The effect of phototherapy on Demodex density: a case-control study.

BACKGROUND: Human Demodex mites, Demodex folliculorum and Demodex brevis, are microorganisms that reside in the pilosebaceous units, usually without causing symptoms. Phototherapy has been linked to demodicosis in previous studies. We aimed to determine whether there was an increase in the frequency of demodicosis and Demodex density after 20 phototherapy sessions. METHODS: A case-control study was conducted with 32 participants who received narrowband ultraviolet B or ultraviolet A-1 therapy for various dermatological indications. Standardized skin surface biopsies were performed before and after phototherapy to assess Demodex density. The presence of Demodex-related skin conditions was assessed before phototherapy. A statistical analysis was performed to compare the Demodex densities and prevalence of demodicosis between the baseline and 20th session of phototherapy. RESULTS: No significant change was observed in Demodex density after 20 sessions of phototherapy. The average Demodex density before treatment was 2.75 ± 4.48 (/cm2 ), and after treatment, it was 2.85 ± 4.81 (/cm2 ), indicating no significant difference (P = 0.879). The percentage of patients with demodicosis in at least one region of the face was 28.1% (9/32) before treatment, and after treatment, it was 31.3% (10/32), with no significant difference (P = 1.00). CONCLUSIONS: Our findings contradict previous studies that suggested an increased Demodex density and demodicosis prevalence after phototherapy. The data from previous studies are open to debate due to their selected samples, designs, and interpretations regarding the phototherapy-immunosuppression-Demodex relationship. Larger-scale longitudinal studies conducted on a homogeneous sample are warranted to better understand the relationship between phototherapy and demodicosis.

The Efficacy of Warm Compresses in the Treatment of Meibomian Gland Dysfunction and Demodex Folliculorum Blepharitis.

Purpose: To investigate and compare the effect of warm compresses on meibomian gland dysfunction and Demodex folliculorum blepharitis.Methods: Forty-two subjects (13 males, 29 females; mean age of 56.45 years) enrolled and completed the two-month warm compress treatment study. Three warm compress therapies were compared: Warm face cloth, MGDRx EyeBag® and OPTASETM Moist Heat Mask. Subjects attended for four visits: baseline, two weeks, four weeks, and eight weeks. Subjective symptoms, osmolarity, non-invasive tear break-up time, ocular surface staining, Schirmer I test, meibum expressibility and clarity, and eyelash manipulation and epilation to assess for the presence of Demodex folliculorum, were measured at each visit.Results: Meibomian gland dysfunction, based on a composite score of meibum quality and expressibility, reduced significantly with the MGDRx EyeBag® and the OPTASETM Moist Heat Mask (p < .05). There was no significant difference in efficacy for treating meibomian gland dysfunction between the two devices (p = .29). No improvement in meibomian gland dysfunction was detected with the warm face cloth. Only the OPTASETM Moist Heat Mask significantly reduced the quantity of Demodex folliculorum over eight-weeks of treatment (p = .036, only baseline to week eight significant p = .008). Symptoms and ocular surface staining improved significantly in all three groups (p < .05). There was no significant change observed in osmolarity, non-invasive tear break-up time or Schirmer I test within each group (p > .05, respectively).Conclusion: The MGDRx EyeBag® and the OPTASETM Moist Heat Mask exhibited superior efficacy in treating signs and symptoms of meibomian gland dysfunction, compared to the use of a warm face cloth, over the eight-week period. The OPTASETM Moist Heat Mask demonstrated dual therapeutic abilities, treating both meibomian gland dysfunction and Demodex folliculorum blepharitis. Repeated application of heat for the treatment of meibomian gland dysfunction may continue to present a good home-remedy option for patients.

Intense Pulsed Light Therapy for Patients with Meibomian Gland Dysfunction and Ocular Demodex Infestation.

To observe the clinical changes of meibomian gland dysfunctipn (MGD) and ocular Demodex infestation after intense pulsed light (IPL) treatment to further examine the mechanism of IPL treating patients with MGD and ocular Demodex infestation. The medical records of 25 patients (49 eyes) with MGD treated with IPL, were retrospectively examined to determine outcomes. Associated ocular-surface parameters (ocular surface disease index, OSDI; lipid layer thickness, LLT; noninvasive first breakup time, NIF-BUT; noninvasive average breakup time, NIAvg-BUT; tear film breakup area, TBUA; Schirmer I Test, SIT; corneal fluorescein staining, CFS), eyelid margin abnormalities, meibum quality and expressibility, MG morphological parameters (macrostructure and microstructure), and the number of Demodex infestation were examined before and after treatment. The MG microstructure and the Demodex infestation were examined via in vivo confocal microscopy (IVCM). The results showed that there were statistically significant differences in associated ocular-surface parameters (all P<0.05) before and after IPL treatment, except SIT (P=0.065). Eyelid margin abnormalities, meibum quality and expressibility obviously improved in upper and lower eyelid after IPL treatment (all P<0.0001). MG macrostructure (MG dropouts) decreased in upper (P=0.002) and lower eyelid (P=0.001) after IPL treatment. The nine parameters of MG microstructure in upper and lower eyelid all distinctly improved after IPL treatment (all P<0.0001). The mean number of Demodex mites on the upper lid margin (6.59±7.16 to 3.12±3.81/9 eyelashes) and lower lid margin (2.55±2.11 to 1.29±1.53/9 eyelashes) significantly reduced after IPL treatment (all P<0.0001). The Demodex eradication rate was 20% (8/40) in upper lid margin and 34.15% (14/41) in lower lid margin. These findings indicate that IPL shows great therapeutic potential for patients of MGD and ocular Demodex infestation.

Efficacy of treatments for Demodex blepharitis: A systematic review and meta-analysis.

PURPOSE: We conducted a systematic review and meta-analysis to evaluate the efficacy of different treatment for Demodex blepharitis. Parameters studied were mites count, improvement of symptoms and mites' eradication, stratified on type of treatments and mode of delivery of treatments (local or systemic). METHOD: The PubMed, Cochrane Library, Embase, ClinicalTrials.gov, Google scholar and Science Direct databases were searched for studies reporting an efficacy of treatments for Demodex blepharitis. RESULTS: We included 19 studies (14 observational and 5 randomized clinical trials), for a total of 934 patients, 1741 eyes, and 13 different treatments. For mites count, eradication rate, and symptoms improvement, meta-analysis included fifteen, fourteen and thirteen studies, respectively. The overall effect sizes for efficiency of all treatments, globally, were 1.68 (95CI 1.25 to 2.12), 0.45 (0.26-0.64), and 0.76 (0.59-0.90), respectively. Except usual lid hygiene for mites count, Children's Hospital of Eastern Ontario ointment (CHEO) for both eradication rate and symptoms, and CHEO, 2% metronidazole ointment, and systemic metronidazole for eradication rate, all treatments were efficient. Stratified meta-analysis did not show significant differences between local and systemic treatments (1.22, 0.83 to 1.60 vs 2.24, 1.30 to 3.18 for mites count; 0.37, 0.21 to 0.54 vs 0.56, 0.06 to 0.99 for eradication rate; and 0.77, 0.58 to 0.92 vs 0.67, 0.25 to 0.98 for symptoms improvement). CONCLUSION: We reported the efficiency of the different treatments of Demodex blepharitis. Because of less systemic side effects, local treatments seem promising molecules in the treatment of Demodex blepharitis.

Therapeutic Effect of Intense Pulsed Light on Ocular Demodicosis.

PURPOSE: To evaluate the clinical efficacy of Lumenis® M22TM intense pulsed light (IPL) in reduction of ocular Demodex infestation in eyelashes in a prospective study. METHODS: Forty patients with ocular demodicosis were recruited. Then half were randomly picked to receive the IPL treatment, while the other half got 5% tea tree oil (as the control group). Demodex counts, the ocular surface disease index (OSDI) score, lid margin abnormalities, conjunctival congestion, tear break-up time (TBUT), corneal staining with fluorescein, meibomian gland (MG) expressibility, meibum quality, modified Schirmer I test with anaesthetic (SIT), were assessed on the day before treatment and after treatment of 30 and 90 days, respectively. Changes in the parameters were compared between the IPL group and the control group on the days after treatment of 30 and 90 days. RESULTS: No differences were observed in Demodex counts, lid margin abnormalities, conjunctival congestion, corneal staining with fluorescein, MG expressibility, SIT in the two groups on the days after treatment of 30 and 90 days (p > 0.05), whereas there was a statistically significant difference in the OSDI score, TBUT, meibum quality (p < 0.05). The Demodex eradication rate was more thorough in the IPL group (100%) than in the control group (75%). CONCLUSIONS: IPL shows the preferably therapeutic potential for ocular Demodicosis.

Recent advances on ocular Demodex infestation.

PURPOSE OF REVIEW: To summarize recent advances on ocular Demodex infestation. RECENT FINDINGS: Demodex infestation is a potential cause of ocular surface inflammation. The pathogenesis of Demodex in eliciting ocular surface inflammation has been further clarified. Cliradex is currently the treatment of choice, it comprises the most active ingredient of tea tree oil, that is terpinen-4-ol, which helps eradicate Demodex mites and reduce ocular surface inflammation. SUMMARY: Ocular demodicosis is a common but overlooked eye disease that manifests a number of morbidities. Demodex folliculorum causes chronic anterior blepharitis whereas Demodex brevis causes posterior blepharitis, meibomian gland dysfunction, recurrent chalazia, and refractory keratoconjunctivitis. The lash sampling and microscopic counting method and in-vivo confocal microscopy are key diagnostic methods. Cliradex shows promising potential to reduce Demodex counts with additional antibacterial, antifungal, and anti-inflammatory actions.

Arthropod bites.

The phylum Arthropoda includes arachnids and insects. Although their bites typically cause only local reactions, some species are venomous or transmit disease. The two medically important spiders in the United States are widow spiders (Latrodectus), the bite of which causes intense muscle spasms, and the brown recluse (Loxosceles), which may cause skin necrosis. Widow bites usually respond to narcotics, benzodiazepines, or, when necessary, antivenom. Most recluse bites resolve uneventfully without aggressive therapy and require only wound care and minor debridement. Tick bites can transmit diseases only after prolonged attachment to the host. Treatment of clothing with permethrin and proper tick removal greatly reduce the risk of infection. Ticks of medical importance in the United States include the black-legged tick, the Lone Star tick, and the American dog tick. The prophylactic use of a single dose of doxycycline for Lyme disease may be justified in high-risk areas of the country when an attached, engorged black-legged tick is removed. Bites from fleas, bedbugs, biting flies, and mosquitoes present as nonspecific pruritic pink papules, but the history and location of the bite can assist with diagnosis. Flea bites are usually on ankles, whereas mosquito bites are on exposed skin, and chigger bites tend to be along the sock and belt lines. Antihistamines are usually the only treatment required for insect bites; however, severe mosquito reactions (skeeter syndrome) may require prednisone. Applying insect repellent containing diethyltoluamide (DEET) 10% to 35% or picaridin 20% is the best method for preventing bites.

Ocular demodicosis.

We present a case of blepharitis with symptoms lasting two years in duration and refractory to a host of prior medical treatments, including antibiotics, corticosteroids, cyclosporine, and baby shampoo. We recognized the clinical presentation as pathogomonic for demodicosis caused by the parasitic mite, demodex folliculorum, confirmed with light microscopy, and treated appropriately with tea tree oil and hygiene measures--achieving full resolution of symptoms. We highlight the presentation, treatment, and underscore demodicosis as an important, under recognized cause of blepharitis.

Rosacea treatments: What's new and what's on the horizon?

Rosacea is a common, chronic, cutaneous disorder presenting with recurrent episodes of facial flushing, erythema, papules, pustules and telangiectasias. It is a multifactorial disease and its various clinical presentations probably represent the consequence of combined different triggers upon a specific background. Its management is largely based on long-established treatments empirically tailored to the specific presenting symptoms and no real breakthrough has occurred to date. However, recent insights into the still rather obscure pathophysiology of rosacea seem to open the way for etiologically oriented treatments. These may include, on the one side, the more effective application of traditional drugs, such as tetracyclines and metronidazole, to specifically selected patients or, on the other side, new therapeutic options, such as vitamin D receptor antagonists. It is to be remarked that the quality of most studies evaluating rosacea treatment is rather poor, mainly due to a lack of proper standardization. For a major breakthrough to occur in the management of rosacea, we need both a better understanding of its pathogenesis and the adherence of future clinical trials to clearly defined grading and inclusion criteria, which are crucial for investigators to correctly compare and interpret the results of their work.

Evaluación de una nueva formulación de ivermectina de larga acción contra sarna sarcóptica de alpacas en Junín / Evaluation of a new formulation of ivermectina of long action against mange sarcoptica of Junin's alpacas

Se realizó una prueba experimental de campo, con el fin de evaluar la eficacia y el efecto residual de una ivermectina de larga acción contra la sarna sarcóptica en alpacas criadas a 4,300 msnm en la sierra de Junín (Unidad de Producción Cochas, SAIS Túpac Amaru). Estas alpacas se encontraban infestadas naturalmente por Sarcoptes scabiei var. auchenia, y la mayoría presentaba dermatitis costosa y fístulas profundas. La evaluación se realizó en 2 grupos compuestos por 10 animales cada uno y distribuidos aleatoriamente. Grupo I: tratados con ivermectina. L. A. (ALPAMEC L.A.), vía subcutánea a la dosis de 0.2 mg/kg de peso vivo. Grupo II: controles no tratados. En los dos grupos se evaluó el porcentaje de ácaros vivos obtenidos por raspados cutáneos de cada animal, en los días 0, 15, 30, 45, 60 y 75 días posteriores al tratamiento. En función al número de ácaros vivos se halló el porcentaje de efectividad en el grupo tratado y se evaluó la evolución clínica de las lesiones. Los resultados mostraron que la ivermectina de larga acción presentó una efectividad del 98, 100, 100, 100 y 100 a los 15, 30, 45, 60 y 75 días post tratamiento en el Grupo I. La evaluación clínica de las lesiones permitió observar un notable desprendimiento de costras en los animales en los 15 días posteriores; asimismo, el 70 por ciento de la población no presentó costras a los 30 y 45 días posteriores, y cerca del 50 por ciento de los animales tratados evidenciaron crecimiento de fibra en las áreas afectadas a los 60 y 75 días post tratamiento, mientras que los restantes no presentaban ...

La sarna y otras dermatitis por ácaros / Scabies and other dermatitis due to mites

La sarna es una enfermedad contagiosa, que suele presentarse en ondas epidémicas. Después de su difusión en la década de los cuarenta en España, declinó su frecuencia, siendo desde entonces muy poco frecuente. Sin embargo en estos últimos años se ha constatado un aumento de los casos de sarna debido a múltiples factores, lo que ha hecho crecer el interés por este proceso (AU)

[Persistent scalp infestation by Dermanyssus gallinae in an Emilian country-woman]. / Infestazione persistente del cuoio capelluto da Dermanyssus gallinae in una contadina emiliana.

A case of persistent infestation of the scalp due to Dermanyssus gallinae.--Infestation due to Dermanyssus gallinae, the common red mite of poultry, in a country-woman aged 69 years from Crevalcore (Emilia-Romagna region, Northern Italy), is described. The case was unusual either for its location, the scalp, and for its persistence, 9 months. Specimens of the mite were also found in the henhouse adjacent to the patient's house. Apparently the woman recovered by means of daily washing of camomile tea.

Sarna noruega: evolución y tratamiento / Norwegian scabies: evolution and treatment

Se realizó un estudio retrospectivo de 130 pacientes ingresados con el diagnóstico de escabiosis en 5 años, determinándose que 4 presentaban la variedad de sarna noruega; en el cuadro clínico de estos últimos predominó el eritema y la hiperqueratosis fisurada palmoplantar y el comprometimiento de áreas extensas de la piel. Mejoraron todos con la terapéutica antiescabiósica(AU)

Sarna noruega: evolución y tratamiento / Norwegian scabies: evolution and treatment

Se realizó un estudio retrospectivo de 130 pacientes ingresados con el diagnóstico de escabiosis en 5 años, determinándose que 4 presentaban la variedad de sarna noruega; en el cuadro clínico de estos últimos predominó el eritema y la hiperqueratosis fisurada palmoplantar y el comprometimiento de áreas extensas de la piel. Mejoraron todos con la terapéutica antiescabiósica

Economic evaluation of specific immunotherapy versus symptomatic treatment of allergic rhinitis in Germany.

OBJECTIVE: To use published data to compare the economic consequences of specific immunotherapy (SIT) lasting 3 years with those of continuous symptomatic treatment in patients with either pollen or mite allergy. DESIGN AND SETTING: The evaluation was conducted from the following 3 perspectives in Germany: (i) society; (ii) healthcare system; and (iii) statutory health insurance (SHI) provider. A modelling approach was used which was based on secondary analysis of existing data. The follow-up period was 10 years. The break-even point of cumulated costs, their difference per patient and the additional cost per additional patient free from asthma symptoms [incremental cost-effectiveness ratio (ICER)] were used as target variables, each from the viewpoint of SIT. The types of costs were direct and indirect (society), direct (healthcare system) and those incurred by SHI (i.e. expenses). In the base-case analysis, the average values of the clinical parameters and average case-related costs/expenses were applied. MAIN OUTCOME MEASURES AND RESULTS: The break-even point was reached between year 6 and year 8 after the start of therapy, resulting in net savings of between 650 and 1190 deutschmarks (DM) per patient after 10 years. The ICERs of SIT were between -DM3640 and -DM7410, depending on study perspective and nature of the allergy (1990 values for symptomatic treatment and treatment of asthma, 1995 values for SIT; DM1 approximately $US0.58). The sensitivity analysis demonstrated the robustness of the model and its results. First, all the independent variables of the model were varied. Secondly, the influence of the model variables was quantified using a deterministic model. SIT was more likely to result in net savings than in additional costs. An economic parameter (cost for symptomatic treatment) had the highest influence on the results. CONCLUSIONS: This evaluation showed that SIT for 3 years is economically advantageous in patients who are allergic to pollen or mites and whose symptoms are inadequately controlled by continuous symptomatic treatment. After 10 years, the administration of SIT leads to net savings from the perspectives of society, the healthcare system and SHI (third-party payer) in Germany.

El Hepar Sulphuris Kalinum CH12 en el tratamiento de la sarna / Hepar sulphuris kalinum CH12 in terapy of mite infestations

Se detalla la repeticion de un trabajo, el tratamiento homeopatico de la sarna, publicado originalmente en el ano 1910. En el mismo se establece que con Hepar Sulfuris Kalinum (Sulfuro de potasio), a la CH12 por via bucal, se consigue manejar y curar las manifestaciones de sarna

El Hepar Sulphuris Kalinum CH 12 en el tratamiento de la sarna / The Hepar Sulphuris Kalinum CH 12 in the scabies treatment

Se detalla la repetición de un trabajo, el tratamiento homeopático de la sarna, publicado originalmente en el año 1910. En el mismo se establece que con Hepar Sulfuris Kalinum (Sulfuro de potasio), a la CH 12 por vía bucal, se consigue manejar y curar las manifestaciones de sarna

El Hepar Sulphuris Kalinum CH 12 en el tratamiento de la sarna / The Hepar Sulphuris Kalinum CH 12 in the scabies treatment

Se detalla la repetición de un trabajo, el tratamiento homeopático de la sarna, publicado originalmente en el año 1910. En el mismo se establece que con Hepar Sulfuris Kalinum (Sulfuro de potasio), a la CH 12 por vía bucal, se consigue manejar y curar las manifestaciones de sarna (AU)

Acupuncture for dermatologic disorders.

Veterinary acupuncture is a useful therapeutic modality for treating dermatologic disease. The principles of TCM diagnosis can be applied to the animal patient, and acupuncture points chosen based on the cause and clinical manifestations of the disease.