Diagnostic Indicators of Rosacea and Demodicosis

Forton, F.; Maertelaer, Viviane De

doi:10.2340/00015555-3041

Cited by 17 publications

(28 citation statements)

References 37 publications

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“…When this proliferation continues, the opisthosomes of the mites become visible to the naked eye, appearing as thin, discreet, regularly dispersed, whitish follicular scales at the base of the hair, often associated with diffuse erythema (which is a key feature of rosacea) [ 57 , 99 – 102 ]. These clinically visible symptoms constitute the first stage of demodicosis—pityriasis folliculorum [ 8 , 56 , 57 , 99 , 101 – 103 ] (Fig. 1 c), called by some primary demodicosis [ 7 ].…”

Section: Demodex and Demodicosismentioning

confidence: 99%

“…The symptoms are very discreet and, if the dermatologist is not familiar with the condition and trained to detect it, may go unnoticed, so that this entity is often underdiagnosed [ 56 , 98 , 102 , 104 ]. To detect the follicular scales, the dermatologist must examine the skin from a distance of maximum 30 cm, with good tangential lighting; sometimes cleaning the skin with ether may be necessary to reveal the scales [ 97 , 99 , 101 , 105 ]. Subjective complaints (sensation of burning, pruritus, dry skin, hypersensitive skin, irregular or rough skin) may also be present [ 7 , 56 , 57 , 99 , 101 – 103 ].…”

Section: Demodex and Demodicosismentioning

confidence: 99%

“…To detect the follicular scales, the dermatologist must examine the skin from a distance of maximum 30 cm, with good tangential lighting; sometimes cleaning the skin with ether may be necessary to reveal the scales [ 97 , 99 , 101 , 105 ]. Subjective complaints (sensation of burning, pruritus, dry skin, hypersensitive skin, irregular or rough skin) may also be present [ 7 , 56 , 57 , 99 , 101 – 103 ]. Nevertheless, despite the discreet symptoms (likely because of the mites’ control over host immunity), Demodex densities in the skin of these patients are usually high [ 101 – 103 ], with values ranging from 7 to 61 D/cm 2 depending on the sampling method used and the population studied [ 56 , 57 , 106 , 107 ], and reaching as much as 285 ± 12 D/cm 2 when the densities of two consecutive standardized skin surface biopsies (SSSBs) are summed [ 108 , 109 ].…”

Section: Demodex and Demodicosismentioning

confidence: 99%

“…b Some patients have persistent erythema without visible follicular scales, but nevertheless have high Demodex densities (Dd): they are considered to have subclinical demodicoses/subclinical pityriasis folliculorum, and so are included into the demodicosis group. c As a practical example of the schema in b , we provide the data from the 445 patients clinically diagnosed with pityriasis folliculorum and 23 patients clinically diagnosed with ETR from our recent studies [ 97 , 99 , 108 ]. According to the NRS definition, 332 of these 468 patients would have been diagnosed as ETR, of whom 309 (93%) had follicular scales.…”

Section: Demodex and Immunotolerance: A Role For Vegf And Thmentioning

confidence: 99%

“…Patients with persistent erythema and high Demodex density (i.e., subclinical PF with erythema or clinical PF with erythema/ETR with follicular scales) were the most numerous (319/468 = 68%). In real life, the proportion of patients with ETR without follicular scales is nevertheless certainly higher (“+++”) because in our studies these patients were only included when we had time to perform the SSSB, whereas all patients with follicular scales were included [ 97 , 99 , 108 ] …”

Section: Demodex and Immunotolerance: A Role For Vegf And Thmentioning

confidence: 99%

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The Pathogenic Role of Demodex Mites in Rosacea: A Potential Therapeutic Target Already in Erythematotelangiectatic Rosacea?

Forton¹

2020

Dermatol Ther (Heidelb)

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Rosacea is an inflammatory continuum, with all characteristics being already present from the onset of the disease, even if not clinically visible. Demodex proliferation also appears to be a continuum process in rosacea, and high Demodex density is beginning to be accepted as an important trigger of the inflammatory cascade and as a marker of rosacea: moreover, papulopustules of rosacea can be treated using acaricides. Immunological studies are providing new hypotheses according to which Demodex may induce tolerogenic dendritic cells and collaborate with VEGF to induce T cell exhaustion favoring its own proliferation. This proliferation may not be clinically visible initially. The interactions among VEGF, Demodex, and immunity need to be explored, and the nosology of rosacea definitions adapted accordingly. The effectiveness of treating any patient who only has visible vascular symptoms with an acaricidal cream needs to be confirmed in prospective controlled clinical trials with long-term follow-up, but it is already important to detect patients with pityriasis folliculorum among those with only vascular symptoms of rosacea in order to treat at least these patients with an acaricidal cream. DIGITAL FEATURES This article is published with digital features to facilitate understanding of the article. You can access the digital features on the article's associated Figshare page. To view digital features for this article go to

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Section: Demodex and Demodicosismentioning

confidence: 99%

Section: Demodex and Demodicosismentioning

confidence: 99%

Section: Demodex and Demodicosismentioning

confidence: 99%

Section: Demodex and Immunotolerance: A Role For Vegf And Thmentioning

confidence: 99%

Section: Demodex and Immunotolerance: A Role For Vegf And Thmentioning

confidence: 99%

See 3 more Smart Citations

The Pathogenic Role of Demodex Mites in Rosacea: A Potential Therapeutic Target Already in Erythematotelangiectatic Rosacea?

Forton¹

2020

Dermatol Ther (Heidelb)

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Detection of demodex mites in papulopustular rosacea using microscopic examination and polymerase chain reaction: a comparative case-control study

Trave,

Salvi,

Canepa

et al. 2024

Arch Dermatol Res

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Demodex mite proliferation is frequently involved in the pathogenesis of rosacea. The gold standard for Demodex identification is microscopic examination on a standardized skin surface biopsy. However, this method of sampling can be distressing and painful, especially when performed on hairy sites. In this case-control study, we compared the sensitivity of PCR and microscopic examination in diagnosing a Demodex infestation. Moreover, we investigated the possible correlations between the presence of Demodex mites and clinical characteristics. In total, 20 patients affected by papulopustular rosacea and 10 controls were included. At both microscopic examination and PCR, patients with rosacea presented a greater prevalence of positive samples than controls at the scalp and at the face. Microscopy had sensitivity of 50% at the face and of 46.7% at the scalp. PCR had sensitivity of 93.75% at the face and of 86.7% at the scalp. The positivity of PCR was associated to a higher frequency of facial papules and pustules. Patients with positivity at the face had a more frequent positivity at the scalp. The scalp could represent a reservoir for the Demodex mites, and should be investigated by sensitive and painless methods. PCR performed on painlessly collected samples should be further investigated.

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