inpatient treatment. In addition the long existence of the rash on the face that is the "business card" leads to the secondary sometimes severe neurotic disorders that results in reducing abilities, isolation, unwillingness to be in a team, family, etc.We investigated the effect of complex therapy which had been conducted by means of antiparasitic, immunomodulatory, anti-inflammatory and desensitizing drugs in patients with demodicosis, as well as mandatory adjustment of changes in the hepato- panсreato-duodenal system. We examined 109 patients with demodicosis from 18 to 39 years old and 10 healthy individuals of the corresponding age and sex. It was established that the effectiveness of treatment of demodicosis based on the application of albendazole in the complex treatment along with immune-modulating therapy and hepatoprotection increased significantly. There has been a reliable rapid regression of clinical symptoms in most patients with demodicosis

Reflectance confocal microscopy for the diagnosis of skin infections and infestations

Reflectance confocal microscopy (RCM) is a noninvasive real-time imaging technique that has been widely used for the diagnosis of skin cancer. More recently, it has been reported as a useful tool for the diagnosis and management of several inflammatory and infectious skin disorders. This article provides an overview of the current available applications of RCM use in cutaneous infections and infestations. PubMed was used to search the following terms in various combinations: reflectance confocal microscopy, skin, hair, nail, infection, parasitosis, mycosis, virus, bacteria. All papers were accordingly reviewed. In most cutaneous infections or infestations, the main alterations are found in the epidermis and upper dermis, where the accuracy of confocal microscopy is nearly similar to that of histopathology. The high resolution of this technique allows the visualization of most skin parasites, fungi, and a few bacteria. Although viruses cannot be identified because of their small size, viral cytopathic effects can be observed on keratinocytes. In addition, RCM can be used to monitor the response to treatment, thereby reducing unnecessary treatments

Demodex- a silent "friend"

Demodex is commonly found in the human population, in skin sebaceous glands or follicles. The frequency of Demodex infection increases with age, as it is mainly diagnosed after the age of seventy. Demodex folliclorum and Demodex brevis (commonly referred to as Demodex) are the most common human osteoporosis. Demodex folliculorum occurs in the hair follicle (especially in genes), while Demodex brevis occurs in the sebaceous glands

Роль ураження демодексом шкіри зовнішнього вуха, як фактору розвитку інших паразитарних захворювань зовнішньго вуха

Збудники демодекозу у людини — це кліщі Demodex folliculorum та Demodex brevis, що з родини Demodecidae. У 1841 році збудник демодекозу був вперше відкритий. У 1843 році класифікований та отримав назву Demodex folliclorum. У 1963 році був виділений Demodex brevis, а у 1972 році вчені довели існування двох видів демодексу

Tetracycline Actions Relevant to Rosacea Treatment

Until today, the pathogenesis of rosacea is not known in detail. Yet in recent years evidence has been accumulating that rosacea with its common symptoms such as inflammatory lesions, erythema, telangiectasia, phymatous changes, and ocular symptoms is of inflammatory nature. Tetracycline derivatives like doxycycline successfully used in the treatment of skin diseases like acne and rosacea seem to inhibit different inflammatory pathways involved in the pathogenesis by various modes of action. Although data for skin diseases are relatively scanty, the following modes of action of tetracyclines seem to be most relevant for an effective treatment of acne and rosacea: inhibition of matrix metalloproteinases, downmodulation of cytokines, inhibition of cell movement and proliferation, inhibition of granuloma formation, inhibition of reactive oxygen species, nitric oxide, and angiogenesis, whereas inhibition of phospholipase A2 seems to be of lower importance. The role of the saprophytic mite Demodex folliculorum remains to be clarified. Additional studies are necessary to further elucidate how tetracyclines work in rosacea treatment. Copyright (C) 2009 S. Karger AG, Base

The role of hypothalamus-pituitary-adrenal (HPA)-like axis in inflammatory pilosebaceous disorders

Skin is the largest peripheral endocrine organ and functions as a hormone target and endocrine gland. A cutaneous hypothalamus-pituitary-adrenal (HPA)-like axis enables the skin to respond to stress and regulates its steroidogenic activity. The pilosebaceous unit is a site for production and metabolism of a number of steroid hormones, including stress and sex hormones. This is an overview of the important role that the cutaneous HPA-like-axis plays in the pathogenesis and treatment of inflammatory pilosebaceous disorders, including acne, rosacea, seborrheic dermatitis, and hidradenitis suppurativa

Investigation and Management of Demodex Folliculorum Blepharitis in Clinical Practice

Introduction: Blepharitis is a chronic inflammatory disorder of the eyelid margin. Blepharitis patients routinely present to and are managed by optometrists and ophthalmologists in practice. Demodex folliculorum is associated with anterior blepharitis. Presently, treatment with 50% tea tree oil is recommended by the American Academy of Ophthalmology for Demodex blepharitis. However, over-the-counter products have been developed and marketed at being effective for treating Demodex blepharitis. Purpose: To examine the efficacy of over-the-counter lid hygiene products and warm compress therapy for the treatment of Demodex blepharitis. Methods: Two hundred and forty-six participants were examined at multiple visits over four studies, for the presence and quantity of Demodex folliculorum. OCuSOFT® Lid Scrub® PLUS, dr.organic® tea tree face wash, Johnson’s® No More Tears® baby shampoo, MGDRx EyeBag® and the OPTASETM Moist Heat Mask were examined for treating Demodex blepharitis. Results and Conclusions: OCuSOFT® Lid Scrub® PLUS significantly reduced the quantity of Demodex folliculorum when used over two and four weeks. Dr.organic® tea tree face wash significantly reduced the quantity of Demodex folliculorum when used over four weeks. The OPTASETM Moist Heat Mask significantly reduced the quantity of Demodex folliculorum when used over eight weeks. The MGDRx EyeBag® did not demonstrate a significant reduction in the quantity of Demodex folliculorum over the duration of the study. Johnson’s® No More Tears® baby shampoo had no effect on the quantity of Demodex folliculorum and demonstrated a significant increase in tear film instability when used over an eight-week treatment period

Under the lash: Demodex mites in human diseases

Demodex mites, class Arachnida and subclass Acarina, are elongated mites with clear cephalothorax and abdomens, the former with four pairs of legs. There are more than 100 species of Demodex mite, many of which are obligatory commensals of the pilosebaceous unit of mammals including cats, dogs, sheep, cattle, pigs, goats, deer, bats, hamsters, rats and mice. Among them, Demodex canis, which is found ubiquitously in dogs, is the most documented and investigated. In excessive numbers D. canis causes the inflammatory disease termed demodicosis (demodectic mange, follicular mange or red mange), which is more common in purebred dogs and has a hereditary predisposition in breeding kennels1. Two distinct Demodex species have been confirmed as the most common ectoparasite in man. The larger Demodex folliculorum, about 0.3–0.4 mm long, is primarily found as a cluster in the hair follicle (Figure 1a), while the smaller Demodex brevis, about 0.2–0.3 mm long with a spindle shape and stubby legs, resides solitarily in the sebaceous gland (Figure 1b). These two species are also ubiquitously found in all human races without gender preference. The pathogenic role of Demodex mites in veterinary medicine is not as greatly disputed as in human diseases. In this article, we review the key literature and our joint research experience regarding the pathogenic potential of these two mites in causing inflammatory diseases of human skin and eye. We hope that the evidence summarized herein will invite readers to take a different look at the life of Demodex mites in several common human diseases

Efficacy of oral fluralaner for the treatment of canine generalized demodicosis: a molecular-level confirmation

BackgroundCanine generalized demodicosis is a common parasitic disease caused by the proliferation of Demodex mites. The introduction of isoxazoline class treatments in veterinary dermatology has resulted in apparently effective treatment of generalized demodicosis. The objective of this study was to evaluate the effectiveness of fluralaner for the treatment of canine generalized demodicosis using real-time PCR for the detection and quantification of Demodex DNA.MethodsTwenty privately owned dogs with clinical symptoms of generalized demodicosis and deep skin scrapings positive for Demodex canis mites were enrolled in the study. Following diagnosis (day 0) each dog was treated with fluralaner at the recommended commercial dose for tick and flea treatment (25-56 mg/kg) based on body weight. Clinical and mite count assessments, and hair sampling for molecular analyses were performed on days 0, 28, 56, 84 and 112. Demodex DNA was detected and quantified using real-time PCR.ResultsA single oral dose of fluralaner reduced Demodex mite counts in skin scrapings by an average of 98.9% in all dogs by day 28. No mites were recovered from skin scrapings from any treated dog by day 56, at which time the dog was considered to be clinically cured, with total hair regrowth. There were significant differences among examined dogs in qPCR cycle threshold (Ct) values on days 0, 28, 56, 84 and 112. Demodex DNA levels decreased (increasing Ct values) throughout the study. Mite DNA was present on day 112, possibly from dead mites, at values significantly lower than in samples taken on days 0, 28 and 56. Based on qPCR testing of diluted samples, the Demodex mite population was reduced by approximately 1000-fold on day 112.ConclusionsOral administration of fluralaner at the recommended dose to dogs with generalized demodicosis is highly effective for reducing Demodex mite populations and resolving clinical signs of generalized demodicosis. The presence of mite DNA may indicate that treatment did not kill all Demodex mites