Anyone with rosacea knows how frustrating it is and how few good treatment options there are. I’ve long been treating my rosacea patients with medicines and skin care recommendations that are more art than science out of necessity. I developed my recommendations based on what worked for my many rosacea patients. Recent scientific studies are giving us some interesting information that supports my treatment methods and I’m thrilled. As scientists learn more about rosacea, I’ll be able to build on their findings and refine my treatment recommendations even further.
Rosacea is a common, frustrating and often disfiguring inflammatory facial rash. In spite of years of excellent scientific studies, the cause of rosacea remains elusive. In the entire 25 years that I’ve practiced dermatology, the standard rosacea therapies have relied on oral and topical antibiotics. Many of my patients are unwilling to use antibiotics long term so I’ve worked hard to find alternative treatments to help them.
What’s new is that scientists are starting to rethink the significance of mites in rosacea.
- We’ve always known that every person has Demodex mites in their skin pores (yes, it’s unsavory but true).
- We’ve also always known that people with rosacea have even more mites in their pores than normal.
Because everybody has Demodex mites doctors have ignored their presence. I haven’t. I’ve been treating Demodex mites for years and my rosacea patient’s skin improves.
Results of recent scientific papers suggest a significant role for Demodex mites in rosacea of the facial skin and eyes. Even more interestingly, one of the papers suggests that it’s not just the mites, it’s a protein on a bacteria that the mites carry that causes some of the inflammation of rosacea-Wow!
So, what are my current recommendations for my patients with rosacea?
- Wash and rinse the facial skin twice a day because mites can be washed off-sort of.
- Use antimicrobial skin cleansers for skin cleansing and wash the entire face including the eyelids(of course, don’t get cleansers in the eyes!).
- The amount of mites on the skin goes down with the use of antiseptic cleansers, though many antiseptic cleansers are harsh to sensitive rosacea prone skin.
- I’ve had patients use prescription antibiotic cleansers that contain sulfa drugs, if they aren’t allergic to this medicine.
- My favorite antimicrobial cleanser is the 2% pyrithione zinc in Noble Zinc. Noble Zinc does not dry or irritate sensitive rosacea skin.
- Use the Clarisonic brush with the antiseptic cleanser to really get the cleanser into the pores. (On the facial skin not the eyelids.)
- Apply Replenix CF Cream or Green Tea Antioxidant Skin Therapy – Replenix Power of Three Cream immediately after washing. I find that it soothes the skin sensitivity and redness of rosacea.
- I have patients apply anti-mite medicines after the Replenix Cream. This is tricky because there aren’t specific topical medicines to treat human skin mites. On the other hand, the mites seem to respond to many things. One study showed that mites died quickly on contact with 100% tea tree oil, caraway oil or dill oil. I’ve never used those and would expect them to irritate sensitive rosacea facial skin. I have had patients use Metro Gel and Cream, benzoyl peroxide (this can be very irritating to some people with rosacea) and even permethrin cream (a prescription scabies medicine not usually used on facial skin). The trick is to keep the mite population controlled and I customize the anti mite treatment for each patient.
The new research results are exciting and I expect that soon we’ll have new treatment medicines for facial Demodex mites, and that these medicines will help to control rosacea.
I’d be curious to know what other treatments have worked for you. Please let me know by including them as comments below or sending them to me using the email link at the top left of this page.
Zhao YE, Wu LP et. al., Retrospective analysis of the association between Demodex infestation and rosacea, Arch Dermatol. 2010 Aug;146(8):896-902
Elston DM, Demodex mites: facts and controversies, Clin Dermatol. 2010 Sept-Oct;28(5):502-4
Li J, O’Reilly N, et. al., Correlation between ocular Demodex infestation and serum immunoreactivity to Bacillus proteins in patients with facial rosacea, Ophthalmology. 2010 May;117(5):870-877
Gao YY, Di Pascuale MA, In vitro and in vivo killing of ocular Demodex by tea tree oil, Br J Ophthalmol 2005 Nov;89(11);1468-73
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Photo: Thanks and gratitude to XMatt