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In Vivo Confocal Microscopy: A Standard Operating Procedure for the Detection of Demodex Mites at the Eyelid Margin
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In Vivo Confocal Microscopy: A Standard Operating Procedure for the Detection of Demodex Mites at the Eyelid Margin

Published on: July 3, 2025

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Clinical picture, diagnosis and treatment of rosacea, complicated by Demodex mites

Alexey Kubanov1, Yuliya Gallyamova1, Anzhela Kravchenko1

  • 1Russian Medical Academy of Continuous Professional Education, Ministry of Healthcare of the Russian Federation, Moscow, Russia.

Dermatology Reports
|April 23, 2019
PubMed

Insights

Demodex mites worsen rosacea, increasing inflammation, duration, and recurrence, negatively impacting quality of life. Topical 1% ivermectin effectively treats Demodex-associated rosacea.

Area of Science:

  • Dermatology
  • Parasitology
  • Microscopy

Background:

  • Rosacea is a common inflammatory skin condition.
  • Demodex mites are frequently implicated in rosacea pathogenesis.
  • Accurate diagnosis and effective treatment of Demodex are crucial for managing rosacea.

Purpose of the Study:

  • To investigate the impact of Demodex mites on rosacea clinical presentation and disease course.
  • To compare light microscopy and confocal laser scanning microscopy for Demodex detection.
  • To evaluate the efficacy of topical antiparasitic therapy for Demodex-related rosacea.

Main Methods:

  • Cross-sectional study involving 212 participants (healthy, rosacea with/without Demodex).
  • Demodex detection using light microscopy of skin scrapes and in vivo confocal laser scanning microscopy.
  • Assessment of clinical parameters, disease duration, recurrence rates, and quality of life.

Main Results:

  • Demodex mites correlate with increased inflammatory lesions, longer disease duration (>5 years), and higher recurrence rates.
  • Confocal laser scanning microscopy offers advantages over light microscopy for Demodex diagnosis.
  • Topical 1% ivermectin demonstrated high therapeutic efficacy (93.3%) in eliminating Demodex mites.
  • Disease severity did not correlate with mite load in skin scrapes.

Conclusions:

  • Demodex mites significantly exacerbate rosacea, leading to poorer outcomes and reduced quality of life.
  • Confocal laser scanning microscopy is a valuable diagnostic tool for Demodex in rosacea.
  • Topical 1% ivermectin is a highly effective treatment for Demodex-associated rosacea.
Keywords:
Demodex folliculorumDemodex folliculorum brevisDemodex mitesDermatology life quality index

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