Demodex worms the cause of Seborrheic Dermatitis : theory

hello everyone,

I have been noticing some research of late, by chinese and american doctors (particularly Dr. Bokiowski of Ohio State U) claiming that microscopic demodex worms may be the cause of SD.

Demodex worms are more often considered to be a cause of Rosacea, but some reports are also associating demodex with SD.

I take interest in these reports for a number of reasons.

1) The food source of the worms is sebum. SD is an infection of the sebaceous glands. "The worms live around hair follicles (Demodex folliculorum hominis) or in the secretory ducts of sebaceous (fat) glands connected to the hair follicles (Demodex brevis) of humans. The preferred sites are facial skin, forehead, cheeks, nose wings..."

2) I have noticed several times that my SD has cleared while away on vacation. I have never had an explanation.

3) There have been scientific reports claiming that SD occurance is very, across the population, within some residential settings, such as elderly homes.

4) I first contracted SD in a group medical overnight setting with other patients.

5) The effectiveness against SD, of topical solutions such as sulfur, a product that is primarily sold to fight chiggers and other pests. Various oils are reputed to suffocate the worms.

6) The worms die from exposure to sunlight and pulsed light.



A lowered immune system response or allergy to mites or bacteria (all demodex carry bacteria) could be closer to the root cause, as demodex worms live in many people that do not have SD, perhaps in lower levels, a higher level of the skin, or amongst the non allergic population, therefore no symptoms.

A problem with the demodex theory is that anti-biotics are considered by many of us to be a cause of SD, and anti-biotics are actually considered to be a killer of the worms.

My main question for everyone .... Has anyone noticed huge improvements while away on vacation? (thus, perhaps, away from bedding, other family members, or pets that may also be infected) ? ?



Here is the article about Dr. Bokiowski :

Empirical treatment is key to identifying rosacea, other dermatoses
Modern Medicine - Publish date: Nov 1, 2007

Sewickley, Pa. — Although Demodex mites are frequently associated with rosacea,
one expert says they don't cause the condition. Due to the frequent overlap of
rosacea and other dermatoses with each other and Demodex dermatitis, the
physician's first step in such cases should be empirical treatment for Demodex
dermatitis, he says.
"Any patient who presents with a red face — especially a red, dry, scaly face —
should have an empirical trial of a topical or systemic medication to treat
Demodex," says Joseph Bikowski, M.D., director, Bikowski Skin Care Center, and
clinical assistant professor of dermatology, Ohio State University, Columbus,
Ohio.

"There are three distinct facial dermatoses of consequence — rosacea, seborrheic
dermatitis and Demodex dermatitis," he says. All three occur commonly, and
commonly cross over, so that a patient can have more than one at a time, adds
Dr. Bikowski, who says his conclusions are based on anecdotal evidence.

Furthermore, he says, "I do not believe that Demodex mites cause rosacea. I'm
very emphatic about that."
Demodex dermatitis and rosacea are entirely separate clinical entities, Dr.
Bikowski tells Dermatology Times, "and I believe there are numerous patients who
present with red, scaly faces who have rosacea in combination with either
seborrheic dermatitis or Demodex dermatitis. They could also have seborrheic or
Demodex dermatitis alone," he says.

One study has shown that 10 percent of skin biopsies and 12 percent of hair
follicles contain Demodex mites. The same study shows that both Demodex
folliculorum and the smaller D. brevis exhibit their heaviest infestations on
the face (Aylesworth R, Vance JC. Demodex folliculorum and Demodex brevis in
cutaneous biopsies. J Am Acad Dermatol. November 1982; 7(5):583-589).

However, Dr. Bikowski says that if one performs a potassium hydroxide (KOH)
preparation of the facial skin and examines it for mites microscopically, "Even
if the sample is negative, it does not mean the patient does not have Demodex
dermatitis. And just because the scraping is positive, it does not mean the
patient has Demodex dermatitis."

Indeed, dermatologists generally consider the D. folliculorum mite a normal part
of the human flora that only becomes a pathogen after it multiplies and invades
the dermis, provoking an inflammatory response (Bhatia B, Del Rosso JQ. Acne &
rosacea: just the facts — dispelling the mystery of Demodex.
http://www.skinandaging.com/article/6756/).


Accordingly, Dr. Bikowski says, "At this point in time, the only way to
determine if a patient has Demodex dermatitis is through an empirical trial of
one of three medications."

Those medications are topical Elimite (permethrin, Allergan), topical Eurax
(crotamiton, Ranbaxy) or systemic ivermectin.

When a patient who has had no previous treatment presents with a red, scaly
face, he says, "The first thing one should do is discuss skincare. Skincare to
me means cleansing and moisturizing with a product that contains ceramide,"
which helps restore the skin barrier. "No matter which of these diseases is
involved," Dr. Bikowski says, "the skin barrier is disrupted."

As a next step, he continues, "I always do KOH preparation just to see if I can
find the Demodex mite."

Whether he finds this mite or not, Dr. Bikowski says, "I undertake an empirical
trial, usually with crotamiton, used twice daily for two weeks as indicated."

If the patient's skin improves dramatically after two weeks, he says, "This
probably proves that at least part, if not all, of the disease process is
Demodex dermatitis."


Conversely, Dr. Bikowski says if the patient experiences partial or no response,
"Then one can assume that one is dealing with either rosacea or seborrheic
dermatitis, or a combination thereof."

For patients who do not achieve complete clearance after standard treatment for
rosacea, seborrheic dermatitis or both, he recommends the same approach.

In a best-case scenario, Dr. Bikowski says, "The KOH shows many mites; one
treats the patient for two weeks with one of the indicated products; and then a
repeat of the KOH shows no mites," although repeating the KOH isn't absolutely
necessary.

Dr. Bikowski says the association between Demodex mites and rosacea or other
dermatoses is so common that "Every single patient who presents with a red,
scaly face needs an empirical trial of one of these medicines."
However, he says very few physicians agree with his theory that Demodex mites do
not cause rosacea. "I've only figured this theory out in the last 12 to 18
months," he says.

In particular, he reports that he'd been treating a patient for what he believed
was seborrheic dermatitis for two years, "and the patient kept getting worse. No
matter what I used, he didn't get better," even after treatment for rosacea.
"Finally," Dr. Bikowski says, "I did a KOH of his forehead and found a
significant infestation of mites." After treating the patient with topical
permethrin for two weeks, he says, "He cleared."

Disclosure: Dr. Bikowski is a consultant to Ranbaxy.

For more information: http://www.bikowskimd.com/




I've read that it's possible to conduct an at-home test, so this could at least be worth a try.


Additional informative links:

http://rosacea-support.org/weve-all-been-exposed-to-demodex-bacteria-proteins.html


http://www.beautymagonline.com/pages/demodex_folliculorum.htm

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