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Lam NSK, Long XX, Li X, Yang L, Griffin RC, Doery JCG. Comparison of the efficacy of tea tree ( Melaleuca alternifolia) oil with other current pharmacological management in human demodicosis: A Systematic Review. Parasitology 2020; 147:1587-1613. [PMID: 32772960 PMCID: PMC10317738 DOI: 10.1017/s003118202000150x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/20/2020] [Accepted: 08/01/2020] [Indexed: 12/12/2022]
Abstract
Various treatments are found to be moderately effective in managing Demodex-related diseases except tea tree oil (TTO) and terpinen-4-ol (T4O), which showed superior miticidal and anti-inflammatory effects in numerous clinical studies. Their possible effects include lowering mite counts, relieving Demodex-related symptoms, and modulating the immune system. This review summarizes the current clinical topical and oral treatments in human demodicosis, their possible mechanisms of action, side-effects and resistance in treating this condition. TTO (especially T4O) is found to be the most effective followed by metronidazole, ivermectin and permethrin in managing the disease. This is because TTO has anti-parasitic, anti-bacterial, anti-fungal, anti-inflammatory and wound-healing effects. Furthermore, nanoTTO can even release its contents into fungus and Pseudomonas biofilms. Combinations of different treatments are occasionally needed for refractory cases, especially for individuals with underlying genetic predisposal or are immuno-compromised. Although the current treatments show efficacy in controlling the Demodex mite population and the related symptoms, further research needs to be focused on the efficacy and drug delivery technology in order to develop alternative treatments with better side-effects profiles, less toxicity, lower risk of resistance and are more cost-effective.
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Affiliation(s)
- Nelson Siu Kei Lam
- Department of Medicine, Monash University, Clayton, Victoria, Australia
- Department of Pathology, Monash Medical Centre, Clayton, Victoria, Australia
- Department of General Medicine, Monash Medical Centre, Clayton, Victoria, Australia
- Department of Pharmacy, Monash Medical Centre, Clayton, Victoria, Australia
- Faculty of Health and Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Xin Xin Long
- Faculty of Health and Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Xuegang Li
- Department of Rheumatology, The Fifth affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong province, China
| | - Li Yang
- Department of Dermatology, The Fifth affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong province, China
| | - Robert C Griffin
- Consultant Emeritus of The Canberra Hospital, Woden Valley, Canberra, Australian Capital Territory, Australia
| | - James CG Doery
- Department of Medicine, Monash University, Clayton, Victoria, Australia
- Department of Pathology, Monash Medical Centre, Clayton, Victoria, Australia
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Demodex spp. as a possible aetiopathogenic factor of acne and relation with acne severity and type. Postepy Dermatol Alergol 2018; 35:174-181. [PMID: 29760618 PMCID: PMC5949547 DOI: 10.5114/ada.2018.75239] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 12/18/2016] [Indexed: 01/09/2023] Open
Abstract
Introduction Acne is a very common skin disease in adolescents and young adults, but it also affects adults. However, its aetiology is not yet fully understood. Demodex appears to be associated with multiple skin disorders, but controversy persists. Some reports indicate a connection between acne vulgaris and demodicosis. Aim To confirm the association between Demodex infestation and acne vulgaris. Material and methods A total of 108 patients were enrolled in the acne group. Acne severity was calculated as GASS and acne type (adolescent and post adolescent) was recorded. An age-sex matched healthy control group comprising 65 individuals were included in the study. Dermatological examinations were performed and an SSSB was used to determine the presence of Demodex. Results In our study, Demodex positivity was seen in 46 (42.6%) patients in the acne group and 8 (12.3%) in the control group; this difference was statistically significant (p < 0.001). A multivariate Backward Step-By-Step Logistic Regression analysis identified the most effective factors for acne development such as Demodex positivity (OR = 5.565, 95% CI: 2.384–12.99 and p < 0.001) and age under 25 years (OR = 2.3 and 95% CI: 1.183–4.473 and p = 0.014). Alcohol consumption was related to Demodex positivity (p = 0.019) in post adolescent acne. Conclusions Our study is the first one to evaluate acne severity, acne type and the relationship to Demodex prevalence. We suggest that Demodex infestation should be considered when the classical therapies are ineffective especially in cases of post adolescent acne.
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Zhao Y, Yang F, Wang R, Niu D, Mu X, Yang R, Hu L. Association study of Demodex bacteria and facial dermatoses based on DGGE technique. Parasitol Res 2017; 116:945-951. [PMID: 28063008 DOI: 10.1007/s00436-016-5370-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 12/25/2016] [Indexed: 12/27/2022]
Abstract
The role of bacteria is unclear in the facial skin lesions caused by Demodex. To shed some light on this issue, we conducted a case-control study comparing cases with facial dermatoses with controls with healthy skin using denaturing gradient gel electrophoresis (DGGE) technique. The bacterial diversity, composition, and principal component were analyzed for Demodex bacteria and the matched facial skin bacteria. The result of mite examination showed that all 33 cases were infected with Demodex folliculorum (D. f), whereas 16 out of the 30 controls were infected with D. f, and the remaining 14 controls were infected with Demodex brevis (D. b). The diversity analysis showed that only evenness index presented statistical difference between mite bacteria and matched skin bacteria in the cases. The composition analysis showed that the DGGE bands of cases and controls were assigned to 12 taxa of 4 phyla, including Proteobacteria (39.37-52.78%), Firmicutes (2.7-26.77%), Actinobacteria (0-5.71%), and Bacteroidetes (0-2.08%). In cases, the proportion of Staphylococcus in Firmicutes was significantly higher than that in D. f controls and D. b controls, while the proportion of Sphingomonas in Proteobacteria was significantly lower than that in D. f controls. The between-group analysis (BGA) showed that all the banding patterns clustered into three groups, namely, D. f cases, D. f controls, and D. b controls. Our study suggests that the bacteria in Demodex should come from the matched facial skin bacteria. Proteobacteria and Firmicutes are the two main taxa. The increase of Staphylococcus and decrease of Sphingomonas might be associated with the development of facial dermatoses.
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Affiliation(s)
- YaE Zhao
- Department of Pathogen Biology and Immunology, School of Basic Medical Sciences, Xi'an Jiaotong University, No. 76 Yanta West Road, Xi'an, 710061, China.
| | - Fan Yang
- Department of Pathogen Biology and Immunology, School of Basic Medical Sciences, Xi'an Jiaotong University, No. 76 Yanta West Road, Xi'an, 710061, China
| | - RuiLing Wang
- Department of Pathogen Biology and Immunology, School of Basic Medical Sciences, Xi'an Jiaotong University, No. 76 Yanta West Road, Xi'an, 710061, China
| | - DongLing Niu
- Department of Pathogen Biology and Immunology, School of Basic Medical Sciences, Xi'an Jiaotong University, No. 76 Yanta West Road, Xi'an, 710061, China
| | - Xin Mu
- Department of Dermatology and Venereology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Rui Yang
- Department of Pathogen Biology and Immunology, School of Basic Medical Sciences, Xi'an Jiaotong University, No. 76 Yanta West Road, Xi'an, 710061, China
| | - Li Hu
- Department of Pathogen Biology and Immunology, School of Basic Medical Sciences, Xi'an Jiaotong University, No. 76 Yanta West Road, Xi'an, 710061, China
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Luo Y, Sun YJ, Zhang L, Luan XL. Treatment of mites folliculitis with an ornidazole-based sequential therapy: A randomized trial. Medicine (Baltimore) 2016; 95:e4173. [PMID: 27399141 PMCID: PMC5058870 DOI: 10.1097/md.0000000000004173] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE Treatment of Demodex infestations is often inadequate and associated with low effective rate. We sought to evaluate the efficacy of an ornidazole-based sequential therapy for mites folliculitis treatment. METHODS Two-hundred patients with mites folliculitis were sequentially treated with either an ornidazole- or metronidazole-based regimen. Sebum cutaneum was extruded from the sebaceous glands of each patient's nose and the presence of Demodex mites were examined by light microscopy. The clinical manifestations of relapse of mites folliculitis were recorded and the subjects were followed up at 2, 4, 8, and 12 weeks post-treatment. RESULTS Patients treated with the ornidazole-based regimen showed an overall effective rate of 94.0%. Additionally, at the 2, 4, 8, and 12-week follow-up, these patients had significantly lower rates of Demodex mite relapse and new lesion occurrence compared with patients treated with the metronidazole-based regimen (P < 0.05). CONCLUSION Sequential therapy using ornidazole, betamethasone, and recombinant bovine basic fibroblast growth factor (rbFGF) gel is highly effective for treating mites folliculitis.
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Affiliation(s)
- Yang Luo
- Department of Dermatology, Lanzhou General Hospital of Lanzhou Military Area Command, Lanzhou, China
- Correspondence: Yang Luo, Department of Dermatology, Lanzhou General Hospital of Lanzhou Military Area Command, 333 Binhenan Road, Lanzhou 730050, China (e-mail: )
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Cardwell LA, Alinia H, Moradi Tuchayi S, Feldman SR. New developments in the treatment of rosacea - role of once-daily ivermectin cream. Clin Cosmet Investig Dermatol 2016; 9:71-7. [PMID: 27051311 PMCID: PMC4807898 DOI: 10.2147/ccid.s98091] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Rosacea is a chronic dermatological disorder with a variety of clinical manifestations localized largely to the central face. The unclear etiology of rosacea fosters therapeutic difficulty; however, subtle clinical improvement with pharmacologic treatments of various drug categories suggests a multifactorial etiology of the disease. Factors that may contribute to disease pathogenesis include immune abnormality, vascular abnormality, neurogenic dysregulation, presence of cutaneous microorganisms, UV damage, and skin barrier dysfunction. The role of ivermectin in the treatment of rosacea may be as an anti-inflammatory and anti-parasitic agent targeting Demodex mites. In comparing topical ivermectin and metronidazole, ivermectin was more effective; this treatment modality boasted more improved quality of life, reduced lesion counts, and more favorable participant and physician assessment of disease severity. Patients who received ivermectin 1% cream had an acceptable safety profile. Ivermectin is efficacious in decreasing inflammatory lesion counts and erythema.
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Affiliation(s)
- Leah A Cardwell
- Department of Dermatology, Center for Dermatology Research, Winston-Salem, NC, USA
| | - Hossein Alinia
- Department of Dermatology, Center for Dermatology Research, Winston-Salem, NC, USA
| | - Sara Moradi Tuchayi
- Department of Dermatology, Center for Dermatology Research, Winston-Salem, NC, USA
| | - Steven R Feldman
- Department of Dermatology, Center for Dermatology Research, Winston-Salem, NC, USA; Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, USA; Department of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
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