1
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Gra M, Blaizot R, Grotta G, Drak Alsibai K, Couppie P. Papules on the face after cART introduction: Demodicosis as an immune reconstitution inflammatory syndrome. J Eur Acad Dermatol Venereol 2024; 38:e177-e179. [PMID: 37728527 DOI: 10.1111/jdv.19519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 09/15/2023] [Indexed: 09/21/2023]
Affiliation(s)
- M Gra
- Dermatology Department, Cayenne Hospital Center, Cayenne, French Guiana
| | - R Blaizot
- Dermatology Department, Cayenne Hospital Center, Cayenne, French Guiana
- UMR 1019 Tropical Biomes and Immunophysiopathology (TBIP), Université de Cayenne, Cayenne, French Guiana
| | - G Grotta
- Dermatology Department, Cayenne Hospital Center, Cayenne, French Guiana
| | - K Drak Alsibai
- Department of Pathology and Center of Biological Resources (CRB Amazonie), Cayenne Hospital Center, Cayenne, French Guiana
| | - P Couppie
- Dermatology Department, Cayenne Hospital Center, Cayenne, French Guiana
- UMR 1019 Tropical Biomes and Immunophysiopathology (TBIP), Université de Cayenne, Cayenne, French Guiana
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2
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Chudzicka-Strugała I, Gołębiewska I, Brudecki G, Elamin W, Zwoździak B. Demodicosis in Different Age Groups and Alternative Treatment Options-A Review. J Clin Med 2023; 12:jcm12041649. [PMID: 36836184 PMCID: PMC9961532 DOI: 10.3390/jcm12041649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 01/26/2023] [Accepted: 02/01/2023] [Indexed: 02/22/2023] Open
Abstract
Infestation with Demodex mites is a common occurrence, especially in adults and the elderly. More recent attention has been paid to the presence of Demodex spp. mites in children, even ones without comorbidities. It causes both dermatological and ophthalmological problems. The presence of Demodex spp. is often asymptomatic, thus it is suggested to include parasitological investigation tests in dermatological diagnostics, in addition to bacteriological analysis. Literature reports show that Demodex spp. are related to the pathogenesis of numerous dermatoses, including rosacea or demodicosis gravis, and common eye pathologies reported by patients such as dry eye syndrome or ocular surface inflammatory conditions, such as blepharitis, chalazia, Meibomian gland dysfunction, and keratitis. Treatment of patients is a challenge and is usually prolonged, therefore it is important to carefully diagnose and properly select the therapy regimen for the treatment to be successful, and with minimal side effects, especially for young patients. Apart from the use of essential oils, research is ongoing for new alternative preparations active against Demodex sp. Our review was focused on the analysis of the current literature data on the available agents in the treatment of demodicosis in adults and children.
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Affiliation(s)
- Izabela Chudzicka-Strugała
- Department of Medical Microbiology, Poznan University of Medical Sciences, Rokietnicka 10, 60-806 Poznan, Poland
| | - Iwona Gołębiewska
- Earth and Life Institute (ELI), Université Catholique de Louvain, Croix du Sud 2, 1348 Louvain-La-Neuve, Belgium
- Correspondence:
| | - Grzegorz Brudecki
- Group 42 (Healthcare), Masdar City, Abu Dhabi P.O. Box 112778, United Arab Emirates
| | - Wael Elamin
- Group 42 (Healthcare), Masdar City, Abu Dhabi P.O. Box 112778, United Arab Emirates
| | - Barbara Zwoździak
- Department of Medical Microbiology, Poznan University of Medical Sciences, Rokietnicka 10, 60-806 Poznan, Poland
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3
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Martinot M, Korganow AS, Wald M, Second J, Birckel E, Mahé A, Souply L, Mohseni-Zadeh M, Droy L, Tarabeux J, Okada S, Migaud M, Puel A, Guffroy A. Case Report: A New Gain-of-Function Mutation of STAT1 Identified in a Patient With Chronic Mucocutaneous Candidiasis and Rosacea-Like Demodicosis: An Emerging Association. Front Immunol 2022; 12:760019. [PMID: 34987506 PMCID: PMC8721043 DOI: 10.3389/fimmu.2021.760019] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 11/15/2021] [Indexed: 12/29/2022] Open
Abstract
Purpose Heterozygous missense STAT1 mutations leading to a gain of function (GOF) are the most frequent genetic cause of chronic mucocutaneous candidiasis (CMC). We describe the case of a patient presenting a new GOF mutation of STAT1 with the clinical symptoms of CMC, recurrent pneumonia, and persistent central erythema with papulopustules with ocular involvement related to rosacea-like demodicosis. Methods Genetic analysis via targeted next-generation sequencing (NGS; NGS panel DIPAI v.1) exploring the 98 genes most frequently involved in primary immunodeficiencies, including STAT1, was performed to identify an underlying genetic defect. Results NGS identified a novel variant of STAT1, c.884C>A (exon 10), p.T295Y, not previously described. This variant was found to be gain of function using an in vitro luciferase reporter assay. Rosacea-like demodicosis was confirmed by substantial Demodex proliferation observed via the microscopic examination of a cutaneous sample. A review of literature retrieved 20 other cases of STAT1 GOF mutations associated with early-onset rosacea-like demodicosis, most with ocular involvement. Conclusion We describe a new STAT1 GOF mutation associated with a phenotype of CMC and rosacea-like demodicosis. Rosacea-like demodicosis appears as a novel and important clinical phenotype among patients with STAT1 GOF mutation.
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Affiliation(s)
- Martin Martinot
- Infectious Diseases Department, Hôpitaux Civils de Colmar, Colmar, France
| | - Anne Sophie Korganow
- Department of Clinical Immunology and Internal Medicine, National Reference Center for Systemic Autoimmune Diseases (CNR RESO), Tertiary Center for Primary Immunodeficiency, Strasbourg University Hospital, Strasbourg, France
| | - Mathieu Wald
- Infectious Diseases Department, Hôpitaux Civils de Colmar, Colmar, France
| | - Julie Second
- Dermatology Department, Hôpitaux Civils de Colmar, Colmar, France
| | - Elodie Birckel
- Dermatology Department, Hôpitaux Civils de Colmar, Colmar, France
| | - Antoine Mahé
- Dermatology Department, Hôpitaux Civils de Colmar, Colmar, France
| | - Laurent Souply
- Microbiology Department, Hôpitaux Civils de Colmar, Colmar, France
| | | | - Laure Droy
- Pathology Department, Hôpitaux Civils de Colmar, Colmar, France
| | - Julien Tarabeux
- Genetic Diagnostic Laboratory, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Satoshi Okada
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM, UMR 1163, University of Paris, Paris, France
| | - Mélanie Migaud
- Department of Pediatrics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Anne Puel
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM, UMR 1163, University of Paris, Paris, France.,University of Paris, Imagine Institute, Paris, France.,St. Giles Laboratory of Human Genetics of Infectious Diseases, The Rockefeller University, New York, NY, United States
| | - Aurelien Guffroy
- Department of Clinical Immunology and Internal Medicine, National Reference Center for Systemic Autoimmune Diseases (CNR RESO), Tertiary Center for Primary Immunodeficiency, Strasbourg University Hospital, Strasbourg, France
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4
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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: 37] [Impact Index Per Article: 9.3] [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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5
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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 DOI: 10.1017/s003118202000150x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [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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6
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Hachfi W, Slama D, Ben Lasfar N, Mnif K, Bellazreg F, Fathallah A, Letaief A. Demodicosis revealing an HIV infection. New Microbes New Infect 2019; 31:100525. [PMID: 31388432 PMCID: PMC6676229 DOI: 10.1016/j.nmni.2019.100525] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 02/20/2019] [Accepted: 02/27/2019] [Indexed: 11/25/2022] Open
Abstract
We report an observation of facial and upper limb demodicosis, revealing a human immunodeficiency virus infection. After an initial improvement with metronidazole, worsening of skin lesions related to immune reconstitution inflammatory syndrome was observed, requiring the use of steroids.
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Affiliation(s)
- W Hachfi
- Service des maladies infectieuses, CHU Farhat Hached, Sousse, Tunisia.,Faculté de médecine, Ibn El Jazzar de Sousse, Université de Sousse, Sousse, Tunisia
| | - D Slama
- Service des maladies infectieuses, CHU Farhat Hached, Sousse, Tunisia
| | - N Ben Lasfar
- Service des maladies infectieuses, CHU Farhat Hached, Sousse, Tunisia.,Faculté de médecine, Ibn El Jazzar de Sousse, Université de Sousse, Sousse, Tunisia
| | - K Mnif
- Service des maladies infectieuses, CHU Farhat Hached, Sousse, Tunisia
| | - F Bellazreg
- Service des maladies infectieuses, CHU Farhat Hached, Sousse, Tunisia.,Faculté de médecine, Ibn El Jazzar de Sousse, Université de Sousse, Sousse, Tunisia
| | - A Fathallah
- Faculté de médecine, Ibn El Jazzar de Sousse, Université de Sousse, Sousse, Tunisia.,Laboratoire de parasitologie et mycologie, CHU Farhat Hached, Sousse, Tunisia
| | - A Letaief
- Service des maladies infectieuses, CHU Farhat Hached, Sousse, Tunisia.,Faculté de médecine, Ibn El Jazzar de Sousse, Université de Sousse, Sousse, Tunisia
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7
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Can the tea tree oil (Australian native plant: Melaleuca alternifolia Cheel) be an alternative treatment for human demodicosis on skin? Parasitology 2018; 145:1510-1520. [PMID: 29667560 DOI: 10.1017/s0031182018000495] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Australian tea tree oil (TTO) and its extract terpinen-4-ol (T4O) are found to be effective in moderating demodex-related diseases. Their possible effects are lowering the mite counts, relieving the demodex-related symptoms and modulating the immune system especially the inflammatory response. This review summarizes the topical treatments of TTO and T4O in human demodicosis, their possible mechanism of actions, side-effects and potential resistance in treating this condition. Although current treatments other than TTO and T4O are relatively effective in controlling the demodex mite population and the related symptoms, more research on the efficacy and drug delivery technology is needed in order to assess its potential as an alternative treatment with minimal side-effect profile, low toxicity and low risk of demodex resistance.
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8
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Forton FMN, De Maertelaer V. Papulopustular rosacea and rosacea-like demodicosis: two phenotypes of the same disease? J Eur Acad Dermatol Venereol 2018; 32:1011-1016. [PMID: 29478301 PMCID: PMC6001808 DOI: 10.1111/jdv.14885] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 01/26/2018] [Indexed: 01/25/2023]
Abstract
Background Papulopustular rosacea and rosacea‐like demodicosis have numerous similarities, but they are generally considered as two distinct entities, mainly because the causal role of the Demodex mite in the development of rosacea is not yet widely accepted. Several clinical characteristics are traditionally considered to differentiate the two conditions; for example, papulopustular rosacea is typically characterized by central facial papulopustules and persistent erythema, whereas small superficial papulopustules and follicular scales rather suggest rosacea‐like demodicosis. However, none of these characteristics is exclusive to either entity. Objective To explore differences in Demodex densities according to clinical characteristics traditionally associated with these two conditions. Methods Retrospective, observational, case–control study of 242 patients with central face papulopustules. Demodex densities were measured on two consecutive standardized skin surface biopsies. Results In the whole cohort, Demodex densities were greater in patients with persistent erythema than in those without. In 132 patients without recent treatment or other facial dermatoses, 120 (91%) had persistent erythema, 119 (90%) small superficial papulopustules and 124 (94%) follicular scales; 116 (88%) simultaneously had clinical characteristics traditionally associated with both papulopustular rosacea and rosacea‐like demodicosis. Higher Demodex densities were linked to the presence of follicular scales, but not to papulopustules size, nor to the presence/absence of persistent erythema. Conclusion Our observations highlight the difficulty differentiating between these entities and suggest that rosacea‐like demodicosis and papulopustular rosacea should no longer be considered as two separate entities, but rather as two phenotypes of the same disease.
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Affiliation(s)
| | - V 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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9
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Abstract
Persistent centrofacial erythema is a predominant component of rosacea. The authors review the topical and systemic treatments for rosacea-related erythema and flushing to aid in treatment decision making in clinical practice. Databases were searched for literature pertaining to treatment options for erythema related to rosacea. The paucity of large-scale clinical trials in patients with the erythematotelangiectatic rosacea subtype makes it difficult to draw firm conclusions regarding treatment. Although certain topical and oral treatments appear to have modest benefit in reducing erythema, there is a need for high-quality, well-designed, and rigorously reported studies for the treatments for rosacea.
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Affiliation(s)
- Abigail Cline
- Augusta University Medical Center, Augusta, GA 30912, USA
| | - Sean P McGregor
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1071, USA.
| | - Steven R Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1071, 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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10
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Anzengruber F, Czernielewski J, Conrad C, Feldmeyer L, Yawalkar N, Häusermann P, Cozzio A, Mainetti C, Goldblum D, Läuchli S, Imhof L, Brand C, Laffitte E, Navarini AA. Swiss S1 guideline for the treatment of rosacea. J Eur Acad Dermatol Venereol 2017; 31:1775-1791. [PMID: 28833645 DOI: 10.1111/jdv.14349] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 05/08/2017] [Indexed: 12/28/2022]
Abstract
Rosacea (in German sometimes called 'Kupferfinne', in French 'Couperose' and in Italian 'Copparosa') is a chronic and frequently relapsing inflammatory skin disease primarily affecting the central areas of the face. Its geographic prevalence varies from 1% to 22%. The differential diagnosis is wide, and the treatment is sometimes difficult and varies by stage of rosacea. For erythematous lesions and telangiectasia, intense pulsed light (IPL) therapy and lasers are popular treatment option. In addition, a vasoconstrictor agent, brimonidine, has recently been developed. For papulopustular rosacea, topical antibiotics, topical and systemic retinoids, as well as systemic antibiotics are used. A topical acaricidal agent, ivermectin, has undergone clinical development and is now on the market. In the later stages, hyperplasia of the sebaceous glands develops, resulting in phymatous growths such as the frequently observed bulbous nose or rhinophyma. Ablative laser treatments have largely replaced classical abrasive tools. Here, we reviewed the current evidence on the treatment of rosacea, provide a guideline (S1 level) and discuss the differential diagnosis of rosacea.
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Affiliation(s)
- F Anzengruber
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - J Czernielewski
- Department of Dermatology, University Hospital Lausanne, Lausanne, Switzerland
| | - C Conrad
- Department of Dermatology, University Hospital Lausanne, Lausanne, Switzerland
| | - L Feldmeyer
- Department of Dermatology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - N Yawalkar
- Department of Dermatology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - P Häusermann
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - A Cozzio
- Department of Dermatology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - C Mainetti
- Department of Dermatology, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | - D Goldblum
- Department of Ophthalmology, University Hospital Basel, Basel, Switzerland
| | - S Läuchli
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - L Imhof
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - C Brand
- Department of Dermatology, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - E Laffitte
- Department of Dermatology, University Hospital Geneva, Geneva, Switzerland
| | - A A Navarini
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
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11
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Abstract
Rosacea represents a common and chronic inflammatory skin disorder. Clinical features include transient and permanent erythema, inflammatory papules and pustules, phymatous changes, and ocular signs and symptoms. Rosacea is generally classified into four subtypes and one variant. Subtype 1, erythematotelangiectatic rosacea, includes clinical features of flushing and persistent central facial erythema with or without telangiectasia. Subtype 2, papulopustular rosacea, is characterized by persistent central facial erythema with transient papules or pustules or both on the central face. Subtype 3, phymatous rosacea, includes thickening of the skin with irregular surface nodularities and enlargement. Subtype 4, ocular rosacea, includes inflammation of different parts of the eye and eyelid. A variant, granulomatous rosacea, is noninflammatory and is characterized by hard, brown, yellow, or red cutaneous papules or nodules of uniform size. Patients may present with more than one subtype, and each individual characteristic may fluctuate. There is debate whether rosacea progresses from one subtype over time or subtypes represent discreet entities. Defining clinical presentation and improved understanding of pathophysiology has resulted in identification of novel treatment approaches. This contribution outlines a rationale for treatment, highlights an evidence-based approach with approved treatments, and considers novel developments and off-license therapy available.
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Affiliation(s)
- Alison M Layton
- Department of Dermatology, Harrogate and District NHS Foundation Trust, Harrogate, United Kingdom.
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12
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Lacey N, Russell-Hallinan A, Powell F. Study of Demodex
mites: Challenges and Solutions. J Eur Acad Dermatol Venereol 2015; 30:764-75. [DOI: 10.1111/jdv.13517] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 10/13/2015] [Indexed: 12/12/2022]
Affiliation(s)
- N. Lacey
- The Charles Institute of Dermatology; University College Dublin; Belfield Dublin 4 Ireland
| | - A. Russell-Hallinan
- The Charles Institute of Dermatology; University College Dublin; Belfield Dublin 4 Ireland
| | - F.C. Powell
- The Charles Institute of Dermatology; University College Dublin; Belfield Dublin 4 Ireland
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13
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Chronic lymphocytic lymphoma presenting with recurrent demodicidosis. Ann Allergy Asthma Immunol 2015; 114:426-7. [PMID: 25707323 DOI: 10.1016/j.anai.2015.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 01/19/2015] [Accepted: 01/21/2015] [Indexed: 11/22/2022]
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14
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Abstract
Rosacea is a common skin disorder with multiple symptoms. The emergence of research that furthers understanding of pathophysiological mechanisms has created new targets for disease treatment. Specifically, there is a need for new treatments that address the various erythematic symptoms associated with rosacea. Systemic and topical therapies have both yielded positive results in treating rosacea with various medications. Subantimicrobial-dose doxycycline is one such promising treatment. Development of novel products in the near future should help achieve more satisfactory outcomes for patients.
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15
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Jarmuda S, O'Reilly N, Żaba R, Jakubowicz O, Szkaradkiewicz A, Kavanagh K. Potential role of Demodex mites and bacteria in the induction of rosacea. J Med Microbiol 2012; 61:1504-1510. [PMID: 22933353 DOI: 10.1099/jmm.0.048090-0] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Rosacea is a common dermatological condition that predominantly affects the central regions of the face. Rosacea affects up to 3 % of the world's population and a number of subtypes are recognized. Rosacea can be treated with a variety of antibiotics (e.g. tetracycline or metronidazole) yet no role for bacteria or microbes in its aetiology has been conclusively established. The density of Demodex mites in the skin of rosacea patients is higher than in controls, suggesting a possible role for these mites in the induction of this condition. In addition, Bacillus oleronius, known to be sensitive to the antibiotics used to treat rosacea, has been isolated from a Demodex mite from a patient with papulopustular rosacea and a potential role for this bacterium in the induction of rosacea has been proposed. Staphylococcus epidermidis has been isolated predominantly from the pustules of rosacea patients but not from unaffected skin and may be transported around the face by Demodex mites. These findings raise the possibility that rosacea is fundamentally a bacterial disease resulting from the over-proliferation of Demodex mites living in skin damaged as a result of adverse weathering, age or the production of sebum with an altered fatty acid content. This review surveys the literature relating to the role of Demodex mites and their associated bacteria in the induction and persistence of rosacea and highlights possible therapeutic options.
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Affiliation(s)
- Stanisław Jarmuda
- Department and Clinic of Dermatology, University of Medical Sciences, Poznań, Poland
| | - Niamh O'Reilly
- Department of Biology, National University of Ireland Maynooth, Co. Kildare, Ireland
| | - Ryszard Żaba
- Department and Clinic of Dermatology, University of Medical Sciences, Poznań, Poland
| | - Oliwia Jakubowicz
- Department and Clinic of Dermatology, University of Medical Sciences, Poznań, Poland
| | | | - Kevin Kavanagh
- Department of Biology, National University of Ireland Maynooth, Co. Kildare, Ireland
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16
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Forton F. Papulopustular rosacea, skin immunity and Demodex: pityriasis folliculorum as a missing link. J Eur Acad Dermatol Venereol 2011; 26:19-28. [DOI: 10.1111/j.1468-3083.2011.04310.x] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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17
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Affiliation(s)
- John R Vu
- University of Pittsburgh, Department of Dermatology, Pittsburgh, PA, USA
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18
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Gerber PA, Kukova G, Buhren BA, Homey B. Density of Demodex folliculorum in patients receiving epidermal growth factor receptor inhibitors. Dermatology 2011; 222:144-7. [PMID: 21346311 DOI: 10.1159/000323001] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Accepted: 11/18/2010] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Rosacea-like papulopustular eruptions (rash) are considered the most frequent toxicities associated with the use of inhibitors of the epidermal growth factor receptor (EGFR). Recently, evidence has been accumulating of infectious complications in patients suffering from these adverse effects. OBJECTIVE We sought to analyze the density of Demodex folliculorum (DF) in cutaneous lesions of patients presenting with EGFR-inhibitor (EGFRI)-induced rashes. METHODS This is a retrospective study of 19 adult patients presenting with EGFRI rashes. Patients were reviewed for the density of DF (Demodex density, Dd; mites per square centimeter) by standardized skin surface biopsy. RESULTS In our patient collective the mean Dd of 4.7/cm² significantly exceeded the mean Dd reported for the healthy adult population (Dd = 0.7/cm²). LIMITATIONS The retrospective nature of the study. CONCLUSIONS EGFRI patients have an increased susceptibility to DF colonization or infection, respectively. Our results support the recent concept that EGFRI may induce an impairment of antimicrobial defense mechanisms.
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Affiliation(s)
- Peter A Gerber
- Department of Dermatology, University Hospital Düsseldorf, Düsseldorf, Germany
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Lacey N, Ní Raghallaigh S, Powell FC. Demodex Mites – Commensals, Parasites or Mutualistic Organisms? Dermatology 2011; 222:128-30. [DOI: 10.1159/000323009] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Nara T, Katoh N, Inoue K, Yamada M, Arizono N, Kishimoto S. Eosinophilic folliculitis with aDemodex folliculoruminfestation successfully treated with ivermectin in a man infected with human immunodeficiency virus. Clin Exp Dermatol 2009; 34:e981-3. [DOI: 10.1111/j.1365-2230.2009.03621.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Karincaoglu Y, Esrefoglu Seyhan M, Bayram N, Aycan O, Taskapan H. Incidence of Demodex Folliculorum in Patients with End Stage Chronic Renal Failure. Ren Fail 2009; 27:495-9. [PMID: 16152985 DOI: 10.1080/08860220500198037] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Demodex folliculorum (DF), found in the pilosebaceous unit, is the most common ectoparasite in humans. It has been implicated in various clinical lesions such as pustular folliculitis, papulopustular scalp eruption, perioral dermatitis, and skin lesions of immunosuppressed patients on chemotherapy or with acquired immunodeficiency syndrome (AIDS). OBJECTIVE We aimed to determine DF carriers and location of DF among patients on chronic dialysis because of end stage renal failure (ESRF), to compare them with healthy controls, and to examine the relationship between DF incidence and dialysis method and symptoms. METHODS Sixty-seven patients on dialysis and 67 healthy controls were taken into the study. The patient groups were classified according to the diseases causing ESRF [diabetes mellitus (DM), polycystic disease (PCD), glomerulonephritis (GN), hypertensive nephrosclerosis (HTNS), others (OT), unknown etiology (UE)], and mode of dialysis. Five standardized skin surface biopsies (SSSB) were taken. The determination of five and more living parasites/cm2 area was diagnosed as infestation. RESULTS The mean mite count in the ESRF group, 6.12/cm2, was significantly higher than that in controls, 0.31/cm2, (Independent Samples Test, p=0.000). The DF positivity according to primary disease causing ESRF revealed that it was most frequent in DM with 12 patients (44.4%), followed by UE with nine patients (33.4%). CONCLUSIONS Our findings indicate that the DF number is increased in ESRF patients on dialysis treatment. We recommend that demodicidosis should be included in the differential diagnosis of facial eruptions in patients with ESRF.
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Affiliation(s)
- Yelda Karincaoglu
- Department of Dermatology, School of Medicine, Inonu University, Malatya, Turkey.
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Ramos Rincón JM, Zubero Sulibarría Z, Ena Muñoz J. [Immigration and HIV Infection. An approximation to parasitic and viral infections]. Enferm Infecc Microbiol Clin 2008; 26 Suppl 5:42-53. [PMID: 18590665 DOI: 10.1157/13123266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Highly-active antiretroviral therapy is effective in reducing opportunistic infections in industrialized countries. However, opportunistic parasitic infections remain the leading cause of HIV-related mortality in developing countries. These infections can also affect HIV-positive immigrants residing in Spain, as well as HIV-infected patients traveling to low-income countries. In addition, immigrants often have viral infections caused by herpesvirus, papillomavirus and polyomavirus, which are closely related to risk behaviors and commercial sex. The present article reviews the characteristics of parasitic and viral infections in patients with HIV infection with the aim of improving understanding of this vulnerable population group.
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Aisa Y, Mori T, Tanikawa A, Takae Y, Kato J, Ikeda Y, Okamoto S. Demodicidosis as a cause of facial eruption developing early after allogeneic hematopoietic stem cell transplantation. Transpl Int 2008; 21:1192-3. [PMID: 18783387 DOI: 10.1111/j.1432-2277.2008.00749.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Vidigal MR, Kakihara CT, Gatti TRSR, Tebcherani AJ, Pires MC. Gnatophyma: a rare variant of phyma. Clin Exp Dermatol 2008; 33:743-4. [PMID: 18616722 DOI: 10.1111/j.1365-2230.2008.02862.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We report a case of a 44-year-old woman with an 8-year history of gnatophyma. Rosacea is a facial dermatosis that may present as flushing, erythema, telangiectases, papules, pustules and phyma. Phyma is considered the final evolution stage of rosacea and is a rare variant. Treatment of phyma with atypical localization may be a challenge for dermatologists in clinical practice.
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Affiliation(s)
- M R Vidigal
- Dermatology Service, Hospital Complex Padre Bento de Guarulhos, São Paulo, Brazil
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Yagdiran Düzgün O, Aytekin S. Comparison of Demodex folliculorum density in haemodialysis patients with a control group. J Eur Acad Dermatol Venereol 2007; 21:480-3. [PMID: 17373974 DOI: 10.1111/j.1468-3083.2007.01926.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Demodex folliculorum (DF) is resident in human pilosebaceous follicles. Mite density is low in healthy skin. Many cases of demodicosis in association with immunosuppression have been reported. Patients undergoing haemodialysis are also immunosuppressed. OBJECTIVE We aimed to compare the Demodex folliculorum density in haemodialysis patients and healthy subjects. METHODS Mite density of 87 patients undergoing haemodialysis was compared with that of age- and sex-matched controls. Two samples of standardized skin surface biopsies were taken from each subject from the forehead, cheek and nose. The number of mites counted on the surface area of 1 cm2 was accepted as the density of DF. The length and width of mites were measured by oculometer. RESULTS DF density was found in 17 (19.54%) of the 87 dialysis patients and in 9 (10.34%) of 87 controls. A mean mite density of 5.11+/-5.65 was found in dialysis patients and of 2.55+/-1.6 in controls. Differences between the two groups in mite density were not statistically significant (P=0.13). There was also no significant difference in mite length between the two groups (P=0.06). There was, however, a significant difference in mite width (P=0.018). CONCLUSION Despite the presence of sebaceous gland atrophy in haemodialysis patients, the higher density of DF in these patients than controls supports the supposition that this mite can increase immunosuppression.
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Clyti E, Klisnik J, Sainte-Marie D, Pradinaud R, Couppié P. Placards papulo-croûteux prurigineux des régions malaires. Ann Dermatol Venereol 2007; 134:79-80. [PMID: 17384555 DOI: 10.1016/s0151-9638(07)89001-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- E Clyti
- Service de Dermatologie, Centre Hospitalier Andrée Rosemon de Cayenne, BP 6006, 97306 Cayenne Cedex.
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Clyti E, Nacher M, Sainte-Marie D, Pradinaud R, Couppie P. Ivermectin treatment of three cases of demodecidosis during human immunodeficiency virus infection. Int J Dermatol 2006; 45:1066-8. [PMID: 16961510 DOI: 10.1111/j.1365-4632.2006.02924.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Demodecidosis is an ectoparasitosis that is infrequently observed in subjects with human immunodeficiency virus (HIV) infection. It has a rosacea-like presentation. We present three cases in patients with acquired immunodeficiency syndrome (AIDS). Two of these patients had a profuse eruption, and all three cases were cured by ivermectin. The single-dose treatment could be repeated in cases of subsequent recurrence. Ivermectin thus seems to be a good alternative in the treatment of demodecidosis in patients with HIV infection.
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Affiliation(s)
- Emmanuel Clyti
- Institut Guyanais de Dermatologie Tropicale, Service de Dermatologie, Center Hospitalier de Cayenne, Cayenne, France.
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Santarém VA, Farias MR, Tostes RA. Demodectic mange in fattening pigs in São Paulo, Brazil. Vet Parasitol 2005; 131:169-71. [PMID: 15919154 DOI: 10.1016/j.vetpar.2005.03.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2005] [Indexed: 11/18/2022]
Abstract
An investigation was conducted of mange in five Large White adult sows refractory to pyrethroid treatment (cypermethrin 15%). The most important clinical signs consisted of erythema, hyperkeratosis, alopecic macules, micaceous scaling, follicular pluging, and numerous comedones, especially on the facial region. Skin samples were scraped and punched. Elongate mites were found that were classified as Demodex sp., according to the morphological and histopathological characteristics. The protein, vitamin, and mineral levels contained in the rations were considered to be lower than those recommended to attend the requirements of fattening pigs. Adjustment of the rations was adopted, and the treatment of animals with ivermectin premix (450g/tonne of food) daily orally for a further 7 days was prescribed. The success of treatment was observed 15 days after adoption of these measures, when the beginning of remission of signs was observed. No mites were found on scrapings or biopsy punches after the treatment of the sows.
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Affiliation(s)
- V A Santarém
- Hospital Veterinário da Universidade do Oeste Paulista, Rodovia Raposo Tavares km 572, Bairro Limoeiro, 19067-150 Presidente Prudente, São Paulo, Brazil.
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Clyti E, Sayavong K, Chanthavisouk K. Démodécie chez un malade infecté par le VIH : guérison par ivermectine. Ann Dermatol Venereol 2005; 132:459-61. [PMID: 15988358 DOI: 10.1016/s0151-9638(05)79308-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Demodex is a saprophyte parasite in mammals. In Man, it is associated with differing clinical profiles (rosacea-like dermatitis, folliculitis and blepharitis). We report a case of demodecidosis in an HIV-infected patient that was successfully treated with ivermectin. CASE REPORT A man from Laos, infected by HIV and treated for glandular tuberculosis, presented with a prurigenous eruption on the face and the pre-sternal and interscapular areas. Direct examination of scraped product and histopathological examinations confirmed the diagnosis of demodecidosis. Clinical cure was obtained after 2 single cures of ivermectin a one month's distance. DISCUSSION The features of demodecidosis are often similar to those of rosacea. In immunodeficient patients, the semiology remains the same but the eruption is more abundant. During HIV-infection, demodecidosis occurs at the AIDS stage or with a CD4 count lower than 200/mm3. Many anti-dust mite molecules are used to treat the disease but frequently lead to irritation. Administration of a single cure of ivermectin, repeated if necessary, appears to be an interesting alternative to contact anti-dust mite agents.
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Affiliation(s)
- E Clyti
- Service de Dermatologie, Institut Guyanais de Dermatologie Tropicale, Hôpital de Cayenne, Guyane Française
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Mumcuoglu KY, Akilov OE. The Role of HLA A2 and Cw2 in the Pathogenesis of Human Demodicosis. Dermatology 2005; 210:109-14. [PMID: 15724092 DOI: 10.1159/000082565] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Demodicosis is a chronic skin disease caused by parasitic mites of the genus Demodex. It usually affects the face area causing major esthetical problems. The pathogenesis of demodicosis is not fully understood; however, it is quite apparent that immunological mechanisms mediate its development. OBJECTIVE The goal of this study was to study the correlation between immunological and immunogenetic data obtained from patients with demodicosis in order to clarify the pathogenesis of Demodex infestation. METHODS Twenty-five patients with demodicosis and 13 age- and sex-matched healthy subjects participated in the study. The presence of mites was determined by microscopic inspection of sebum gland secretions. The immune response was evaluated by identifying membrane markers of different immune cells using monoclonal antibodies (anti-CD3+, CD4+, CD8+, CD16+, CD20+ and CD95+) while the concentration of IgA, IgM and IgG was measured by simple radial immunodiffusion. The level of circulating immune complexes and total hemolytic complement as well as the preparatory and digestive function of neutrophils and the functional activity of leukocytes were also studied. Patients were typed for HLA A, B, Bw and Cw using the microlymphocytotoxicity method. RESULTS The comparison between patients with and without the A2 phenotype showed that the latter have lower numbers of CD8+, lower functional activity of leukocytes, higher concentrations of IgA, larger affected skin areas and are more often affected by deep papular and papulopustular forms of demodicosis than those with the A2 phenotype, showing that this allele has a protective role in demodicosis. Patients exhibiting the Cw2 phenotypes were rather susceptible to demodicosis. They showed decreased numbers of CD3+, increased levels of phagocytic activity, higher mite density and severer skin damage as compared to patients lacking Cw2. CONCLUSIONS The HLA A2 and Cw2 phenotypes have an important diagnostic, prognostic and pathogenetic significance and could play a role in resistance or susceptibility to demodicosis by regulating the end phase of the immune response.
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Affiliation(s)
- Kosta Y Mumcuoglu
- Department of Parasitology, Hebrew University-Hadassah Medical School, Jerusalem, Israel.
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Affiliation(s)
- Jill C Fichtel
- Section of Dermatology, Department of Medicine, The Medical College of Georgia, Augusta, Georgia 30904, USA
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Forton F, Germaux MA, Brasseur T, De Liever A, Laporte M, Mathys C, Sass U, Stene JJ, Thibaut S, Tytgat M, Seys B. Demodicosis and rosacea: Epidemiology and significance in daily dermatologic practice. J Am Acad Dermatol 2005; 52:74-87. [DOI: 10.1016/j.jaad.2004.05.034] [Citation(s) in RCA: 111] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
Ivermectin is a semi-synthetic derivative of a macrocyclic lactone. It causes paralysis in many nematodes and arthropodes because of its effect on ion-channels in cell membranes. Ivermectin was first used in veterinary medicine. In man, it was shown to be microfilaricid against Onchocerca volvulus. Most of the adverse reactions following treatment were mild, without the systemic and ocular side effects usually complicating diethylcarbamazine therapy. In endemic areas after repeated administration of ivermectin, a dramatic reduction in dermal microfilarial load was observed, resulting in a decrease in transmission. There was a significant decrease in the prevalence of anterior segment lesions in the eyes and acute onchocercal skin disease. Moreover, ivermectin also exhibited microfilaricidal activity against Wuchereria bancrofti and Brugia malayi. Annual mass treatment with a single dose of diethylcarbamazine alone, or associated with ivermectin, was initiated in endemic areas for lymphatic filariasis. The preliminary results showed a decrease in the reservoir of microfilariae and rate of transmission, a reduction in the frequency of clinical lymphatic abnormalities due to bancroftan filariasis. In Loa loa infections ivermectin decreases microfilaremia, but serious adverse events such as encephalopathy can be induced in patients with high rate of microfilaremia. Ivermectin appears to be the drug of choice in Strongyloides stercoralis infections, a single dose is highly effective with less frequent side effects than thiabendazole. Oral ivermectin is an alternative to topical scabicides, it appears as effective as local treatment for common scabies, but there are few comparative studies. The best indications for ivermectin in this ectoparasitic infection could be the outbreak in institutions and crusty scabies, but in association with topical treatment. The precise position of this agent in the treatment of scabies remains to be specified. Ivermectin is also affective in the treatment of ascariasis and cutaneous larva migrans. It could also be a promising treatment for head lice.
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Affiliation(s)
- M Develoux
- Service de Parasitologie-Mycologie, Hôpital Tenon, 4, rue de la Chine, 75020 Paris.
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Delfos NM, Collen AFS, Kroon FP. Demodex folliculitis: a skin manifestation of immune reconstitution disease. AIDS 2004; 18:701-2. [PMID: 15090780 DOI: 10.1097/00002030-200403050-00019] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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