Demodex Folliculitis and Recent Dupilumab Administration

Krakowski, Andrew C.; Senft, Stephen C.; Heymann, Warren R.

doi:10.1542/peds.2020-029520

Cited by 11 publications

(8 citation statements)

References 5 publications

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“…Thus, the use of dupilumab in AD patients has been associated with uncommon rosacea-like inflammation with demodex mite colonization. [15][16][17][18][19][20] Interestingly, paradoxical psoriasis-like skin reaction has also been observed during dupilumab therapy, a condition that shows IL-17 skew similar to rosacea and acne. [21][22][23] Collectively, facial skin of AD patients seems to be fundamentally different from the skin of patients with inflammatory disease in other organs.…”

Section: Discussionmentioning

confidence: 99%

“…This observation is reminiscent of the facial redness (and ocular surface problems) that is observed in some patients with AD following treatment with dupilumab, but not in patients with asthma and chronic rhinosinusitis with nasal polyps. Thus, the use of dupilumab in AD patients has been associated with uncommon rosacea‐like inflammation with demodex mite colonization 15–20 . Interestingly, paradoxical psoriasis‐like skin reaction has also been observed during dupilumab therapy, a condition that shows IL‐17 skew similar to rosacea and acne 21–23 .…”

Section: Discussionmentioning

confidence: 99%

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Incidence, prevalence and risk of acne in adolescent and adult patients with atopic dermatitis: a matched cohort study

Thyssen

Maul

Schmid‐Grendelmeier

et al. 2022

Acad Dermatol Venereol

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Background Use of Janus kinase 1 inhibitors in moderate‐to‐severe atopic dermatitis (AD) is associated with incident acne in adolescent and adults that is mostly mild, transient and treatable. There is a need for more knowledge about the risk and severity of acne in patients with AD. Objectives To examine the prevalence, incidence and risk of acne in adolescents and adults with AD using nationwide prescription data. Methods A matched cohort study of 6600 adults with AD and 66 000 controls was conducted using routinely and prospectively collected nationwide administrative data. Adjusted hazard ratios (HR) are reported with 95% confidence intervals (CIs). Results The 12‐month prevalence of acne was 3.7% in the general population and 3.9% among AD patients. The incidence rate of acne was highest among 12‐ to 18‐year‐old AD patients, and overall slightly higher in women with AD compared with males. The overall risk in patients with AD was similar with that of the general population (HR 0.96; 95% CI 0.88–1.06), whereas the risk of being treated for severe acne was reduced in AD patients (HR 0.59; 95% CI 0.47–0.73) and mainly among adolescents and young adults. The HR of acne increased with age reaching 1.41 (95% CI 1.07–1.87) for ages 30–39 years, and 2.07 (95% CI 1.42–3.03) for patients ≥40 years compared with controls. Conclusions The risk and severity of acne in AD patients change with age and sex, which may be used for the risk assessment of acne following treatment with Janus kinase 1 inhibitors.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Incidence, prevalence and risk of acne in adolescent and adult patients with atopic dermatitis: a matched cohort study

Thyssen

Maul

Schmid‐Grendelmeier

et al. 2022

Acad Dermatol Venereol

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“…41 Colonisation with demodex mites and concomitant IL-17 increase has also been hypothesised to play a role in OSDs in association with dupilumab. 42,43 Staphylococcus aureus has been suspected to play a role in the aetiology of OSDs in AD patients. 19,44 A recent study showed that AKC patients have a higher percentage of staphylococci in their conjunctival microbiome compared to controls, but the species remained not differentiated.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with ocular surface disease and severity in adults with atopic dermatitis: a nationwide survey

Rønnstad

Hansen

Halling

et al. 2021

Acad Dermatol Venereol

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Background Ocular surface diseases (OSDs), including conjunctivitis and blepharitis, are common in atopic dermatitis (AD) patients, but the magnitude and patient characteristics are unclear. Objectives To examine the prevalence of OSDs in adults with AD and identify patient characteristics and risk factors.Methods We designed a cross-sectional questionnaire-based survey and sent it via a secure public mail to all adult Danes with a hospital diagnosis of AD (ICD-10 code L20.x) registered in the National Patient Register (n = 16 718) between 2000 and 2019 and 7044 (42%) participated. Primary outcomes were OSDs and severity according to Ocular Surface Disease Index (OSDI). Adjusted odds ratios (aOR) were calculated with 95% confidence intervals (CIs) using logistic regression models. ResultsRespondents were mostly females and middle-aged (67.4%, mean [SD] age, 39.0 [15.5] years). Based on Patient-Oriented SCORing Atopic Dermatitis 49% had mild AD, 35% moderate, 10% severe and in 6% AD was inactive; 44.3% reported physician-diagnosed asthma bronchiale and 55.8% rhinitis. The lifetime prevalence of OSDs was 66.6% for conjunctivitis, 63.5% for hordeolum, 11.0% for blepharitis, 9.7% for keratitis, 2.0% for pterygium, 1.5% for symblepharon, 1.1% for keratoconus and 12.7% reported current conjunctivitis. Factors associated with lifetime occurrence of conjunctivitis included mild, moderate, and severe AD (aOR = 1.48 [95% CI, 1.02-2.14], aOR = 1.73 [95% CI, 1.19-2.53], aOR = 2.17 [95% CI, 1.42-3.21]), asthma bronchiale and rhinitis (aOR = 1.76 [95% CI, 1.49-2.07]), childhoodonset of AD (aOR = 1.34 [95% CI,) and systemic AD treatment (aOR = 1.27 [95% CI, 1.08-1.50]). Use of soft and hard contact lenses (aOR = 2.15 [95% CI, 1.65-2.80], aOR = 3.35 [95% CI, 1.62-6.92]) were associated with lifetime occurrence of keratitis. Moderate and severe AD, asthma bronchiale and rhinitis were also associated with a higher OSDI level.Conclusions This study identified important patient factors associated with OSDs. Clinicians should be attentive of ocular signs and symptoms in AD patients and ask about these.

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“…Th2 immunity is activated in response to both allergens and parasitic infections [48]. In recent years, cases of rosacea-like lesions have been reported in patients following the use of dupilumab [49, 50]. Live Demodex mites’ colonization of the face was discovered after further study by direct scraping of pustules [50].…”

Section: Discussionmentioning

confidence: 99%

Evidence for the Clinical Association between <i>Demodex</i> and Rosacea: A Review

Wei,

Li,

Kong

et al. 2023

Dermatology

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Background: Rosacea is a chronic inflammatory dermatological condition in humans, and its pathogenesis remains unclear. However, the development of rosacea is suspected to be related to Demodex, a microscopic commensal organism that resides in or near hair follicles and sebaceous glands. Although Demodex is known to be a host-specific, obligate commensal organism, it is currently difficult to be cultured in vitro to parasitize and infect other animal hosts. Therefore, direct evidence for a pathogenic role of Demodex in rosacea is currently lacking. Summary: As circumstantial evidence, non-invasive skin-detecting techniques have shown abnormally elevated numbers of Demodex in rosacea patients. Increased cytokine levels such as IL-10, IL-8, and IL-12p70 have been observed in human sebocytes following Demodex challenge, and acaricides have been found to be effective in rosacea therapy, all point to a close relationship between Demodex and rosacea. Based on these findings, we conducted a comprehensive literature review to summarize the current state of knowledge, research insights, and clinical treatment recommendations for Demodex-associated rosacea, with the ultimate goal of improving patient outcomes. Key Messages: Rosacea appears to have a close bond with Demodex. Recent studies have implicated that Demodex mites are involved in the development of rosacea. Based on a comprehensive review of the current literature, we have cited substantial evidence supporting this relationship, proposed a possible vicious cycle between Demodex and rosacea, and illustrated the changes in immune responses during this process. In addition, we recommend that patients with both rosacea and Demodex infection be treated early with a combination of topical ivermectin and topical Th1 inhibitors to improve treatment outcomes.

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Demodex Folliculitis and Recent Dupilumab Administration

Cited by 11 publications

References 5 publications

Incidence, prevalence and risk of acne in adolescent and adult patients with atopic dermatitis: a matched cohort study

Incidence, prevalence and risk of acne in adolescent and adult patients with atopic dermatitis: a matched cohort study

Factors associated with ocular surface disease and severity in adults with atopic dermatitis: a nationwide survey

Evidence for the Clinical Association between <i>Demodex</i> and Rosacea: A Review

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