Clinical picture, diagnosis and treatment of rosacea, complicated by Demodex mites
The article analyzes the clinical picture and course of rosacea in patients with Demodex mites. It presents the advantages of using the method of confocal laser scanning microscopy over the method of light microscopy of facial skin scrapes. The aimes were to study the influence of Demodex mites on the clinical picture and course of rosacea; to compare laboratory and instrumental diagnostic methods for detecting Demodex mites; to evaluate the effectiveness of external therapy aimed at eliminating Demodex mites. 212 people were examined. The study included healthy patients, patients with a diagnosis of rosacea with the presence and absence of Demodex. The presence of Demodex mites was confirmed by two methods of study (light microscopy of skin scrapes and confocal laser scanning in vivo microscopy). Demodex mites promote the development of acute-inflammatory morphological elements, increase the duration of the condition (more than 5 years, P<0.01) and the probability of recurrence (from 1 to 3 relapses in 39.5% of patients, P<0.05), resulting in a decrease in the quality of life of patients (dermatology life quality index is 12.5±4.5, P<0.05). Antiparasitic drug ivermectin, in the form of an external form, at a concentration of 1% has a high therapeutic efficacy (in 93.3% of cases). Demodex folliculorum shows signs of parasitism, while Demodex folliculorum brevis is a saprophyte. The severity of the condition does not depend on the quantitative load of the mites in the scrape. As an antiparasitic drug, it is recommended to use 1% ivertmectin.
In connection with the growth of cultural level of the society as a whole and the increase in individual exactingness to one’s own appearance, both among men and women, face dermatosis remain one of the pressing problems. Despite the large number of scientific works devoted to the pathogenesis of rosacea, the question of Demodex mites’ role in the development of the clinical picture of the condition remains open in the contemporary literature.
According to some authors, Demodex mites are representatives of the conditionally pathogenic microflora of facial skin along with Propionibacterium acnes, Staphylococcus epidermidis and Malassezia fungi.1,2 This opinion is supported by the fact that in 55-100% of cases, mites are detected, both in patients with face dermatosis and with patients having no clinical signs of dermatological illnesses.3-5 However, there are scientific papers proving that Demodex mites are capable of pathogenic parasitization and are the most frequently detected microbial agents in rosacea.4 At the same time, attention is drawn to the lack of Demodicosis diagnosis in the International Classification of Illnesses of X revision, which points to the fact that Demodex mites species act rather as an agent complicating the course of rosacea. Currently, two species of Demodex mites parasitize on human skin: Demodex folliculorum and Demodex brevis.6 The modern literature has no substantiated scientific studies indicating the role of the species belonging of the causative agent in the formation of the clinical picture of rosacea. Existing assumptions are not fully proven. The available data on the parasitization of Demodex mites in patients with rosacea are inconsistent and, in many cases, are mutually exclusive.
The available diagnostic methods for detecting Demodex mites do not meet the requirements of modern medicine, do not guarantee the absolute reliability of the test results, and are often traumatic. One modern diagnostic technique in dermatology is 25 lasers scanning in vivo microscopy.7 This is an innovative method, the advantages of which are non-invasiveness and high information content, however, to date, in the Russian Federation this method has not been used to detect Demodex mites. Thus, in order to improve the quality of diagnosis and therapy, it becomes necessary to conduct a scientific study with an analysis of the clinical picture, comparing the methods of diagnosis and treatment of patients with rosacea associated with Demodex mites.
The purpose of the study is to evaluate laboratory and instrumental diagnostics and therapy of patients with rosacea complicated by Demodex mites.