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Al-Chaer RN, Bouazzi D, Jemec G, Mogensen M. Confocal microscopy and optical coherence tomography of inflammatory skin diseases in hairs and pilosebaceous units: A systematic review. Exp Dermatol 2023. [PMID: 37140216 DOI: 10.1111/exd.14830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 04/14/2023] [Accepted: 04/23/2023] [Indexed: 05/05/2023]
Abstract
Common skin disorders such as acne vulgaris, rosacea and folliculitis are bothersome prevalent inflammatory diseases of hair follicles that can easily be investigated bedside using optical coherence tomography (OCT) and reflectance confocal microscopy (RCM) with micrometre resolution, opening a novel era for high-resolution hair follicle diagnostics and quantitative treatment evaluation. EMBASE, PubMed and Web of Science were searched until 5 January 2023 to identify all studies imaging hair follicle characteristics by RCM and OCT for diagnosis and monitoring of treatment in hair follicle-based skin disorders. This study followed PRISMA guidelines. After inclusion of articles, methodological quality was assessed using the QUADAS-2 critical appraisal checklist. Thirty-nine in vivo studies (33 RCM and 12 OCT studies) were included. The studies focused on acne vulgaris, rosacea, alopecia areata, hidradenitis suppurativa, folliculitis, folliculitis decalvans, lichen planopilaris, discoid lupus erythemasus, frontal fibrosing alopecia and keratosis pilaris. Inter- and perifollicular morphology including number of demodex mites, hyperkeratinization, inflammation and vascular morphology could be assessed by RCM and OCT in all included skin disorders. Methodological study quality was low, and interstudy outcome variability was high. Quality assessment showed high or unclear risk of bias in 36 studies. Both RCM and OCT visualize quantitative features as size, shape, content and abnormalities of hair follicles, and have potential to support clinical diagnosis and evaluate treatment effects. However, larger studies with better methodological quality are needed to implement RCM and OCT directly into clinical practice.
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Affiliation(s)
- Rami Nabil Al-Chaer
- Department of Dermatology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Dorra Bouazzi
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
| | - Gregor Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
| | - Mette Mogensen
- Department of Dermatology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
- Department of Clinical Medicine, The Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Huang Y, He J, Zhang S, Tang Y, Wang B, Jian D, Xie H, Li J, Chen F, Zhao Z. A novel multi-layer perceptron model for assessing the diagnostic value of non-invasive imaging instruments for rosacea. PeerJ 2022; 10:e13917. [PMID: 35996670 PMCID: PMC9392450 DOI: 10.7717/peerj.13917] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 07/28/2022] [Indexed: 01/19/2023] Open
Abstract
Background Reflectance confocal microscopy (RCM), VISIA, and dermoscopy have emerged as promising tools for objective diagnosis and assessment of rosacea. However, little is known about the diagnostic value of these imaging systems for rosacea. Objectives To assess the diagnostic value of RCM, VISIA, and dermoscopy for rosacea by establishing a novel multilayer perceptron (MLP) model. Methods A total of 520 patients with rosacea and other facial diseases were included in this study. A total of 474 samples of dermoscopy data, 374 samples of RCM data, 434 samples of VISIA data, and 291 samples containing three data sources were collected. An MLP model was built with the total data to explore the association between the imageological features of each instrument and the probability of rosacea. Results Our MLP model revealed that the area under the receiver operating characteristic curve (AUROC) values of RCM, VISIA and dermoscopy for diagnosing rosacea were 0.5233, 0.5646 and 0.7971, respectively. The integration of these three tools with clinical data could further improve the accuracy of the predictive diagnosis to 0.8385. For the imageological features of each tool, abnormalities (hyperkeratosis or parakeratosis) in the stratum corneum were effective variables for excluding rosacea (odds ratio [OR], 0.4333) under RCM. The indicators of rosacea under VISIA included overall severity of erythema, erythema involving the cheek or superciliary arch, visible red blood vessels, and papules (OR = 2.2745, 3.1592, 1.8365, 2.8647, and 1.4260, respectively). The candidate variables of dermoscopy included yellow background, white background, uniform distribution of vessels, branched vessels, and reticular blood vessels (OR = 0.4259, 0.4949, 2.2858, 3.7444, and 2.4576, respectively). Conclusions RCM, dermoscopy, and VISIA each can present several imageological features and were of certain value for assisting rosacea diagnosis. The combined analysis of these three tools using our MLP model may be useful for improving the accuracy of diagnosing rosacea.
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Affiliation(s)
- Yingxue Huang
- Department of Dermatology, Xiangya Hospital of Central South University, Changsha, Hunan, China,Hunan Key Laboratory of Aging Biology, Xiangya Hospital of Central South University, Changsha, Hunan, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Jieyu He
- School of Public Health, Kunming Medical University, Kuming, Yunnan, China
| | - Shuping Zhang
- Department of Dermatology, Xiangya Hospital of Central South University, Changsha, Hunan, China,Hunan Key Laboratory of Aging Biology, Xiangya Hospital of Central South University, Changsha, Hunan, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yan Tang
- Department of Dermatology, Xiangya Hospital of Central South University, Changsha, Hunan, China,Hunan Key Laboratory of Aging Biology, Xiangya Hospital of Central South University, Changsha, Hunan, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Ben Wang
- Department of Dermatology, Xiangya Hospital of Central South University, Changsha, Hunan, China,Hunan Key Laboratory of Aging Biology, Xiangya Hospital of Central South University, Changsha, Hunan, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Dan Jian
- Department of Dermatology, Xiangya Hospital of Central South University, Changsha, Hunan, China,Hunan Key Laboratory of Aging Biology, Xiangya Hospital of Central South University, Changsha, Hunan, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Hongfu Xie
- Department of Dermatology, Xiangya Hospital of Central South University, Changsha, Hunan, China,Hunan Key Laboratory of Aging Biology, Xiangya Hospital of Central South University, Changsha, Hunan, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Ji Li
- Department of Dermatology, Xiangya Hospital of Central South University, Changsha, Hunan, China,Hunan Key Laboratory of Aging Biology, Xiangya Hospital of Central South University, Changsha, Hunan, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Feng Chen
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Zhixiang Zhao
- Department of Dermatology, Xiangya Hospital of Central South University, Changsha, Hunan, China,Hunan Key Laboratory of Aging Biology, Xiangya Hospital of Central South University, Changsha, Hunan, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, Hunan, China
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Gosalia H, Chandrakanth P, Verghese S, Rammohan R, Narendran K, Narendran V. Rapid Office-Based Diagnosis of Demodex Using an Innovative Smartphone-Aided Intraocular Lens Tool. Eye Contact Lens 2022; 48:306-307. [PMID: 35333809 DOI: 10.1097/icl.0000000000000881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Demodex is an important pathogen causing eyelid and eyelash diseases. This article describes a quick, efficient, cost-effective office-based imaging of demodex with the help of an intraocular lens (IOL) and smartphone-aided innovated tool. Eyelid photography of a 56-year-old man with suspected demodex infestation was obtained using a 20-diopter (D) IOL over the smartphone camera called as Anterior Segment Photography using IOL (ASPI). A video or photograph of the epilated eyelash was taken using four 30-D IOLs attached to the smartphone camera to form an optical system called IOLSCOPE, which clearly detected the demodex parasite. The importance of ASPI and IOLSCOPE for the rapid office-based diagnosis of demodex pathogen in peripheral health centers devoid of slitlamp and microscopes has been emphasized here.
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Erdal B, Albayrak H. Investigation of the Prevalence of Demodex spp. in Dermatological Diseases. TURKIYE PARAZITOLOJII DERGISI 2022; 46:54-59. [PMID: 35232707 DOI: 10.4274/tpd.galenos.2021.93685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE An increase in the counts of the Demodex mites that exist in the microbiota of healthy individuals may lead to some dermatological diseases. This study aimed to investigate the prevalence of Demodex spp. among patients diagnosed with acne vulgaris, rosacea, perioral dermatitis, seborrheic dermatitis, eczema, and pityriasis folliculorum and the relationship between the demographic and clinical data of such patients and Demodex. METHODS This study included 144 patients (70 with acne vulgaris, 6 with pityriasis folliculorum, 15 with seborrheic dermatitis, 39 with rosacea, 8 with eczema, and 6 with perioral dermatitis) and 73 healthy subjects. We evaluated Demodex positivity using the standard superficial skin biopsy method in all groups. The presence of more than five Demodex mites per square centimeter was considered positive at the diagnosis. RESULTS Of the 144 patients included in the study, 107 (74.3%) were female, and 37 (25.7%) were male, while 40 (54.8%) of the 73 healthy subjects were female, and 33 (45.2%) were male. Twenty-one patients (14.5%) and five of the healthy subjects (6.8%) tested positive for Demodex. We found that Demodex positivity rates in the rosacea and acne vulgaris groups were higher than in the control group. However, this level was not statistically significant (p>0.05). We found the highest positivity rate among the patient groups in the pityriasis folliculorum (4/6, 66.7%), rosacea (8/39, 20.5%), and perioral dermatitis (1/6, 16.7%) groups. Lastly, we found no statistically significant relationship between the demographic and clinical characteristics of the groups and Demodex positivity (p>0.05). CONCLUSION The present study is the only study that investigated Demodex positivity in six different dermatological diseases. Based on the results, we believe that investigating Demodex spp. positivity in dermatological diseases such as acne vulgaris, rosacea, and pityriasis folliculorum would be beneficial for early diagnosis and treatment.
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Affiliation(s)
- Berna Erdal
- Tekirdağ Namık Kemal Üniversitesi Tıp Fakültesi, Tıbbi Mikrobiyoloji Anabilim Dalı, Tekirdağ, Türkiye
| | - Hülya Albayrak
- Tekirdağ Namık Kemal Üniversitesi Tıp Fakültesi, Deri ve Zührevi Hastalıkları Anabilim Dalı, Tekirdağ, Türkiye
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The Pathogenic Role of Demodex Mites in Rosacea: A Potential Therapeutic Target Already in Erythematotelangiectatic Rosacea? Dermatol Ther (Heidelb) 2020; 10:1229-1253. [PMID: 33095403 PMCID: PMC7649190 DOI: 10.1007/s13555-020-00458-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Indexed: 12/15/2022] Open
Abstract
Rosacea is a common facial dermatosis but its definition and classification are still unclear, especially in terms of its links with demodicosis. Triggers of rosacea (ultraviolet light, heat, spicy foods, alcohol, stress, microbes) are currently considered to induce a cascading innate and then adaptive immune response that gets out of control. Recent histological and biochemical studies support the concept that this inflammatory response is a continuum, already present from the onset of the disease, even when no clinical signs of inflammation are visible. The Demodex mite is beginning to be accepted as one of the triggers of this inflammatory cascade, and its proliferation as a marker of rosacea; moreover, the papulopustules of rosacea can be effectively treated with topical acaricidal agents. Demodex proliferation appears to be a continuum process in rosacea, and may not be clinically visible at the onset of the disease. Molecular studies suggest that Demodex may induce tolerogenic dendritic cells and collaborate with vascular endothelial growth factor (VEGF) to induce T cell exhaustion and favor its own proliferation. These interactions among VEGF, Demodex, and immunity need to be explored further and the nosology of rosacea adapted accordingly. However, treating early rosacea, with only clinically visible vascular symptoms, with an acaricide may decrease early inflammation, limit potential flare-ups following laser treatment, and prevent the ultimate development of the papulopustules of rosacea. The effectiveness of this approach needs to be confirmed by prospective controlled clinical trials with long-term follow-up. Currently, the evidence suggests that patients with only vascular symptoms of rosacea should be carefully examined for the presence of follicular scales as signs of Demodex overgrowth or pityriasis folliculorum so that these patients, at least, can be treated early with an acaricidal cream.
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Forton FMN, De Maertelaer V. Effectiveness of benzyl benzoate treatment on clinical symptoms and Demodex density over time in patients with rosacea and demodicosis: a real life retrospective follow-up study comparing low- and high-dose regimens. J DERMATOL TREAT 2020; 33:456-465. [PMID: 32427504 DOI: 10.1080/09546634.2020.1770168] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Patients with rosacea and demodicosis have high facial skin Demodex densities (Dds), which decrease with benzyl benzoate (BB) treatment.Objectives: To evaluate the impact of topical BB (+crotamiton) treatment on Dds and clinical symptoms during prolonged follow-up and to compare low (12% once daily) and high (12% twice daily or 20-24% once daily) BB dose regimens.Methods: This retrospective study included 344 patients (103 rosacea, 241 demodicosis) observed for 7.1 ± 0.5 months. Dds were measured on two consecutive standardized skin surface biopsies and symptoms evaluated using investigator global assessment. Compliance was considered good if patients correctly followed treatment instructions.Results: At final follow-up, in the 248 patients with good compliance, Dd had normalized in 217 (88%) and symptoms cleared in 204 (82%). The high dose was associated with better compliance and faster results than the low-dose. The higher the initial Dd, the longer it took to normalize. In the 96 poorly compliant patients, treatment was less effective and slower.Conclusions: These findings indirectly support a key role of the mite in rosacea and suggest that topical treatment with BB (+crotamiton), especially the higher dose, may be a useful alternative treatment for rosacea as well as for demodicosis.[Formula: see text].
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Affiliation(s)
| | - Viviane De Maertelaer
- Institut de Recherche Interdisciplinaire en Biologie humaine et moléculaire (IRIBHM) & Service de Biostatistique et Informatique médicale (SBIM), Université Libre de Bruxelles (ULB), Brussels, Belgium
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Quint T, Brunner PM, Sinz C, Steiner I, Ristl R, Vigl K, Kimeswenger S, Neubauer K, Pirkhammer D, Zikeli M, Hoetzenecker W, Reider N, Bangert C. Dupilumab for the Treatment of Atopic Dermatitis in an Austrian Cohort-Real-Life Data Shows Rosacea-Like Folliculitis. J Clin Med 2020; 9:jcm9041241. [PMID: 32344789 PMCID: PMC7230957 DOI: 10.3390/jcm9041241] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 04/18/2020] [Accepted: 04/22/2020] [Indexed: 12/18/2022] Open
Abstract
Dupilumab is the first biological treatment approved for moderate-to-severe atopic dermatitis (AD). Efficacy and safety have been demonstrated in clinical trials, but real-life data is still limited. The objective of this study was to retrospectively evaluate Dupilumab treatment in AD patients in a real-life clinical setting. Effectiveness and safety outcomes were collected at baseline and after 2, 6, 10, 24, 39, and 52 weeks by using clinical scores for disease activity, as well as serological markers. Ninety-four patients from five dermatological hospitals were included. After 24 weeks of treatment, the median Investigator Global Assessment (IGA) and Eczema Area and Severity Index (EASI) showed a significant reduction compared to baseline (3.9 ± 0.7 vs. 1.4 ± 0.8 and 26.5 ± 12.5 vs. 6.4 ± 6.5). Interestingly, we observed rosacea-like folliculitis as an unexpected side effect in 6.4% of patients. Dupilumab proves to be an effective and well-tolerated treatment under real-life conditions. The occurrence of rosacea-like folliculitis warrants further mechanistic investigation.
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Affiliation(s)
- Tamara Quint
- Department of Dermatology, Medical University of Vienna, 1090 Vienna, Austria; (T.Q.); (P.M.B.); (C.S.)
| | - Patrick M. Brunner
- Department of Dermatology, Medical University of Vienna, 1090 Vienna, Austria; (T.Q.); (P.M.B.); (C.S.)
| | - Christoph Sinz
- Department of Dermatology, Medical University of Vienna, 1090 Vienna, Austria; (T.Q.); (P.M.B.); (C.S.)
| | - Irene Steiner
- Institute of Medical Statistics, Medical University Vienna, 1090 Vienna, Austria; (I.S.); (R.R.)
| | - Robin Ristl
- Institute of Medical Statistics, Medical University Vienna, 1090 Vienna, Austria; (I.S.); (R.R.)
| | - Kornelia Vigl
- Department of Dermatology, Rudolfstiftung City Hospital, 1030 Vienna, Austria; (K.V.); (D.P.)
| | - Susanne Kimeswenger
- Department of Dermatology, Kepler University Hospital, 4020 Linz, Austria; (S.K.); (W.H.)
- Department of Soft Matter Physics, Institute for Experimental Physics, Johannes Kepler University, 4020 Linz, Austria
| | - Katharina Neubauer
- Department of Dermatology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (K.N.); (N.R.)
| | - Detlev Pirkhammer
- Department of Dermatology, Rudolfstiftung City Hospital, 1030 Vienna, Austria; (K.V.); (D.P.)
| | - Martin Zikeli
- Department of Dermatology, Wiener Neustadt Public Hospital, 2700 Wiener Neustadt, Austria;
| | - Wolfram Hoetzenecker
- Department of Dermatology, Kepler University Hospital, 4020 Linz, Austria; (S.K.); (W.H.)
| | - Norbert Reider
- Department of Dermatology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (K.N.); (N.R.)
| | - Christine Bangert
- Department of Dermatology, Medical University of Vienna, 1090 Vienna, Austria; (T.Q.); (P.M.B.); (C.S.)
- Correspondence: ; Tel.: +43-1-40400-77200
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Logger JGM, Peppelman M, van Erp PEJ, de Jong EMGJ, Nguyen KP, Driessen RJB. Value of reflectance confocal microscopy for the monitoring of rosacea during treatment with topical ivermectin. J DERMATOL TREAT 2020; 33:195-203. [PMID: 32189533 DOI: 10.1080/09546634.2020.1741501] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background: Reflectance confocal microscopy (RCM) enables noninvasive Demodex mite detection in rosacea. Objective scoring of rosacea severity is currently lacking.Objectives: To determine the value of RCM for monitoring Demodex, inflammation and vascular parameters in rosacea during treatment.Methods: In 20 rosacea patients, clinical and RCM examination were performed before, during, and 12 weeks after a 16-week treatment course with topical ivermectin. Using RCM, number of mites and inflammatory cells, epidermal thickness, and vascular density and diameter were measured. RCM features were correlated with clinical assessment.Results: Treatment resulted in clinical reduction of inflammatory lesions. Mites were detected in 80% of patients at baseline, 30% at week 16, and 63% at week 28. The number of mites reduced significantly during treatment, but no changes in inflammatory cells, epidermal thickness or vascular parameters were observed. Correlation between number of inflammatory lesions and mites was low. None of the RCM variables were significant predictors for clinical success.Conclusions: RCM enables anti-inflammatory effect monitoring of topical ivermectin by determining mite presence. Quantifying exact mite number, and inflammatory and vascular characteristics is challenging due to device limitations. In its current form, RCM seems of limited value for noninvasive follow-up of rosacea in clinical practice.
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Affiliation(s)
- Jade G M Logger
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Malou Peppelman
- Healthcare Policy, Santiz Hospitals, Doetinchem and Winterswijk, The Netherlands
| | - Piet E J van Erp
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Elke M G J de Jong
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Kim P Nguyen
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rieke J B Driessen
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
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Logger J, Vries F, Erp PJ, Jong E, Peppelman M, Driessen R. Noninvasive objective skin measurement methods for rosacea assessment: a systematic review. Br J Dermatol 2019; 182:55-66. [DOI: 10.1111/bjd.18151] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2019] [Indexed: 12/11/2022]
Affiliation(s)
- J.G.M. Logger
- Department of Dermatology Radboud University Medical Center Nijmegen the Netherlands
| | - F.M.C. Vries
- HU University of Applied Sciences Utrecht the Netherlands
| | - P.E J. Erp
- Department of Dermatology Radboud University Medical Center Nijmegen the Netherlands
| | - E.M.G.J. Jong
- Department of Dermatology Radboud University Medical Center Nijmegen the Netherlands
| | - M. Peppelman
- Department of Dermatology Radboud University Medical Center Nijmegen the Netherlands
| | - R.J.B. Driessen
- Department of Dermatology Radboud University Medical Center Nijmegen the Netherlands
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Forton F, De Maertelaer V. Erythematotelangiectatic rosacea may be associated with a subclinical stage of demodicosis: a case-control study. Br J Dermatol 2019; 181:818-825. [PMID: 30801673 DOI: 10.1111/bjd.17817] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Facial densities of Demodex mites have been observed to be greater in patients with demodicosis and papulopustular rosacea than in healthy control patients. In patients with erythematotelangiectatic rosacea (ETR), this density has been observed to be similar to or greater than that of healthy controls. Erythema and telangiectasia, characteristics of ETR, are often observed among patients with pityriasis folliculorum, a discreet demodicosis, suggesting a possible link between these conditions. OBJECTIVES To compare the facial Demodex densities of patients with clinical ETR and patients with healthy skin, demodicosis, rosacea with papulopustules, and other facial dermatoses. METHODS In this retrospective study, we recorded Demodex densities measured using two consecutive standardized skin surface biopsies (SSSB1 and SSSB2) in 23 patients with ETR, 20 healthy control patients, 590 patients with demodicosis, 254 with rosacea with papulopustules and 180 with other facial dermatoses. RESULTS Patients with ETR had higher Demodex densities (D cm-2 ) than did the healthy controls (mean ± SEM; SSSB1: 15·7 ± 6·3 vs. 1·8 ± 1·1 D cm-2 , P = 0·042; SSSB2: 38·0 ± 13·7 vs. 5·1 ± 2·1 D cm-2 , P = 0·026) and patients with other dermatoses (SSSB1: 0·4 ± 0·1 D cm-2 , P = 0·004; SSSB2: 1·3 ± 0·3 D cm-2 , P = 0·004), but lower densities than patients with demodicosis (SSSB1: 82·7 ± 4·2 D cm-2 , P = 0·008; SSSB2: 172·2 ± 7·7 D cm-2 , P = 0·001) or rosacea with papulopustules (SSSB1: 86·6 ± 7·3 D cm-2 , P = 0·027; SSSB2: 197·0 ± 12·1 D cm-2 , P = 0·002). CONCLUSIONS ETR may be associated with nonvisible Demodex proliferation, possibly corresponding to a subclinical stage of demodicosis. Dermatologists should be aware of this potential association and look for subclinical demodicosis in patients with ETR, so that topical acaricidal treatment can be offered if Demodex density is high.
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Affiliation(s)
- F Forton
- Dermatologist, rue Frans Binjé 8, 1030, Brussels, Belgium
| | - V De Maertelaer
- Free University of Brussels (ULB), Institut de Recherche Interdisciplinaire en Biologie Humaine et Moléculaire (IRIBHM) and Service de Biostatistique et Informatique Médicale (SBIM), Route de Lennik 808/CP602, 1070, Brussels, Belgium
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12
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Abstract
Demodex is an important pathogen in ophthalmology. It is believed to cause a variety of eyelid and eyelash diseases. Currently, light microscopes are being used for imaging demodex. However, microscopes are not available everywhere. Also, it is not cost-effective to perform light microscopy in every case. In this case, we demonstrate a new method: imaging demodex using cell phone. A 90-diopter noncontact double aspheric lens was attached to the posterior camera of the smartphone with clear tape. An eyelash of a patient with blepharitis was removed. A video was taken using smartphone. There was a moving demodex parasite in the root of the eyelash. A clear video image could be taken using the smartphone. A smartphone and a 90-diopter lens are adequate for the imaging and diagnosis of demodex.
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Falay Gur T, Erdemir AV, Gurel MS, Kocyigit A, Guler EM, Erdil D. The investigation of the relationships of demodex density with inflammatory response and oxidative stress in rosacea. Arch Dermatol Res 2018; 310:759-767. [PMID: 30151656 DOI: 10.1007/s00403-018-1857-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 08/05/2018] [Accepted: 08/21/2018] [Indexed: 01/11/2023]
Abstract
The relationships of demodex density with systemic oxidative stress, inflammatory response, and clinical severity in rosacea are not clear. This study aimed to (a) analyze the levels of systemic oxidative stress, antioxidant capacity, inflammatory parameters, and matrix metalloproteinases (MMPs) in systemic circulation in patients with rosacea, (b) identify the relationship between mite density and both oxidative stress and inflammation, and (c) investigate the role of photoaging and sebum secretion in etiopathogenesis. Forty patients with rosacea and 40 age-, sex-, and skin phenotype-matched healthy volunteers were included in the study. Clinical disease severity of the patients was determined. Sebum levels were measured in both the groups, and photoaging was evaluated. Reflectance confocal microscopy was used to calculate demodex density. Serum total antioxidant capacity (TAC), total oxidant capacity (TOC), myeloperoxidase (MPO), MMP-1, MMP-9, arylesterase (ARES), interleukin-1β (IL-1β), paraoxonase-1 (PON-1), and tumor necrosis factor-α (TNF-α) levels were also analyzed. The patients with rosacea had significantly higher serum TOC and lower TAC levels (p < 0.001). The serum ARES and PON-1 levels were significantly lower (p = 0.045 and p < 0.001, respectively); however, the serum levels of MMP-1, MMP-9, IL-1β and MPO were higher in the patient group. Demodex parameters were higher in the patient group compared to the control group. There was no significant correlation between the number of mites and disease severity. In addition, the number of mites was not correlated with the serum levels of TAC, TOC, OSI, MPO, MMP-1, MMP-9, ARES, PON-1, TNF-α, and IL-1β. However, sebum levels were directly proportional to the number of mites. Photoaging severity was similar between the patients and control subjects. The changing sebaceous microenvironment in rosacea leads to an increase in the number of demodex mites. However, increased demodex density does not alter disease severity, level of oxidative stress, or inflammation. Although none of the patients with rosacea had any underlying systemic disease, patients' systemic oxidative stress and inflammation parameters were found high in systemic circulation. It is assumed that the patients with rosacea are more prone to systemic diseases.
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Affiliation(s)
- Tuğba Falay Gur
- Department of Dermatology, Sultan Abdulhamid Han Training and Research Hospital, Health Science University, Usküdar, Istanbul, Turkey.
| | - Aslı Vefa Erdemir
- Department of Dermatology, Göztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Mehmet Salih Gurel
- Department of Dermatology, Göztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Abdurrahim Kocyigit
- Department of Biochemistry, Bezmialem Vakif University Medical School, Istanbul, Turkey
| | - Eray Metin Guler
- Department of Biochemistry, Bezmialem Vakif University Medical School, Istanbul, Turkey
| | - Duygu Erdil
- Department of Dermatology, Ağrı State Hospital, Ağrı, Turkey
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14
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Lacarrubba F, Ardigò M, Di Stefani A, Verzì AE, Micali G. Dermatoscopy and Reflectance Confocal Microscopy Correlations in Nonmelanocytic Disorders. Dermatol Clin 2018; 36:487-501. [PMID: 30201157 DOI: 10.1016/j.det.2018.05.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Dermatoscopy and in vivo reflectance confocal microscopy are noninvasive techniques that provide a horizontal approach, with an en face view of the skin structures. Both techniques assist in the clinical diagnosis of a variety of inflammatory and infectious cutaneous disorders. In many cases, they have shown concordance. Their combined use represents, in several instances, a promising option to reach the final diagnosis without the need for invasive procedures.
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Affiliation(s)
- Francesco Lacarrubba
- Dermatology Clinic, University of Catania, Via Santa Sofia 78, Catania 95123, Italy.
| | - Marco Ardigò
- Department of Clinical Dermatology, San Gallicano Dermatological Institute, Rome, Italy
| | | | - Anna Elisa Verzì
- Dermatology Clinic, University of Catania, Via Santa Sofia 78, Catania 95123, Italy
| | - Giuseppe Micali
- Dermatology Clinic, University of Catania, Via Santa Sofia 78, Catania 95123, Italy
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15
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Uzunçakmak TK, Karadag AS, Cobanoglu B, Aksu Koku AE, Akdeniz N. White spiky papules on face of a 6 year old child. Pediatr Dermatol 2018; 35:244-245. [PMID: 29575067 DOI: 10.1111/pde.13394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Tuğba K Uzunçakmak
- Department of Dermatology, Goztepe Research and Training Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Ayse Serap Karadag
- Department of Dermatology, Goztepe Research and Training Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Bengu Cobanoglu
- Department of Pathology, Goztepe Research and Training Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Ayse Esra Aksu Koku
- Department of Dermatology, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Necmettin Akdeniz
- Department of Dermatology, Goztepe Research and Training Hospital, Istanbul Medeniyet University, Istanbul, Turkey
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16
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Harmelin Y, Le Duff F, Passeron T, Lacour JP, Bahadoran P. Intérêt de la microscopie confocale par réflectance in vivo pour la détection des Demodex. Ann Dermatol Venereol 2017; 144:459-461. [DOI: 10.1016/j.annder.2016.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 09/27/2016] [Accepted: 10/07/2016] [Indexed: 11/29/2022]
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17
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Pampín A, Floristán U, Gamo R, Ascanio ML, López-Estebaranz JL. Facial spinulosis caused byDemodex folliculorum: diagnostic assessment by means of reflectance confocal microscopy. Clin Exp Dermatol 2017; 42:348-350. [DOI: 10.1111/ced.13060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2016] [Indexed: 11/28/2022]
Affiliation(s)
- A. Pampín
- Dermatology Department; Hospital Universitario Fundación Alcorcón; Calle Budapest 1 28922 Alcorcón Madrid Spain
| | - U. Floristán
- Dermatology Department; Hospital Universitario Fundación Alcorcón; Calle Budapest 1 28922 Alcorcón Madrid Spain
| | - R. Gamo
- Dermatology Department; Hospital Universitario Fundación Alcorcón; Calle Budapest 1 28922 Alcorcón Madrid Spain
| | - M. L. Ascanio
- Dermatology Department; Hospital Universitario Fundación Alcorcón; Calle Budapest 1 28922 Alcorcón Madrid Spain
| | - J. L. López-Estebaranz
- Dermatology Department; Hospital Universitario Fundación Alcorcón; Calle Budapest 1 28922 Alcorcón Madrid Spain
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18
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Turgut Erdemir A, Gurel MS, Koku Aksu AE, Falay T, Inan Yuksel E, Sarikaya E. Demodex mites in acne rosacea: reflectance confocal microscopic study. Australas J Dermatol 2016; 58:e26-e30. [PMID: 26969834 DOI: 10.1111/ajd.12452] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 12/28/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND/OBJECTIVES Demodex mite density is emphasised in the aetiopathogenesis of acne rosacea. Reflectance confocal microscopy (RCM) has been shown to be a good method for determining demodex mite density. The objective was to determine demodex mite density using RCM in acne rosacea patients and compare them with controls. METHODS In all, 30 papulopustular rosacea (PPR) and 30 erythematotelangiectatic rosacea (ETR) totally 60 acne rosacea patients and 40 controls, were enrolled in the study. The right cheek was selected for imaging and RCM was used for scanning. Ten images of 1000 × 1000 μm (total 10 mm2 ) area were scanned from adjacent areas. The numbers of follicles, infested follicles and mites were counted. The mean numbers of mites per follicle and infested follicles were calculated and compared in the patients and control groups. RESULTS The mean number of mites was 44.30 ± 23.22 in PPR, 14.57 ± 15.86 in ETR and 3.55 ± 6.48 in the control group (P < 0.001). The mean number of mites per follicle was 1.77 ± 0.90 in PPR, 0.57 ± 0.63 in ETR and 0.13 ± 0.23 in the control group (P < 0.001). The cut-off for the mean number of mites for determining mite infestation was 0.17 and above. CONCLUSIONS Demodex mite density was markedly increased in both ETR and PPR patients. It is believed that the presence of demodex mites plays an important role in rosacea aetiopathogenesis. Demodex mite treatment may reduce the severity of the disease and slow its progressive nature.
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Affiliation(s)
- Asli Turgut Erdemir
- Department of Dermatology, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Salih Gurel
- Department of Dermatology, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Ayse Esra Koku Aksu
- Department of Dermatology, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Tugba Falay
- Department of Dermatology, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Esma Inan Yuksel
- Department of Dermatology, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Ebru Sarikaya
- Department of Dermatology, Istanbul Training and Research Hospital, Istanbul, Turkey
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19
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Kubanov AA, Galljamova JA, Grevtseva AS, Gribanov NV. Modern demodicosis diagnostics methods. VESTNIK DERMATOLOGII I VENEROLOGII 2016. [DOI: 10.25208/0042-4609-2016-92-1-47-54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
An overview of the modern demodicosis diagnostics methods and in-house demodicosis diagnosis with intravital laser scanning confocal microscopy effectiveness studies. The study included 60 patients with acne and rosacea, complicated demodicosis, 60 patients with acne and rosacea and no demodicosis, and 30 healthy volunteers. All the patients underwent skin scraping, eyebrows and/or eyelashes hair removal and confocal laser-scanning microscopy. the advantages of confocal laser-scanning microscopy in vivo in comparison with conventional methods of research are shown.
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20
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Cinotti E, Perrot J, Labeille B, Cambazard F. Reflectance confocal microscopy for cutaneous infections and infestations. J Eur Acad Dermatol Venereol 2015; 30:754-63. [DOI: 10.1111/jdv.13254] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 03/06/2015] [Indexed: 12/28/2022]
Affiliation(s)
- E. Cinotti
- Dermatology Department; University Hospital of Saint-Etienne; Saint Etienne France
| | - J.L. Perrot
- Dermatology Department; University Hospital of Saint-Etienne; Saint Etienne France
| | - B. Labeille
- Dermatology Department; University Hospital of Saint-Etienne; Saint Etienne France
| | - F. Cambazard
- Dermatology Department; University Hospital of Saint-Etienne; Saint Etienne France
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21
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Bahadoran P. Reflectance confocal microscopy: a new key for assessing the role of Demodex in rosacea? Br J Dermatol 2015; 173:8-9. [PMID: 26174637 DOI: 10.1111/bjd.13903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- P Bahadoran
- Department of Dermatology, Clinical Research Centre, Nice, France.
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22
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Kubanova AA, Kubanov AA, Smolyannikova VA, Gribanov NV, Makhakova YUB. Diagnostic value of the confocal laser scanning microscopy in vivo. VESTNIK DERMATOLOGII I VENEROLOGII 2015. [DOI: 10.25208/0042-4609-2015-91-3-67-74] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
The confocal laser scanning microscopy in vivo is a promising study method to visualize cell structures of epidermis and papillary dermis without affecting the skin integrity, which provides for a resolution and contrast similar to those characteristic of the classical histology examination. Goal. To assess the confocal laser scanning microscopy in vivo (CLSM) technique for diagnosing actinic keratosis, psoriasis vulgaris and rosacea vs. the classical histology examination. Study materials. The article describes the results obtained by using the confocal laser scanning microscopy in vivo technique vs. the histology examination in 10 patients with erythematous actinic keratosis, 10 patients with extensive psoriasis and 10 patients with erythematous and papulous rosacea. Results. The article describes diagnostically significant signs of the diseases detected by using the confocal laser scanning microscopy in vivo as well as the potential of this method in terms of diagnosing inflammatory skin diseases.
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23
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Sattler EC, Hoffmann VS, Ruzicka T, Braunmühl TV, Berking C. Reflectance confocal microscopy for monitoring the density of Demodex mites in patients with rosacea before and after treatment. Br J Dermatol 2015; 173:69-75. [PMID: 25801631 DOI: 10.1111/bjd.13783] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Demodex mites seem to serve as a pathogenic trigger in many Demodex-associated diseases such as rosacea. In facial skin of patients with rosacea significantly higher numbers of Demodex mites have been shown compared with healthy controls. Reflectance confocal microscopy (RCM) allows the detection and quantification of Demodex mites in vivo noninvasively. It is hypothesized that a reduction of Demodex mites under rosacea therapy can be monitored by RCM. OBJECTIVES To use RCM to monitor the density of Demodex mites in patients with rosacea before and after treatment. METHODS In 25 patients with facial rosacea RCM was performed before and after therapy. Mosaics of 5 × 5 mm(2) and 8 × 8 mm(2) were scanned, and the total numbers of mites per follicle and per area were counted, along with the number of follicles per area. RESULTS In all patients Demodex folliculorum could be detected and quantified using RCM. RCM showed significant differences pre- and post-treatment (P = 0.0053 for 5 × 5 mm(2) and P < 0.001 for 8 × 8 mm(2)). The mean numbers of mites per follicle were 0.63 (range 0.16-2.28) per 8 × 8 mm(2) area and 0.70 (range 0.11-2.20) per 5 × 5 mm(2) area before treatment, and 0.41 (range 0.074-1.75) and 0.51 (range 0.094-1.70), respectively, after treatment. The corresponding mean numbers of mites were 155 (range 45-446) and 86.2 (range 12-286), respectively, before treatment and 96.2 (range 18-363) and 58.5 (range 12-230), respectively, after treatment. CONCLUSIONS By RCM, a reduction in the density of Demodex mites in facial skin of patients with rosacea under therapy, correlating to clinical improvement, can be quantified and monitored noninvasively. Possible reasons for this therapeutic effect are discussed.
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Affiliation(s)
- E C Sattler
- Department of Dermatology and Allergology, Ludwig-Maximilian University Munich, Frauenlobstraße 9-11, 80337, Munich, Germany
| | - V S Hoffmann
- Institute of Medical Information Sciences, Biometry and Epidemiology (IBE), Ludwig-Maximilian University Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - T Ruzicka
- Department of Dermatology and Allergology, Ludwig-Maximilian University Munich, Frauenlobstraße 9-11, 80337, Munich, Germany
| | - T V Braunmühl
- Department of Dermatology and Allergology, Ludwig-Maximilian University Munich, Frauenlobstraße 9-11, 80337, Munich, Germany
| | - C Berking
- Department of Dermatology and Allergology, Ludwig-Maximilian University Munich, Frauenlobstraße 9-11, 80337, Munich, Germany
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24
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Are Demodex mites principal, conspirator, accomplice, witness or bystander in the cause of rosacea? Am J Clin Dermatol 2015; 16:67-72. [PMID: 25666117 DOI: 10.1007/s40257-015-0115-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
As the only permanent human ectoparasite, the role of human Demodex mites in health and diseases remains largely unclarified. In view of the ecological interaction between organisms of two different species, a type of commensalism between Demodex mites and humans (the former benefit, the latter unaffected) is most likely, while parasitism occurs temporarily and spatially in the diseased state (the former benefit, the latter harmed). As part of normal skin microbiota, the causal role of Demodex mites in the initiation of rosacea can neither fulfill the classical Henle-Koch's principal nor the advanced criteria proposed by Fredericks and Relman for molecular detection of non-cultivatable microorganisms. Epidemiological analysis using Hill's criteria fails to support the causative role of Demodex mites in rosacea regarding the strength of association, specificity and temporality of association, biological gradient and plausibility as well as clinical coherence, therapeutic experimentation and medical analogy. In application of Rothman's sufficient cause model to evaluate the contribution of Demodex mites to rosacea on a population basis, Demodex mites can be regarded as a non-necessary, non-sufficient causal factor for certain forms of rosacea. Further strategies to dissect the association between Demodex mites and rosacea may include studying the possible existence of more virulent forms of mites with a higher pathogenicity, the endosymbiotic bacteria in certain life periods of mites, the interactions between mites and human hosts or between mites and environment, and to set up ex vivo culture models for Demodex mites.
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25
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Hoogedoorn L, Peppelman M, van de Kerkhof P, van Erp P, Gerritsen M. The value ofin vivoreflectance confocal microscopy in the diagnosis and monitoring of inflammatory and infectious skin diseases: a systematic review. Br J Dermatol 2015; 172:1222-48. [DOI: 10.1111/bjd.13499] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2014] [Indexed: 11/27/2022]
Affiliation(s)
- L. Hoogedoorn
- Department of Dermatology; Radboud University Medical Center; PO Box 9101 NL 6500 HB Nijmegen the Netherlands
| | - M. Peppelman
- Department of Dermatology; Radboud University Medical Center; PO Box 9101 NL 6500 HB Nijmegen the Netherlands
| | - P.C.M. van de Kerkhof
- Department of Dermatology; Radboud University Medical Center; PO Box 9101 NL 6500 HB Nijmegen the Netherlands
| | - P.E.J. van Erp
- Department of Dermatology; Radboud University Medical Center; PO Box 9101 NL 6500 HB Nijmegen the Netherlands
| | - M.J.P. Gerritsen
- Department of Dermatology; Radboud University Medical Center; PO Box 9101 NL 6500 HB Nijmegen the Netherlands
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