Demodex Mites – Complete Information

Demodex Mites is a human parasite found in or near the pilosebaceous units. Demodex folliculorum and Demodex brevis are the two types of Demodex mites typically found in humans. D. folliculorum is more commonly localized to the face, while D. brevis is more commonly found on the neck and chest. Infestation with D. folliculorum is more common than with D. brevis, but the latter has a wider distribution on the body.

They are typically found on the face including cheeks, nose, chin, forehead, temples, eyelashes, brows, and the balding scalp, neck, and ears. Other seborrheic regions such as peri-orbital areas, nasolabial folds, and less commonly upper and medial regions of the back and chest are also infested. They may also be found in the ectopic sebaceous glands in the buccal mucosa and also on the penis, mons veneris, and buttocks.

Increased numbers of Demodex mites have been observed in the following conditions:

• Demodex folliculorum – rough skin due to increased scale within hair follicles
• Rosacea, particularly granulomatous variants or asymmetrical papulopustular
• Demodectic frost of the ear – frosted, gritty follicular scaling of the ear lobe and helix
• Some cases of perioral dermatitis (also affecting periorbital or periauricular sites)
• Otitis externa (auricular demodex) 
• Seborrheic dermatitis (dryness, redness, and irritation of the skin)
• Demodex abscess

All cutaneous diseases caused by Demodex mites are clubbed under the term demodicidosis or demodicosis which can resemble a variety of dermatoses.

Demodicidosis can clinically be classified as primary or secondary. Primary demodicidosis refers to the lesions that occur in people who do not have an underlying systemic illness that may impact immunity resulting in reduced normal activity, while secondary demodicidosis occurs in individuals with a systemic condition leading to a history of inflammatory dermatosis or immunosuppression. Phototherapy, chronic renal failure, topical glucocorticoids, calcineurin inhibitors, and treatment with epidermal growth-factor-receptor inhibitors are all potential causes of secondary demodicidosis.

Demodex is diagnosed by KOH examination or skin biopsy.

Demodex mites result in non-specific symptoms and signs on facial skin. These most often include:

• Follicular scales
• Redness
• Sensitive skin
• Itching
• Papules 
• Macules 
• Eczema
• Folliculitis 
• Pigmentation
• Patients may have eye irritation, itching, and scaling of eyelids (blepharitis or eyelid dermatitis)
• There may be lid thickening, conjunctival inflammation, loss of lashes, and decreased vision.

Demodex mites can be cured with various treatments. These include

• Shampoos containing tea tree oil: can help to reduce Demodex mites. It can be used on the hair and eyelashes daily. It can also be combined with macadamia nut or walnut oil to decrease patient discomfort and toxicity to the ocular surface while maintaining efficacy in eradicating the mites.

• Lid scrubs, lid foams, or lid cleansing wipes: can be used with a blepharitis brush or a cotton-tipped applicator to remove eyelash collarettes.

• Cleansing the face: twice daily with a non-soap cleanser.

• Moisturize: the skin continuously

• Avoiding oil-based cleansers and greasy makeup: can help to reduce Demodex mite-built-up

• Exfoliating: periodically to remove dead skin cells

• Skincare ingredients: like squalane, azelaic acid, and hypochlorous acid can be used to reduce Demodex mites

• Diets: You could also try different diets to see if there are any changes in your condition.

• Benzyl benzoate solution
• Permethrin cream
• Sulfur ointment
• Crotamiton cream
• Lindane cream
• Selenium sulfide wash
• Metronidazole gel
• Salicylic acid cream
• Ivermectin cream
• Tacrolimus

• Intense pulsed light (IPL): can be used for managing demodicosis. The heat transfer may be beneficial in killing the Demodex mites and for MGD, reducing inflammatory mediators, and softening meibum.

• Microblepharoexfoliation (MBE): removes debris on the surface of the eyelids and lashes and has been used in combination with daily at-home eyelid hygiene. Although the results were better than eyelid hygiene alone, the results were not clinically meaningful in eliminating Demodex.

• Cliradex and Cliradex Light (towelettes and foam): it contains 4-Terpineol (T40)

• OUST Demodex Swabstix and OUST Demodex Cleanser (premoistened pads): it contains 50% tea tree oil, 40% sea buckthorn oil, and 10% caprylic acid.

• OCuSOFT Lid Scrub Plus (premoistened pads, Swabstix): it contains 1,2-Octanediol and detergents.

• Avenova Eyelid and Eyelash Cleanser Spray: it contains 0.01% hypochlorous acid

Treatment for periorbital demodicosis involves spreading an ointment at the base of the eyelashes at night to trap mites as they emerge from their burrow and move from one hair follicle to another. One treatment is to scrub the lashes and lash roots gently with baby shampoo, then treat the area with macadamia nut oil or tea tree oil to try and kill any eggs.

Patients with ocular demodicosis can use Cliradex (which contains TTO as an active component) as an eyelid scrub twice daily for 3 months to eradicate Demodex mites. Specifically, after washing the face and eyelids with baby shampoo or soap and rinsing with warm water, Cliradex is smeared onto the eyelash roots at both the upper and lower eyelid margins with the eyes closed.

There is also increasing evidence that Demodex infestation is a potential cause of ocular surface inflammation in MGD, pterygium, chalazia, blepharitis, eyelid basal cell carcinoma, blepharoconjunctivitis, and sight-threatening keratitis.

Demodex folliculitis can masquerade as perioral dermatitis making it difficult to diagnose at first. The above-mentioned treatments will help to reduce perioral Demodex folliculitis.

Although sebaceous glands – home to Demodex parasites – are also in the mouth, only one case of Demodex infection in the mouth has been reported. Saliva contains compounds that kill most germs and parasites and make the environment unsuitable for them to live.

You can use topical medical prescriptions like ivermectin, permethrin, tea tree oil shampoo, sulfur ointment, crotamiton, lindane, or metronidazole gel (your doctor can suggest the best one for you). All of these can help get rid of Demodex mites on the scalp.

Hydrogen peroxide can be used for Demodex mites but won’t be as effective as other treatments.

Yes, Demodex mites may cause perioral dermatitis but they are very limited.

Yes, Demodex mites can cause dry eyes.

No, hair dye cannot kill Demodex mites.

No, sunlight does not kill Demodex mites.

No, salt water does not kill Demodex mites.

No, lice shampoo does not kill Demodex mites.

No, ketoconazole does not kill Demodex mites.

Yes, vaseline can help kill Demodex mites and is more effective than tea tree oil. It can be used on the scalp, face, and eyes. Using Vaseline near the eyes can help decrease symptoms of blepharitis associated with dry eyes, such as foreign body sensation and transient blurring of vision. It can also reduce tear evaporation rates and improve blink rates.