Demodex Acne Connetion – What Does The Science Say?

By Seppo | Cause

8

These little creepy crawlers eat, sleep and have sex on your skin. Everybody agrees that having mites on your skin is not something you proudly talk at parties. But besides being socially inappropriate, is it possible that Demodex mites also cause acne?

Lot of people think so, and a less than stellar looking alt-med website states that 90% of teenage acne can be blamed on them. As usual rumors and hype run far ahead of science. In this post we’ll look at the science behind this. Is there actually any good evidence to believe these mites can cause acne?

In short, it’s possible. The mites are more common in people with skin problems and there’s some evidence that mite-killing drugs help with psoriasis and acne. But we just don’t have enough evidence to say for sure.

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Demodex mites are more common in people with skin problems

The role of Demodex mites in acne is controversial. That said, studies seem to show they are more common in people with skin conditions. They seems especially common in rosacea patients. A systemic review of psoriasis studies showed that a rosacea patient is 7.6 times more likely to have an infestation than a person with healthy skin.

In acne the picture is not that clear. Several studies from China and Russia show they are more common in acne patients, but studies from Western countries often show otherwise. One review paper looked at studies on acne patients, and here’s what they found:

  • Demodex mites were 2.8 more common in acne patients than in healthy controls.
  • The infestation rate among acne patients was 51.85% and 31.54% in healthy controls.

Most of these studies were conducted on Chinese patients, and we can’t say for sure whether the infestation rates are similar in Western people.

Correlation doesn’t mean causation

I should once again note that correlation doesn’t mean causation. These mites fund sebum especially yummy, and they are often found more commonly in areas of skin with more sebum. Given how acne-prone skin produces almost 3 times more sebum, you would expect these mites to enjoy this buffet.

Even healthy people have them

Demodex infestations are common. Some papers show 40% infestation rates even in people with healthy skin. So having these mites on your skin doesn’t automatically mean anything bad, in fact they are harmless in most people. Just one of the many organisms that live on our bodies.

How it could happen

Studies that look at mite-infested skin show increased inflammation and higher number of immune system “killer” cells around mite-infested follicles. These studies were done on rosacea patients, and I can’t say for sure whether the same happens in acne patients. Nevertheless, it’s a possible way for the mites to trigger acne – basically anything that increases inflammation in the skin can trigger the acne formation process.

Demodex mites can also carry bacteria, and there’s at least one study that suggest it’s the bacteria the mites carry that’s responsible for psoriasis in infested patients.

If you are just eating, you might want to skip this bit. There’s also another way the mites cause problems in the skin. While they apparently don’t poop, they do spill everything inside of them as they die. The immune system reacts to these foreign proteins and initiates inflammation as it cleans up the mess.

So far all of this is a bit of speculation, as there’s really no good research in this area.

Anti-mite drugs clear skin problems

There’s some evidence to show that mite-killing drugs can be helpful in psoriasis and acne patients. The problem is that the connection between these mites and skin problems is controversial and many dermatologists don’t take it seriously. Because of this there are only a few, quite poor quality studies to draw from.

One in papulopustular rosacea patients showed that 5% permethrin (mite-killing agent) cream was as effective as standard, topical rosacea treatments. There are also a handful of case reports where unresponsive rosacea patients were successfully treated with mite-killing drugs.

The review paper on Demodx and acne also talks about a Chinese study where 100 acne-like demodicidosis cases where topically treated with essential oils. After 6 weeks of treatment both mite density (number of mites per square inch/cm) and inflammatory lesion counts dropped by 90% and 80% respectively. Unfortunately the study was in Chinese and I have no way to verify this. And I haven’t been able to find any similar studies done on acne patients.

This study brings up an interesting point.

Is it acne or not

It’s possible that people who say Demodex causes their acne don’t actually have acne. Both acne rosacea and papulopustular rosacea actually look quite a bit like acne, and a layperson could easily confuse them.

Of course this matters little when your skin is full of pustules. You don’t care what they are called but to get rid of them.

Tea tree oil to the rescue

Let’s say you suspect these mites are to blame for your skin problems, what can you do about it?

Several drugs can kill these mites and scabies. One is permethrin, which should be available in both prescription and over the counter concentrations.

If you use it, please follow the instructions carefully. To eradicate the mites you have to use the drug for some time. A single application may kill some of the mites, but some are burrowed deeper into the skin. And then there are the eggs. Wiping out this generation doesn’t help you if the next generation is going to born a week from now.

You can also kill the mites with tea tree oil (TTO). As far as I can tell it’s perhaps the best natural treatment. Other essential oils can also work, such as dill weed oil and caraway oil, but tea tree oil is the least irritating.

In one study they treated Demodex in eye lids and lashes with weekly scrubs of 50% tea tree oil and dairy scrub with 5% tea tree shampoo. They note that a weekly application of 50% TTO killed the mites, but they quickly came back. Combination of weekly application of 50% TTO and daily scrub with 5% shampoo eradicated the mites completely in most patients.

Another study just used 5% TTO daily and found equally good results.

Conclusion

So can Demodex mites cause acne? The science says it’s possible. Infestation rates are higher in people skin problems than those with healthy skin, they are especially high in psoriasis patients. These mites can irritate the skin, and that can be a trigger for the acne formation process. Finally, a few studies show improvements in skin conditions with mite-killing drugs.

All of this suggests that Demodex mites can play a role in acne. But we just don’t have enough studies and evidence to say either way for sure. I would treat this as a possible cause, especially if your skin itches a lot. Just remember that you can find these mites even on people with healthy skin, and in most people they are completely harmless.

If you suspect this is a problem for you, you should find permethrin over the counter in many countries. Of you can apply 5% tea tree oil to your skin for a few weeks.

Photo by Nottingham Vet School via Flickr.

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About the Author

Seppo Puusa, a.k.a. AcneEinstein shares rational advice about natural and alternative acne treatments. Read more about me and my acne struggles at the page.

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(8) comments

Prof Bob January 12, 2014

Hi Seppo, fascinating topic – I’ve just read a few papers on it and there seems be an association between this little mite and acne (mainly rosacea but also some evidence for vulgaris) – there don’t seem to be many reports of side effects for Permethrin (5% cream available on Amazon) and it seems you only have to apply it a few times with a 7 day interval. Worth trying just to see what happens! Have you come across anyone who’s used it?

Reply
    Seppo January 13, 2014

    Hi Bob,

    No, I haven’t heard of anyone using this. From the papers I’ve seen it’s impossible to say if the mites affect acne or not. Since writing this post I remember reading some papers that showed infections were less common among psoriasis patients than in healthy controls. Anyway, if Permethrin is safe to try, then I guess there’s little harm in doing so. It’s possible that the mites aggravate skin problems.

    Reply
      Prof Bob January 13, 2014

      Research seems to be getting closer to finding mechanisms that support a causal link, e.g. O’Reilly, N., et al. “Demodex‐associated bacterial proteins induce neutrophil activation.” British Journal of Dermatology 166.4 (2012): 753-760 – they found proteins from the bacteria on Demodex increase inflammatory processes.

      Reply
        Seppo January 14, 2014

        Yep, it’s possible that the mites aggravate skin problems.

        Reply
Andrea September 4, 2014

I have had clear skin for most of my life….until I was 31 (I’m now 34) …at this point a couple things happened:
– my dog had skin issues
– my marriage started falling apart
I noticed a breakout on my upper right forehead and my right cheek. It would come and go…and I couldn’t figure out what was making it happen.
I then separated from my husband and my face blew up….I now had a full on break out on my forehead, cheeks and chin….all the time. I went to three dermatologists…..was told I had excema, rosacea, dermatitis. I had cut out everything possible….gluten free, dairy free, sugar free, caffeine free…I pretty much ate like a bird and was miserable….and my face was getting worse. I changed soaps, detergents…nothing helped.
Then I read about the demodex mites a lot….and became obsessed….I mentioned it to the dermatologists and they pretty much laughed in my face. But seeing as nothing else worked I thought I would try some of the methods I read about to kill the suckers. I figured that since mites seem to get worse with stress, etc. that could be it. Also, my dog had mange….and I’m sure that’s how it was transferred to me….as I read there is a connection there.
Well…I’m six weeks in and my face is almost completely clear. I couldn’t be happier. But this is not an easy process….it is pretty terrible.
I used the following…..tea tree oil, selson blue, castor oil, permethrin 5%, coconut oil….and changing my pillowcase nightly. And washed my hair with tea tree shampoo….these mites run for safety….you need to kill them everywhere.
Week 1 – my face was pretty decent…seemed to clear up a little
Week 2-3 – AWFUL!! My face looked horrific…this is from the first die off. I literally didn’t want to leave my house. Hundreds if bumps….redness to the point that I looked like I had a skin peel. And very painful.
Week 4 – my face looked fantastic and I felt pretty for the first time in a long time.
Week 5 – Horrible again! But not as terrible as weeks 2-3…but still wanted to remain a hermit.
Week 6 – I’m here now and my forehead is completely clear…no redness, no bumps. Three bumps on my cheeks…all redness gone….and two on my chin….all redness gone.
I’m hoping a few more weeks will bring me nice healthy clear skin:)
I just thought I’d share seeing as you said you were not sure how it worked on this end of the world.
It works!!! And I’m so bothered that dermatologists do not recognize this as a possibility. This six weeks of hell has changed my life for the better.
Oh and diet wise….I eat healthy, but I have reintroduced dairy, sugar and wheat….in small amounts…..so that I feel human..and no breakouts.

Reply
C November 7, 2014

Tried TTO but just rediscovered Noxzema and my skin is looking good. Found that the mites don’t tolerate the eucalyptus, camphor and menthol in it.

Reply
    Sid November 9, 2014

    Be careful with Noxema. Some of the ingredients are synthetic – camphor is for sure – and they may eventually cause irritation. Plus you’re absorbing the genetically altered ingredient and who knows what that can do to other system in the body.

    Reply
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