The Possible Relation of Demodex and Facial Erythema in Connective Tissue Diseases
-
Abdulsamet Erden
,
Berkan Armağan
,
Serdar Can Güven
,
Özlem Karakaş
,
Fatma Erden
,
Bahar Özdemir
,
Ahmet Omma
,
Orhan Küçükşahin
Abstract
Background: We aimed to investigate the frequency of Demodex infestation and clinical implications in connective tissue disease patients with facial erythema.
Methods: Patients diagnosed with a connective tissue disease and had facial erythema were consecutively enrolled in the study from 2019-2020. An age and gender matched control group was formed from healthy volunteers. Presence of Demodex was investigated by standardized skin surface biopsy. Number of Demodex mites over 5 per centimeter square was considered meaningful for infestation. Topical or systemic metronidazole treatment was given to the connective tissue disease patients with Demodex infestation. Facial erythema visual analog scale was questioned in patients at treatment onset and one month after.
Results: A total of 31 connective tissue disease patients with facial erythema were enrolled. Control group included 31 healthy volunteers. Demographics and comorbidities were similar between groups. Demodex infestation was present in 58.1% of the disease group and in 25.8% of the control group (P=0.01). Pruritus was the most common symptom in patients with infestation. Median (IQR) facial erythema visual analog scale score was 6 (3) at treatment onset and was 2 (2.5) one month later (P<0.001).
Conclusion: When evaluating facial cutaneous lesions, Demodex infestation should not be overlooked in a patient group like connective tissue diseases with dysfunctional immune system.
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22. Ciftci I, Dundar U, Cetinkaya Z, et al. Demodex folliculorum in patients with rheumatoid arthritis. Acta Parasitol. 2007; 52: 70-73.
23. El-Shazly A, Ghaneum B, Morsy T, et al. The pathogenesis of Demodex folliculorum (hair follicular mites) in females with and without rosacea. J Egypt Soc Parasitol. 2001; 31(3): 867-875.
24. Karincaoglu Y, Bayram N, Aycan O, et al. The clinical importance of Demodex folliculorum presenting with nonspecific facial signs and symptoms. J Dermatol. 2004; 31(8): 618-626. DOI: 10.1111/j.1346-8138.2004.tb00567.x.
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2. Alves F, Goncalo M. Suspected inflammatory rheumatic diseases in patients presenting with skin rashes. Best Pract Res Clin Rheumatol. 2019; 33(4): 101440. DOI: 10.1016/j.berh.2019.101440
3. Litwin D, WenChieh C, Dzika E, et al. Human permanent ectoparasites; recent advances on biology and clinical significance of Demodex mites: narrative review article. Iran J Parasitol. 2017; 12(1): 12-21.
4. Elston CA, Elston DM. Demodex mites. Clin Dermatol. 2014; 32: 739-743. DOI: 10.1016/j.clindermatol.2014.02.012
5. Nicholls SG, Oakley CL, Tan A, et al. Demodex species in human ocular disease: new clinicopathological aspects. Int Ophthalmol. 2017; 37(1): 303-312. DOI: 10.1007/s10792-016-0249-9
6. Lacey N, Raghallaigh SN, Powell FC. Demodex mites-commensals, parasites or mutualistic organisms? Dermatology. 2011; 222(2): 128-30. DOI: 10.1159/000323009
7. Aumond S, Bitton E. Palpebral and facial skin infestation by Demodex folliculorum. Cont Lens Anterior Eye. 2020; 43(2): 115-122. DOI: 10.1016/j.clae.2019.09.001
8. Aşkın Ü, Seçkin D. Comparison of the two techniques for measurement of the density of Demodex folliculorum: standardized skin surface biopsy and direct microscopic examination. Br J Dermatol. 2010; 162(5): 1124-1126. DOI: 10.1111/j.1365-2133.2010.09645.x
9. Forton F, Seys B. Density of Demodex folliculorum in rosacea: a case‐control study using standardized skin‐surface biopsy. Br J Dermatol. 1993; 128(6): 650-659. DOI: 10.1111/j.1365-2133.1993.tb00261.x
10. Moran EM, Foley R, Powell FC. Demodex and rosacea revisited. Clin Dermatol. 2017; 35(2): 195-200. DOI: 10.1016/j.clindermatol.2016.10.014
11. Lacey N, Russell‐Hallinan A, Zouboulis C, et al. Demodex mites modulate sebocyte immune reaction: possible role in the pathogenesis of rosacea. Br J Dermatol. 2018; 179(2): 420-430. DOI: 10.1111/bjd.16540
12. Mosca M, Neri R, Bombardieri S. Undifferentiated connective tissue diseases (UCTD): a review of the literature and a proposal for preliminary classification criteria. Clin Exp Rheumatol. 1999; 17(5): 615-620.
13. Aringer M, Costenbader K, Daikh D, et al. 2019 European League Against Rheumatism/American College of Rheumatology classification criteria for systemic lupus erythematosus. Arthritis Rheumatol. 2019; 71(9):1400-1412. DOI: 10.1002/art.40930
14. Shiboski CH, Shiboski SC, Seror R, et al. 2016 American College of Rheumatology/European League Against Rheumatism classification criteria for primary Sjögren's syndrome: a consensus and data-driven methodology involving three international patient cohorts. Arthritis Rheumatol . 2017; 69(1): 35-45. DOI: 10.1002/art.39859
15. Wilson WA, Gharavi AE, Koike T, et al. International consensus statement on preliminary classification criteria for definite antiphospholipid syndrome: report of an international workshop. Arthritis Rheum. 1999; 42(7): 1309-1311. DOI: 10.1002/1529-0131(199907)42:7<1309::AID-ANR1>3.0.CO;2-F
16. Ogunsanya M, Cho S, Hudson A, et al. Validation and reliability of a disease‐specific quality‐of‐life measure in patients with cutaneous lupus erythematosus. Br J Dermatol. 2019; 180(6): 1430-1437. DOI: 10.1111/bjd.17636
17. Asai Y, Tan J, Baibergenova A, et al. Canadian clinical practice guidelines for rosacea. J Cutan Med Surg. 2016; 20(5): 432-445. DOI: 10.1177/1203475416650427
18. Seyhan M, Karincaoglu Y, Bayram N, et al. Density of Demodex folliculorum in haematological malignancies. J Int Med Res. 2004; 32(4): 411-415. DOI: 10.1177/147323000403200410
19. Yazisiz H, Çekin Y, Sezer I, et al. Demodex Species Frequency and Risk Factors in Patients With Rheumatoid Arthritis. Arch Rheumatol. 2020; 35(3): 376-384. DOI: 10.46497/ArchRheumatol.2020.7699
20. Dursun R, Durmaz K, Oltulu P, et al. Demodex positive discoid lupus erythematosus: Is it a separate entity or an overlap syndrome? Dermatol Ther. 2020; 33(3): e13394. DOI: 10.1111/dth.13394
21. Garbacewicz A, Jaworski J, Grytner-Zięcina B. Demodex mite infestation in patients with and without rheumatoid arthritis. Acta Parasitol. 2012; 57(1): 99-100.
22. Ciftci I, Dundar U, Cetinkaya Z, et al. Demodex folliculorum in patients with rheumatoid arthritis. Acta Parasitol. 2007; 52: 70-73.
23. El-Shazly A, Ghaneum B, Morsy T, et al. The pathogenesis of Demodex folliculorum (hair follicular mites) in females with and without rosacea. J Egypt Soc Parasitol. 2001; 31(3): 867-875.
24. Karincaoglu Y, Bayram N, Aycan O, et al. The clinical importance of Demodex folliculorum presenting with nonspecific facial signs and symptoms. J Dermatol. 2004; 31(8): 618-626. DOI: 10.1111/j.1346-8138.2004.tb00567.x.
25. Akilov OE, Butov YS, Mumcuoglu KY. A clinico‐pathological approach to the classification of human demodicosis: Ein klinisch‐pathologischer Ansatz zur Klassifikation der humanen Demodikose. JDDG: J Dtsch Dermatol Ges. 2005; 3(8): 607-614. DOI: 10.1111/j.1610-0387.2005.05725.x.
26. Yun CH, Yun JH, Baek JO, et al. Demodex mite density determinations by standardized skin surface biopsy and direct microscopic examination and their relations with clinical types and distribution patterns. Ann Dermatol. 2017; 29(2): 137-142. DOI: 10.5021/ad.2017.29.2.137
| Files | ||
| Issue | Vol 18 No 2 (2023) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijpa.v18i2.13190 | |
| Keywords | ||
| Parasite Connective tissue Disease Erythema Demodex | ||
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How to Cite
1.
Erden A, Armağan B, Güven S, Karakaş Özlem, Erden F, Özdemir B, Omma A, Küçükşahin O. The Possible Relation of Demodex and Facial Erythema in Connective Tissue Diseases. Iran J Parasitol. 2023;18(2):237-243.
