Clinical characteristics of Demodex-associated recurrent hordeola: an observational, comparative study.

Our study evaluated the association between Demodex infestation and recurrent hordeola and examined the clinical features associated with these eyelid lesions. This was an observational, comparative study. We reviewed 250 patients and divided them into the recurrent hordeolum (n = 153) and control (n = 97) groups. Demodex infestation was detected by epilating eyelashes around the lesion/s and viewing them under a light microscope. Patient medical records and photographs were retrospectively analyzed to identify the clinical characteristics of Demodex-associated recurrent hordeola. Demodex was detected in 91 (59.5%) and 17 (17.5%) patients in the recurrent hordeolum and control groups (p < 0.001), respectively. In the recurrent hordeolum group, Demodex mites were found in 74 (68.5%) and 17 (37.8%) of the adult and pediatric patients (p < 0.001), respectively. Among patients with recurrent hordeola, patients in their 20s were most likely to have concomitant Demodex infestation. Patients with Demodex infestations were also more likely to develop recurrent lesions within a shorter period of time from the primary incision and curettage. The most common presentation of Demodex-associated recurrent lesions was external hordeola (67%) (p = 0.002). Demodex infestation may cause recurrent hordeola in adults and children. These mites may play a greater role in the development of lesions in adult patients. The strongest association between Demodex infestation and recurrent lesions was seen in patients in their 20s. Our results suggest that if the hordeola recur within a short period of time with the clinical characteristics of external location of eyelid, multiple numbers of lesions, or anterior blepharitis, eyelash epilation should be performed to identify the presence of Demodex mites.

[Granulomatous rosacea in a lung transplant recipient : A possible therapy option in a unique group of patients]. / Granulomatöse Rosazea bei einem Lungentransplantierten : Eine mögliche Therapieoption bei einer besonderen Patientengruppe.

Rosacea, a frequent chronic inflammatory disease of the adnexal structures, is associated with an increased number of demodex mites. In patients with immunosuppression, it can present in fulminant progressions like granulomatous rosacea. In this specific subgroup of patients, treatment is not only complicated by aggressive occurrences, but is also limited by possible drug interactions with immunosuppressive drugs. We present a case of a 66-year-old lung transplant recipient, who was successfully treated with oral metronidazole and ivermectin cream.

Latent Demodex infection contributes to intense pulsed light aggravated rosacea: cases serial.

Intense pulsed light (IPL) is a good option for erythema and telangiectasia of rosacea. Demodex, which is light and heat sensitive, is an important risk of Rosacea. Sometimes, IPL can induce rosacea aggravation. Here, we show two cases of erythema rosacea aggravated as pustule in several hours after IPL. Both cases show high density of Demodex after IPL. Neither of them had photosensitivity, systemic disease, or any other contraindication for IPL. One of the patients received IPL again after Demodex infection relieved and this time there was no inflammation induction. We need to attract more attention to IPL-induced rosacea aggravation and latent Demodex infection may act as a cofactor.

Canine demodicosis: a retrospective study of a veterinary hospital population in California, USA (2000-2016).

BACKGROUND: Demodex spp. are cutaneous mites that cause clinical disease when present in increased numbers. There is an association in some dogs with underlying systemic disease or immunosuppressive medications. HYPOTHESIS/OBJECTIVES: Retrospective study to document breed predisposition, identify any concurrent diseases or underlying immunosuppressive conditions, and to determine the frequency of demodicosis recurrence after treatment completion. ANIMALS: There were 431 dogs with demodicosis presented to a veterinary teaching hospital in California, USA, from 2000 to 2016. METHODS: Inclusion in this study required a diagnosis of demodicosis based on direct demonstration of the mite. Records were reviewed for signalment, disease history, potential underlying aetiologies, diagnosed concurrent diseases, medications and demodicosis treatment. Analyses were performed to evaluate for potential breed predispositions and because of the large number of dogs with allergic dermatoses, analyses for this diagnosis as a disease associated with demodicosis was also performed. E-mailed surveys and follow-up telephone calls were used to assess for information about disease recurrence. RESULTS: The pit bull terrier group and West Highland white terrier, based on calculated odds ratio, were breeds predisposed to developing demodicosis. For dogs with demodicosis, allergic dermatoses was an associated disease. Relapse or recurrence of disease after treatment was uncommon, affecting 11% of the dogs with long-term follow-up. CONCLUSIONS/CLINICAL IMPORTANCE: This study identified, in dogs attending the institution based in California, USA, breed predilections for canine demodicosis and associated concomitant diseases. It also revealed a low occurrence of disease relapse, recurrence or persistence.

Demodicosis in two patients with a previous history of Langerhans cell histiocytosis.

Demodex mites are commensal organisms rarely found in healthy children. Human demodicosis can be classified as a primary or a secondary form. The secondary form in children usually affects severely immunodepressed children. To our knowledge, this is the first report of human demodicosis associated with Langerhans cell histiocytosis. These cases show that this skin disorder can occur months after completing chemotherapy, without recurrence of the systemic disease.

Demodicosis in Pediatric Cancer.

Demodicosis is a rare condition that most often occurs in immunocompromised patients. We here describe a boy with T-cell non-Hodgkin lymphoma who developed a facial papulopustular eruption just before finalizing T-cell non-Hodgkin lymphoma treatment. He was treated for several infectious diseases without improvement. Demodicosis was considered and complete resolution was finally reached with topical metronidazole. We conducted a systematic search of all previously described cases of this condition in children with cancer, which showed that almost all demodicosis cases occurred in patients with lymphoreticular malignancies during maintenance chemotherapy. Hence, demodicosis may be seriously considered in antibiotic-resistant facial papulopustular eruptions in this group of patients to prevent delay of adequate treatment.

Demodex musculi Infestation in Genetically Immunomodulated Mice.

Demodex musculi, a prostigmatid mite that has been reported infrequently in laboratory mice, has been identified with increasing frequency in contemporary colonies of immunodeficient mice. Here we describe 2 episodes of D. musculi infestation with associated clinical signs in various genetically engineered mouse strains, as well as treatment strategies and an investigation into transmissibility and host susceptibility. The first case involved D. musculi associated with clinical signs and pathologic lesions in BALB/c-Tg(DO11.10)Il13(tm) mice, which have a defect in type 2 helper T cell (Th2) immunity. Subsequent investigation revealed mite transmission to both parental strains (BALB/c-Tg[DO11.10] and BALB/c-Il13(tm)), BALB/c-Il13/Il4(tm), and wild-type BALB/c. All Tg(DO11.10)Il13(tm) mice remained infested throughout the investigation, and D. musculi were recovered from all strains when they were cohoused with BALB/c-Tg(DO11.10)Il13(tm) index mice. However, only Il13(tm) and Il13/Il4(tm) mice demonstrated persistent infestation after index mice were removed. Only BALB/c-Tg(DO11.10)Il13(tm) showed clinical signs, suggesting that the phenotypic dysfunction of Th2 immunity is sufficient for persistent infestation, whereas clinical disease associated with D. musculi appears to be genotype-specific. This pattern was further exemplified in the second case, which involved NOD.Cg-Prkdc(scid)Il2r(tm1Wjl)/SzJ (NSG) and C;129S4 Rag2(tm1.1Flv) Il2rg(tm1.1Flv)/J mice with varying degrees of blepharitis, conjunctivitis, and facial pruritis. Topical amitraz decreased mite burden but did not eliminate infestation or markedly ameliorate clinical signs. Furthermore, mite burden began to increase by 1 mo posttreatment, suggesting that topical amitraz is an ineffective treatment for D. musculi. These experiences illustrate the need for vigilance regarding opportunistic and uncommon pathogens in rodent colonies, especially among mice with immunologic deficits.

Demodicosis in Renal Transplant Recipients.

Solid organ transplant recipients have an increased incidence of skin infections resulting from immunosuppression. Common pathogens include herpes simplex virus, varicella zoster virus, Gram-positive bacteria and dermatophytes; however, the contribution of multicellular parasitic organisms to dermatologic disease in this population remains less studied. Demodex folliculorum and brevis are commensal mites that reside on human skin. Proliferation of Demodex mites, or demodicosis, is associated with rosacea and rosacea-like disorders, particularly in immunocompromised populations, although their ability to cause disease is still the subject of debate. We present a case series of four renal transplant recipients with the singular chief complaint of acne rosacea who we diagnosed with demodicosis. Although one of the four patients showed complete resolution following initial antiparasitic therapy, the other three required subsequent antibacterial treatment to fully resolve their lesions. We suggest that demodicosis may be more prevalent than once thought in solid organ transplant recipients and showed that Demodex-associated acne rosacea can be effectively treated in this population.

A case of gamasoidosis associated with exposure to a wild lorikeet feeding tray.

Gamasoidosis (acariasis, avian-mite dermatitis or bird-mite dermatitis) is caused by members of the mite superfamily Dermanyssoidea. The mites lay their eggs on the nest of the birds they feed on. The also leave the nest and feed on humans if there is no bird host available. The bites result in urticated plaques and papules. Here we present a case of gamasoidosis from exposure to a wild lorikeet feeding tray.

When mites attack: domestic mites are not just allergens.

Domestic mite species found in indoor environments and in warm or tropical regions are well known for causing allergic disorders. However, little is known about human acariasis, in which mites invade and parasitize the human body in various tissues from the gastrointestinal tract to the lung. Here, we summarize the reported cases of human acariasis of pulmonary, intestinal, oral (anaphylaxis), urinary, otic, and vaginal systems. Because the clinical symptoms of acariasis often overlap with other disease symptoms leading to frequent misdiagnosis, we highlight the need for more attention on these infections.

Immunology and pathogenesis of canine demodicosis.

Demodex mites colonized the hair follicles and sebaceous glands of mammals millions of years ago and have remained relatively unchanged in this protected ecologic niche since then. The host immune system detects and tolerates their presence. Toll-like receptor-2 of keratinocytes has been demonstrated to recognize mite chitin and to elicit an innate immune response. The subsequent acquired immune response is poorly understood at present, but there is experimental and clinical evidence that this is the main mechanism in the control of mite proliferation. A transgenic mouse model (STAT(-/-) /CD28(-/-) ) has demonstrated that the immune response is complex, probably involving both cellular and humoral mechanisms and requiring the role of co-stimulatory molecules (CD28). It is known that a genetic predisposition for developing canine juvenile generalized demodicosis exists; however, the primary defect leading to the disease remains unknown. Once the mite proliferation is advanced, dogs show a phenotype that is similar to the T-cell exhaustion characterized by low interleukin-2 production and high interleukin-10 and transforming growth factor-ß production by lymphocytes, as described in other viral and parasitic diseases. Acaricidal treatment (macrocyclic lactones) decreases the antigenic load and reverses T-cell exhaustion, leading to a clinical cure. Although in recent years there have been significant advances in the management and understanding of this important and complex canine disease, more research in areas such as the aetiology of the genetic predisposition and the immune control of the mite populations is clearly needed.

Severe Demodex infestation of a coal miner.

We report a case of Demodex infestation in a 35 year old coal miner presenting with a 5 year history of scally papulopustular eruption on his face. He had been working inunderground coal tunnels in a humid- hot- dusty environment and he had been used to bath twice a day with hot water and multiple cleaners. The patient was treated successfully with oral metronidazol, topical permethrin, topical steroids and avoidance of undergraund mining . We believe his occupational environment made him prone to infestation by changes in sebum composition and/or viscosity, his bath habituation facilitated infestation, damaging the epidermal barrier function and his previous treatments exaggerated his infestation. During evaluation of the patient, specific occupational factors and habituations will be related with higher succession rates of treatment. We need to conduct further studies in order to draw a definite conclusion about the effect of the occupational environment on Demodex infestation.

Prevalence of Demodex folliculorum and Demodex brevis in childhood malnutrition and malignancy.

BACKGROUND: Hair follicle mites, Demodex folliculorum and Demodex brevis, are known to accompany immune-deficiency states, however no study so far has investigated their presence in malnutrition. In this study we aimed to determine the prevalence of those mites in childhood malnutrition, malignancy and risk factors. METHODS: One hundred children with malnutrition, 31 children with malignancy and 63 children without any chronic disease and infection were included in this study. History, physical examination, anthropometric measurements and routine laboratory findings were recorded. Demodex spp. were investigated by standard superficial skin biopsies. RESULTS: Demodex was found in 25 patients (25%), 10 patients (32.3%), and one patient (1.6%) among malnutrition, malignancy, and control groups, respectively (P = 0.001). By using multilogistic regression binary method, it was found that malnutrition, malignancy and low socioeconomic level increased the risk 17.37 times (P = 0.006), 27.29 times (P = 0.002), and 2.3 times (P = 0.037), respectively. Of 22 children who were evaluated after 6 months, 13 (59.1%) were negative for Demodex. In 11 (84.6%) of those 13, nutritional status was improved. CONCLUSION: Demodex was detected in approximately in one-quarter and one-third of children with malnutrition and malignancy, respectively. Eliminating the cause of immunosuppression, such as poor nutritional status, seems also to be an effective method for eliminating Demodex.

Gamasoidosis illustrated--from the nest to dermoscopy.

Gamasoidosis (acariasis, avian-mite dermatitis or bird-mite dermatitis) is a challenging diagnosis that is becoming more common because of the frequent use of window air conditioners in tropical countries. These devices may serve as shelters for nests of urban birds such as pigeons. Dermatologists should become familiar with this infestation to establish the correct diagnosis and treatment.

Gamasoidosis illustrated: from the nest to dermoscopy / Gamasoidose ilustrada: do ninho à dermatoscopia

Gamasoidosis (acariasis, avian-mite dermatitis or bird-mite dermatitis) is a challenging diagnosis that is becoming more common because of the frequent use of window air conditioners in tropical countries. These devices may serve as shelters for nests of urban birds such as pigeons. Dermatologists should become familiar with this infestation to establish the correct diagnosis and treatment.

Gamasoidose (acaríase, infestação por "piolhinho-de-pombo" ou dermatite por ácaros aviários) é um diagnóstico desafiador que está se tornando mais comum devido ao uso frequente de aparelhos de ar-condicionado de janela em países tropicais, que servem de abrigo para ninhos de pássaros urbanos tais como pombos. Dermatologistas devem se familiarizar com esta infestação para fazerem diagnóstico e tratamento adequados.

Tacrolimus-induced rosacea-like dermatitis: a clinical analysis of 16 cases associated with tacrolimus ointment application.

BACKGROUND: Recently, reports have indicated that the continuous use of topical calcineurin inhibitors such as tacrolimus may induce rosacea-like dermatitis (RD). OBJECTIVE AND METHODS: To assess clinical features of RD associated with tacrolimus, 44 cases of patients diagnosed with RD between 2005 and 2010 at our hospital were retrospectively reviewed. RESULTS: In total, 22 cases were caused by topical steroid use, 8 by topical tacrolimus use, and 8 by consecutive treatment with topical steroids and tacrolimus. Clinical presentation was basically similar among the 3 groups, although the nose was less frequently affected and pustules were rarely observed in the latter 2 sets of cases. Demodex mites were often found in smears of skin lesions from patients with RD caused by steroids and tacrolimus. Treatment with topical metronidazole was effective in most RD patients. CONCLUSION: Topical tacrolimus is becoming an important cause of RD along with topical steroids.

[Evidence-based treatment of canine demodicosis]. / Evidenzbasierte Therapie der Demodikose des Hundes.

This article briefly reviews pathogenesis, clinics and diagnosis of canine demodicosis and summarizes treatment options for this disease based on published evidence. The disease is caused by excessive proliferation of Demodex mites in the hair follicles that may be due to genetic factors or immunosuppressive diseases or treatments. The disease is characterized by alopecia, papules, pustules and crusts. Diagnosis is confirmed by detection of several mites in deep skin scrapings or trichograms. Based on published studies, licensed successful treatments for many patients are weekly amitraz rinses in a concentration of 0.05% and (in dogs with mild to moderate clinical signs) weekly spot-ons containing moxidectin. In severe, treatment-resistant cases, daily oral macrocyclic lactones such as milbemycin oxim (1-2 mg/kg), ivermectin or moxidectin (0.3 mg/kg after daily gradual dose increases from 0.05mg/kg) may be used. Doramectin orally or subcutaneously at 0.6 mg/kg has also been reported as successful therapy. Secondary bacterial skin infections are common and should be treated with antimicrobial shampoos and possibly oral antibiotics.

Risk factors and prevalence of Demodex mites in young adults.

Demodex mites are ectoparasites often found in follicles of facial skin. Their role in human diseases is under investigation, and a growing number of studies indicated that they contribute to chronic inflammatory conditions of the skin, such as rosacea, blepharitis, otitis externa, alopecia and folliculitis. In our study we tested 96 healthy adults for the presence of Demodex mites. Risk factors influencing presence of mites and skin types of the tested individuals were evaluated. We found Demodex folliculorum or Demodex brevis in 17.7% of the samples, more frequently in males (21.9%) and in older adults (20%). Use of make-up seems to reduce the likelihood of Demodex carriage, while pet ownership, use of shared items and living in close contact with older adults had no significant influence of presence of mites. Demodex positive individuals described their skin to be drier, more prone to erythema, but less for folliculitis compared to Demodex negative subjects.