Years ago, Mark Dunbar, OD, FAAO, of Bascom Palmer shared with me some cases about rosacea. I was a little taken aback because the cases he shared concerned Hispanic patients, not the usual patients of Northern English isles descent we read about in school. The skeptic in me was doubtful, even though Mark had great pictures and detailed data from the cases.
Fast forward to today. Dry eyes and lid disease are the main buzzwords in ocular surface. In the past, everyone had aqueous tear deficiency, now everyone has meibomian gland dysfunction (MGD)/evaporative/blepharitis. With respect to blepharitis, Gary Gerber, OD, says it seems like staphylococcus has left the planet and demodex has taken its place.1
Demodex and rosacea
So, let’s look at the demodex prevalence studies. Three studies posit the rates of demodex in blepharitis: 62.9 percent, 88 percent, 97 percent of patients with blepharitis have demodex.2-5 The figures are not exactly the same, but they all represent the majority. There was a time when I believed there was blepharitis and, on a rare occasion, demodex blepharitis. Now, I believe that most blepharitis is actually caused by demodex. Yes, it is that prevalent.
What does this have to do with rosacea? Recent research has pointed to an undeniable link between rosacea and demodex. Meta-analysis of several studies bears this out.5 Demodex even shares the same bacteria as rosacea patients.7,8
We are aware of the treatments for rosacea, and we know it is a chronic disease. Most of the treatments are palliative; there is no cure. Prescribing several treatments in clinical practice with little to no success is almost the norm. Based on the studies, I really do think the demodex mite causes rosacea. Our patterns of frustration with rosacea pretty much follow the patterns with demodex. Try this, try that.
Tea tree oil treatment
We know that the best treatment for demodex is tea tree oil.9 Tea tree oil is merciless against the mite. It comes in pads, ointments, soaps, shampoos, etc. We have noticed it is also effective against rosacea. Typically, we recommend the patient to use the tea tree oil wipes on their face after using on the lids. The results have been excellent. Patients for the first time have the redness in their cheeks resolve. The mite does not only reside in the lashes, it also resides in the skin. Our luck in treating rosacea has increased when we think of it as a demodex problem first.
Since learning more about demodex, I am seeing much more rosacea than ever, even in places I would never expect, like my own clinical practice. Because my patient demographic is mostly Hispanic, I am seeing lots of rosacea and demodex in, of course, mostly Hispanics.
Mark Dunbar, you were right all along.