Clinical picture, diagnosis and treatment of rosacea, complicated by Demodex mites

Kubanov, Alexey А.; Gallyamova, Yuliya; Kravchenko, Anzhela

doi:10.4081/dr.2019.7675

Cited by 23 publications

(25 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The previous studies have shown the prevalence of ocular demodicosis in blepharitis patients between 67.2% and 83.7% (39-42). Demodex is not just responsible for blepharitis, it has also significant roles in meibomian gland disorder, (45) and rosacea (46). All these diseases are frequently seen in the community and require continuous follow-up for treatment.…”

Section: Discussionmentioning

confidence: 99%

Interobserver and Intraobserver Agreements of the Detection of Demodex Infestation by in Vivo Confocal Microscopy

et al. 2022

View full text Add to dashboard Cite

Objectives:The purpose of the study was to determine interobserver and intraobserver agreement, repeatability, and intrasubject variation of the detection of Demodex infestation in eyelids of blepharitis patients using in vivo confocal microscopy (IVCM). Methods: Eighty-three eyes of 42 blepharitis patients were included in the study. All eyelids were evaluated from temporal to nasal with IVCM using section mode and 10 lashes with their follicles were imagined, and every image with suspicion of Demodex infestation was recorded. Two experienced and two inexperienced ophthalmologists were masked for the diagnosis and interpreted the IVCM images regarding the presence of Demodex infestation with a 3-week interval. Interobserver and intraobserver agreements were calculated with Cohen's kappa and its variant statistics between and within experienced observers and between inexperienced observers. Results: While average sensitivity for the diagnosis of demodicosis in IVCM images was 83.35% for experienced and 51.35% for inexperienced observers, the average positive predictive value was 88.6% for experienced observers and 91.05% for inexperienced ones. Interobserver agreement between experienced observers was moderate (κ = 0.529) and intraobserver agreements within experienced observers were perfect (κ = 0.918 for observer-1; κ = 0.958 for observer-2). Interobserver agreement between inexperienced observers was poor (κ = 0.162) and intraobserver agreements within inexperienced observers were fair (κ = 0.427 for observer-3; κ = 0.475 for observer-4). Conclusion:The sensitivity, interobserver and intraobserver agreements in IVCM image analysis for the detection of Demodex infestation were highly associated with the clinical experience on IVCM imaging. In the hands of an experienced clinician, IVCM could be reliable for the diagnosis of ocular demodicosis.

show abstract

Section: Discussionmentioning

confidence: 99%

Interobserver and Intraobserver Agreements of the Detection of Demodex Infestation by in Vivo Confocal Microscopy

et al. 2022

View full text Add to dashboard Cite

show abstract

“…30 Demodex are the most successful ectoparasites of the body; they are commonly found in individuals older than 40 years and are virtually universal after age 45 years. 31,32 Each Demodex has 8 short legs, 4 on each side of their upper body, that advance in a peculiar rotary fashion, which limits its locomotion to 8 to 16 mm/h 29,33 (Fig. 1).…”

Section: Classification and Life Cyclementioning

confidence: 99%

Update on the Management of Demodex Blepharitis

Shah

Stein

Perry

2021

Cornea

View full text Add to dashboard Cite

:Demodex blepharitis is a common ophthalmologic disease that is often overlooked in the workup of blepharitis. Demodex infestation occurs in both symptomatic and asymptomatic individuals at similar rates; consequently, its role in the development of blepharitis has not been well elucidated. Two species have been confirmed to inhabit the human eyelid—Demodex folliculorum and Demodex brevis. These species differ in their preferred location of infestation, with D. folliculorum occupying the base of the eyelash and D. brevis inhabiting the meibomian glands, contributing to anterior and posterior Demodex blepharitis, respectively. A clinical index of suspicion must be developed from the history when blepharitis, conjunctivitis, or keratitis in adults and blepharoconjunctivitis or chalazia in children are resistant to treatment. The diagnosis can be strongly suspected by the presence of cylindrical dandruff at the base of the eyelash and confirmed by light microscopy of an epilated lash or by in vivo confocal microscopy. No cure is currently available. Management most frequently includes topical tea tree oil and its active ingredient terpinen-4-ol, both of which have produced good clinical outcomes. Topical tea tree oil is typically applied by a professional due to risk of toxicity. Several second-line treatment options have been studied, including ivermectin, metronidazole, selenium sulfide, microblepharoexfoliation, and lid hygiene. Novel, targeted therapies such as TP-03 (Tarsus Pharmaceuticals) are also currently being investigated in phase 2b/3 clinical trials. The purpose of this review purpose is to characterize Demodex blepharitis in detail, including its historical perspective and various classifications, and describe the latest diagnostic and management strategies.

show abstract

“…Mechanism of metronidazole action in rosacea had been suggested as anti-inflammatory effects and anti-parasitic activity on Demodex folliculorum 9 10 11 . Recently, the effect of D. folliculorum in increasing the duration of rosacea and probability of recurrence has been described 12 . There have been few reports of systemic metronidazole therapy for Demodex -associated diseases including rosacea and Demodicidosis 5 6 7 8 13 14 15 , which encouraged us to investigate whether the early combination use of oral metronidazole with minocycline could induce rapid resolution and prevention of relapse of rosacea.…”

Section: Introductionmentioning

confidence: 99%

Maintenance of Remission after Oral Metronidazole Add-on Therapy in Rosacea Treatment: A Retrospective, Comparative Study

et al. 2022

View full text Add to dashboard Cite

Background Rosacea is a chronic inflammatory disease which requires treatment to maintain remission. Objective Recently, the effect of Demodex mites in recurrence of rosacea has been described. Although there is limited data, previous reports have suggested that oral metronidazole demonstrated efficacy in treatment of rosacea. Methods Fifty-eight Korean patients with rosacea who received treatment with oral minocycline (50 mg twice daily) only or with two-week of oral metronidazole (250 mg thrice daily) were evaluated retrospectively. Their responses were evaluated by Investigator’s Global Assessment (IGA), Clinician’s Erythema Assessment (CEA), and patient’s Global Assessment. The recurrence rate and odds ratio of risk factors for recurrence were also estimated. Results The combination treatment group reported earlier clinical improvement and lower mean IGA and CEA than the monotherapy group. Approximately 48% of patients with combination treatment did not show relapse within 24 weeks, which is significantly higher than that in the monotherapy group ( p =0.042). Conclusion Add-on therapy of oral metronidazole appeared to be a significant protective factor for recurrence of rosacea ( p <0.05). This study suggests that oral metronidazole can be added to oral minocycline to reduce relapses in rosacea patients with tolerable safety.

show abstract

Clinical picture, diagnosis and treatment of rosacea, complicated by Demodex mites

Cited by 23 publications

References 20 publications

Interobserver and Intraobserver Agreements of the Detection of Demodex Infestation by in Vivo Confocal Microscopy

Interobserver and Intraobserver Agreements of the Detection of Demodex Infestation by in Vivo Confocal Microscopy

Update on the Management of Demodex Blepharitis

Maintenance of Remission after Oral Metronidazole Add-on Therapy in Rosacea Treatment: A Retrospective, Comparative Study

Contact Info

Product

Resources

About