Acne and Rosacea Caused by Mites?

Not science fiction at all, I found after doing a little research (see below). I am definitely a bug-phobe, so when a friend at the gym said, “Your acne may be caused by mites that live on your face,” I had a little shudder, and then she went on to tell me that the bugs crawl around on my face, coming out of my pores to mate at night while I sleep. OMG! I started itching right away. Of course my itching was psychosomatic, but many people on forums I read say that they have tingling or itching that precedes acne or rosacea flares.

What preempted that friend’s comment? Here’s a picture of my face, having gone three weeks without my weekly glycolic acid peel:

Other side and chin look the same

My work-out buddy was surprised to see my face in this condition, although I certainly was not and knew that I needed a peel, but I had let mine run out and was waiting for it to arrive in the mail. Okay, on to the research.

What the Research Shows

I did a Google Scholar search for mites and acne, and I learned that, in fact, a type of mite lives on our skin and is associated with both acne and rosacea. In the  scientific study "A Meta-analysis of the Association between Acne Vulgaris and Demodex Infestation," the scientists concluded that “…acne vulgaris is associated with demodex infestation.” The demodex mite burrows into and lives in our pores or hair follicles and comes out at night to mate.  < Journal of Zhejiang University SCIENCE B, March 2012, Volume 13, Issue 3, pp 192-202.>

This is what the Demodex Mite looks like:

Adult Demodex Mite

According to the article, "Association of Demodex Folliculorum in Acne/Rosacea and Folliculitis and the Efficacy of Combined Therapy (Metronidazole and Benzyl Benzoate)," “84% of patients [with acne/rosacea and/or folliculitis] had positive results for Demodex folliculorum.”  The aim of the study was the evaluation of the role of Demodex infestation in acne/rosacea, folliculitis, perioral dermatitis.
In this clinical study, "148 outpatients were enrolled and the direct microscopic examination of the lesions was done.... Conclusion: Demodex folliculorum infestation has to be considered in resistant acne/folliculitis..."

Demodex was first identified over 150 years ago, but only recently has it attracted wider interest as a contributor to chronic diseases such as acne rosacea or marginal blepharitis.

Eyelash Infestation

Yes, they also live in the eyelash hair follicles. On EyeWorld, I found an article and photos about eyelash infestation (called demodex blepharitis), which can accompany acne and rosacea--or occur alone. According to the Dr. Tseng, "The Demodex lay their eggs on oil, they eat oil, and they live on oil." Here's a picture of what they look like:

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They also live on our heads and may be associated with hair loss and dandruff.

Treatment
Dr. Tseng says that Tea Tree Oil is considered "the go-to treatment." He says, "It can kill mites and and also has other antimicrobial activity." Use extreme caution if with tea tree oil near the eyes--it can cause blindness. For patients with demodex blepharitis (mites on eyelashes), Dr. Tseng recommends Cliradex, which contains the active ingredient in Tea Tree Oil, 4-Terpineol, also called terpinen-4-ol. Reviews on this product say that they're strong and should be used just before bed when the eyes can be kept shut to avoid stinging and tearing.

For recurring acne that has been resistant to normal treatment, this may be something to investigate. Mine is under control with weekly glycolic acid peels, but in doing this research, I read many dermatological papers on the efficacy of using tea tree oil (TTO), for those of us who prefer self-treatment. Some say that the solution can be as low as 10-20% TTO (mixed with a carrier oil or moisturizer, but not water) and should be applied nightly just before going to bed, since that’s when the mites are most active.  Some people on forums say that a mask of 50% TTO once a week is also effective, but I would treat this high percentage as a chemical peel and test first on sensitive skin inside the elbow or wrist! I have used TTO at this percentage mixed with rosehip oil, but it is strong. I may try the 10-20% nightly, mixed with my moisturizer to see if I have any results, without using my glycolic acid peels.

I am always careful handling 100% Tea Tree Oil, especially around the eyes. I’ve read that we should never apply 100% TTO to the skin, but I have used it at the percentage as a spot treatment, but it causes redness, drying, and subsequent peeling—so treat as a strong chemical peel at this percentage.