A Cross-Sectional Survey of the Relationship between Rosacea and Demodex Mite Infestation in Patients Referred to the Medical Centers of Tabriz University of Medical Sciences

Shahab Gitifard; Aliakbar Shekarchi; Mehdi Amirnia; Rahim Asghari-Azar; Teimour Hazratian

A Cross-Sectional Survey of the Relationship between Rosacea and Demodex Mite Infestation in Patients Referred to the Medical Centers of Tabriz University of Medical Sciences

Abstract

Background: Rosacea is a common chronic and recurrent skin disease whose etiology is not precisely clear. This study aimed to investigate the relationship between rosacea and Demodex mite infestation in patients referred to the medical centers of Tabriz University of Medical Sciences during 2023.

Methods: Patients’ information, including age, gender, and clinical symptoms of rosacea diagnosis, was recorded. 60 out of 71 patients underwent standard superficial skin biopsy with a thickness of 5 μm from their faces, with a drop of immersion oil, and were examined under a light microscope.

Results: The mean Demodex density was 19.20 mites/cm². Of these 60 rosacea patients, 47 (78.3%) were female and 13 (21.7%) were male. The highest Demodex mite infestation was in the 31^_40 age group (38%). Out of 50 patients with positive Demodex (83.3%), 41 (68.3%) were related to D. folliculorum and 9 (15%) were related to D. brevis. Of the 41 patients infected with Demodex, 31 (out of 47, 66.0%) were women and 10 (out of 13, 76.9%) were men. The p-values for the relationships between age, gender, and mite species with mite count were all greater than 0.05. This indicates no statistically significant evidence of a direct relationship.

Conclusion: Demodex mite density was higher in rosacea than the normal benchmark of <5 mites/ cm². This strong association suggests Demodex overpopulation plays a key role in the disease. Therefore, treatment strategies for rosacea should include acaricidal therapy targeting the mites.

1. Buechner SA (2005) Rosacea: an update. Derm. 210(2): 100 –108.
2. Tan J, Berg M (2013) Rosacea: Current state of epidemiology. J Am Acad Derm. 69 (6): 27_ 35.
3. Sepoendilin J (2012) A study on the epi¬de-miology of rosacea. Br J Derm. 167 (3): 598–605.
4. Pelle MT, Crawford GH, James WD (2004) Rosacea: II. Therapy. J Am Acad Derm. 51(4): 499–512.
5. Schaller M, Almeida LMC, Bewley A, Cribier B, Dlova NC, Kautz G, Mannis M, Oon HH, Rajagopalan M, Steinhoff M, Thiboutot D, Troielli P, Webster G, Wu Y, Van Zuuren E, Tan J (2017) Rosacea treatment update: recommenda-tions from the global rosacea consensus (ROSCO) panel. Br J Derm. 176(2): 465–471.
6. Yamasaki K, Gallo RL (2009) The mo¬lec-ular pathology of rosacea. J Derm. 55(2): 77–81.
7. Steinhoff M, Buddenkotte J, Aubert J, Sulk M, Novak P, Schwab VD, Mess C, Cevikbas F, Rivier M, Carlavan I, Deret S, Rosignoli C, Metze D, Luger TA, Voegel JJ (2011) Clinical, cellular and molecular aspects in the pathophysiolo-gy of rosacea. J Investig Dermatol Symp Proc. 15(1): 2–11.
8. Culp B, Scheinfeld N (2009) Rosacea: A review. P T. 34(1): 38–45.
9. Oge LK, Muncie HL, Philips-Savoy AR (2015) Rosacea: Diagnosis and treat-ment. Am Fam Physician. 92 (3): 187–196.
10. Powell FC (2005) Rosacea. N Engl J Med. 352: 793–803.
11. Abokwidir M, Feldman SR (2016) Rosacea management. Skin Appendage Disord. 2 (1_2): 26–34.
12. Zuuren EJV (2007) Systematic review of rosacea treatments. J Am Acad Derm. 56 (1): 107_115.
13. Biernat MM, Rusiecka-Ziolkowska J, Pi-atkowska E, Helemejko I, Biernat P, Goscin¬iak G (2018) Occurrence of De-modex species in patients with blephari-tis and in healthy individuals: a 10–year ob¬servational study. Jpn J Ophthalmol. 62(6): 628–633.
14. Forton FMN (2020) The pathogenic role of Demodex mites in rosacea: A poten-tial therapeutic target already in ery-themato¬telangiectatic rosacea. Derm. 10: 1229–1253.
15. Gerber PA, Alexandra Buhren B, Stein-hoff M, Homey B (2011) Rosacea: the cytokine and chemokine network. J In-vestig Dermatol Symp Proc. 15(1): 40_46.
16. Moravvej H, Dehghan–Mangabadi M, Abas¬sia MR, Meshkat–Razavi G (2007) Asso¬ciation of rosacea with democosis. Arch Iranian Med. 10(2): 199–203.
17. Horvath A, Neubrandt DM, Ghidan A, Nagy K (2011) Risk factors and preva-lence of Demodex mites in young adults. Acta Mi¬crobiol Immunol Hung. 58(2): 145_155.
18. Basta- Juzbasic A, Subic JS, Ljubojevic S (2002) Demodex folliculorum in devel-op¬ment of dermatitis rosaceiformis ste-roidica and rosacea-related diseases. Clin Derm. 20: 135–140.
19. Post CF, Juhlin E (1963) Demodex follic-ulorum and blepharitis. Arch Derm. 88: 298–302.
20. Erbagci Z, Ozgoztasi O (1998) The sig-nificance of Demodex folliculorum den-si¬ty in rosacea. Int J Derm. 37: 421–425.
21. Georgala S, Katoulis AC, Kylafis GD, Kou¬mantaki-Mathioudaki E, Georgala C, Aroni A (2001) Increased density of De¬modex folliculorum and evidence of de¬layed hypersensitivity reaction in sub-jects with papulpustular rosacea. J Eur Acad Dermatol Venereol. 15(5): 441–444.
22. Morras PG, Santos SP, Imedio I, Eche-verria ML, Hermosa JMH (2003) Rosacea-like demodicosis in an im-munocomoromised child. Pediatr Der-ma¬tol. 20(1): 28–30.
23. Lane RP, Crosskey RW (2012) Medical Insects and Arachnids. Springer Science & Business Media.
24. Roihu T, Kariniemi AI (1998) Demodex mites in acne rosacea. J Cutan Pathol. 25: 550–552.
25. Lacey N, Delaney S, Kavanagh K, Pow¬ell FC (2007) Mite-related bacterial anti-gens stimulate inflammatory cells in rosacea. Br J Derm. 157: 474–481.
26. Liu J, Sheha H, Tseng SC (2010) Patho-genic role of Demodex mites in blepha¬ri-tis. Curr Opin A Clin Immunol. 10: 505–510.
27. Lee SH, Chun YS, Kim JH, Kim ES, Kim JC (2010) The relationship between De-modex and ocular discomfort. Invest Oph¬thalmol Vis Sci. 51: 2906–2911.
28. Rufli T, Mumcuoglu Y (1981) The hair follicle mites Demodex folliculorum and Demodex brevis: Biology and medical im¬portance. A review. J Derm. 162: 1–11.
29. Gonzalez-Hinojosa D, Jaime-Villalonga A, Aguilar-Montes G, Lammoglia-Ordiales L (2018) Demodex and rosacea: Is there a relationship? Indian J Ophthal¬mol. 66 (1): 36-38.
30. Moran EM, Foley R, Powell FC (2017) Demodex and rosacea revisited. Clin Der¬matol. 35(2): 195–200.
31. Cengiz ZT, Yilmaz H, Uce Ozkol H, Ekici A, Odemis N (2014) The preva¬lence of Demodex sp. in patient admit¬ted to the parasitology laboratory of the Dur¬sun Oda¬bash Medical Center in Yuzuncu Yil Uni¬versity, Van. J T Para¬sitol Derg. 38(1): 9–11.
32. Zhong J, Tan Y, Li S, Peng L, Wang B, Deng Y, Yuan J (2019) The prevalence of Demodex folliculorum and Demodex brevis in Cylindrical dandruff patients. J Ophthalmol. 1(1): 1_7.
33. Jarmuda S, Reilly NO, Zaba R, Jaku¬bow-icz O, Szkaradkiewicz A, Kavanagh K (2012) Potential role of Demodex mites and bac¬teria in the induction of rosacea. J Med Microbiol. 61(11): 1504_1510.
34. Noreen L, Kevin K, Scheffer CGT (2009) Under the lash: Demodex mites in hu-man diseases. J Biochem. 31(4): 20_24.
35. Wilkin JK (1994) Rosacea pathology and treatment. Arch Derm. 130: 359–362.
36. Jansen T, Plewig G (1997) Rosacea: Clas-si¬fication and treatment. J R Soc Med. 90: 144–150.

Files	XML PDF (595KB)
Issue	Vol 19 No 2 (2025)
Section	Original Article
Keywords
Rosacea; Demodex; Mite; Demodicosis; Iran

Rights and permissions
	This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

How to Cite

Gitifard S, Shekarchi A, Amirnia M, Asghari-Azar R, Hazratian T. A Cross-Sectional Survey of the Relationship between Rosacea and Demodex Mite Infestation in Patients Referred to the Medical Centers of Tabriz University of Medical Sciences. J Arthropod Borne Dis. 2025;19(2):165-172.

Vancouver

Download Citation