Demodicosis and symbiophobia: status, terminology, and treatments

All patients are undoubtedly parasitized by hair follicle mites (D. brevis and/or D. folliculorum). Recovery of these may trigger or exacerbate phobias, so they should not be demonstrated on primary presentation. As adjunct treatment for all patients, one can recommend avoidance of long-term topical sterate or corticosteroid preparations, followed by use of daily lavage with soap and water. This is doubly important in sensitive or phobic patients, because ubiquitous demodecids may increase from 'normal' (greater than 5 per pilosebaceous complex) demodiciasis to marked (less than 10 mites) demodicosis. Evidence of phobia should, provisionally, be labelled with the nonperjorative term symbiophobia (herein coined for "fear of association with organisms"), and the causative organisms, if present, treated. Nonremission of phobias, despite counselling and treatment, should be referred to a sensitive, competent, medically trained psychiatrist.