The Demodex Mite: Know it Well! It can and will wreak havoc on an insulin resistant/diabetic population.

This post is the culmination of months of researching in my free time. I hope you find this information helpful! 

Demodex mites, a common component of the human microbiome, typically live in a harmonious balance with the immune system. However, they can become overpopulated and turn parasitic in an opportunistic host.

The 2020 study Association between Demodex Folliculorum and Metabolic Syndrome found that "the presence of Demodex folliculorum was found to be higher in the cases who have metabolic syndrome compared to the healthy group. These results show that in cases with metabolic syndrome, high blood sugar levels make them more susceptible to infestation of Demodex folliculorum."

The 2021 study A Survey on How Ocular Surface Demodex Infestation Interactively Associates with Diabetes Mellitus and Dry Eye Disease stated that: "After statistical analysis, we found that both diabetes mellitus and dry eye disease are closely associated with ocular surface demodex infestion. Compared with dry eye disease, diabetes mellitus has higher priority association with ocular surface demodex infestation, and patients with both diseases have a significantly higher risk of ocular surface demodex infestation."

The 2020 study Is the presence of Demodex Folliculorum Increased with Impaired Glucose Regulation in Polycystic Ovary Syndrome? determined that "Demodex Folliculorum is present in both skin and eyelash lesions in patients with PCOS. These lesions may be prevented by avoiding unregulated glucose levels and obesity."

The 2013 study The Effect of Blood Glucose Regulation on the Presence of Opportunistic Demodex Folliculorum Mites in Patients with Type 2 Diabetes Mellitus found "a significantly higher proportion of patients with poor blood glucose control had demodex folliculorum infestation compared with patients with well-controlled blood glucose."

The 2014 study Increased Density of Demodex Folliculorum Mites in Pregnancies with Gestational Diabetes revealed that "Patients with gestational diabetes had a statistically significantly higher Demodex density compared to the control group. Furthermore, a significantly higher proportion of gestational diabetes patients with unregulated glucose levels had a higher Demodex density compared to those in the regulated subgroup."

The 1990 study Association of Diabetes, Lash Loss, and Staphylococcus Aureus with Infestation of Eyelids by Demodex Folliculorum (Acari: Demodicidae) found: "Mites were more abundant in older persons and in persons with diabetes. Mites also were associated with a scarcity of lashes in the lower lid. Hierarchical log-linear analysis showed that the associations of greater mite abundance with diabetes and with madarosis were independent of age."

The 2019 study Advances in Research on Diabetes and Ocular Surface Demodex states: "Studies show that the incidence of ocular Demodex in diabetic patients is higher than that in normal people, and as the incidence of diabetes increases year by year, ocular Demodex infection also increases, making it a disease that impairs the normal function of the eye in diabetic patients," adding: "In patients with diabetes, many studies have shown that the body immunity of patients with diabetes will be reduced to different degrees due to various reasons, such as neutrophil chemotaxis, mast cell function, the interaction between white blood cells and endothelial cells, lymph node clearance of pathogens decreased, TNF, IL and prostaglandin release decreased. The physiological dysfunction of these cells or cytokines will lead to the decrease of the immune function of the body and increase the susceptibility to ocular Demodex. In normal healthy people, when Demodex is in excessive proliferation, strong immunity will cause a series of immune reactions in the body and inhibit the proliferation of Demodex in order to resist the damage of Demodex to the ocular surface. However, when the immunity of the body is decreased and the immune function is low, it can not effectively resist the infection of eye Demodex and will cause a series of related inflammatory reactions. Therefore, the decrease of immunity may be an important reason for the increase of ocular Demodex infection rate in diabetic patients." In the study's summary, the authors mention current treatments such as tea tree essential oil, oral ivermectin and metronidazole. 

Evaluation of the Efficacy of Oral Ivermectin in Comparison with Ivermectin-Metronidazole Combined Therapy in the Treatment of Ocular and Skin Lesions of Demodex Folliculorum concluded: "Combined therapy was superior in decreasing the demodex folliculorum count in all groups and in reducing the mite count to the normal level in rosacea and in anterior blepharitis.”

The abstract of the 2003 study Demodicosis in a Female Patient Treated as Allergic Blepharoconjunctivitis: A Case Report is as follows: "A 65-year-old woman suffered from therapy resistant chronic blepharoconjunctivitis and rosacea, without improvement under therapy of systemic and topical antibiotics and topical steroids and antihistamines. Demodex folliculorum was found adhered to the hair bulb on microscopic examination. She received oral ivermectin with good response. Two months later demodicosis reoccurred.” (Always will if you’re still eating sugar and a high carbohydrate, immunity-reducing diet.) “Then she was treated with a combination of ivermectin and transfer factor with total remission. Demodex folliculorum considered as saprophytic mite may play a pathogenic role in ocular diseases.”

Immunosuppressants, including steroids (oral, topical or ophthalmic), may worsen a Demodex infestation. The 2020 study Pre-Treatment and Post-Treatment Demodex Densities in Patients under Immunosuppressive Treatments determined that: "When the patient and control groups were evaluated in terms of Demodex number, there was a statistically significant difference in Demodex density in patients treated with immunosuppressives in the first and third months when compared to the control group. Immunosuppressive treatment might increase the number of Demodex mites and demodicosis should be kept in mind with patients on immunosuppressive treatment."

The 2020 study Massive Demodicosis of the Eyes in a Patient with Sjogren's Syndrome: A Case Report discussed treating a 61-year-old Sjogren's patient with a massive ocular demodex infestation: "Demodex mite infestation, typically asymptomatic, is a problem for patients with weakened immune systems because it often takes the form of symptomatic, massive infection. The Demodex mites play an important role in the occurrence of a range of eye surface diseases such as Demodex blepharitis, meibomian gland dysfunctions, conjunctivitis and corneal changes. The ocular infection is closely related to the systemic invasion," adding: "In addition, other authors have identified refractory and recurrent keratitis in patients with confirmed Demodex infestation. Interestingly, these keratitis cases had been treated earlier as herpes, but therapy was not successful. Anti-parasitic treatment with Cliradex has already given positive results after one week." Lastly, "We would like to draw the attention of the physicians of different specialties that special care should be taken with respect to the therapy of dry eye syndrome and ocular demodicosis in patients with immunological disorders to achieve therapeutic success and avoid particularly dangerous consequences of these diseases."

The 2022 study Therapeutic Effect of Intense Pulsed Light in Patients with Sjogrens Syndrome Related to Dry Eye found that three IPL (intense pulsed light) sessions can significantly improve Sjogren's Syndrome dry eye. Correspondingly, IPL treatments kill demodex. The 2019 study Intense Pulsed Light Therapy for Patients with Meibomian Gland Dysfunction and Ocular Demodex Infestation found that "IPL shows great therapeutic potential for patients of MGD and ocular Demodex infestation." There are more studies out there on IPL and demodex. It's a promising therapy for both rosacea (facial demodicosis, now also treated by FDA-approved Soolantra, topical ivermectin cream) and ocular demodex.

The 2014 study Demodex Infestation as a Potential Cause of Keratitis states: "Demodex mites were detected in all cases including Demodex folliculorum in 14 cases and Demodex brevis in 13 cases. Bacterial, fungal and virus culture were negative in all cases. All patients manifested persistent ocular irritation, lid margin and conjunctival inflammation, and keratitis despite prior antibacterial, antiviral and anti-inflammatory treatment. The corneal changes included peripheral infiltration in 8 cases, peripheral ulceration in 4 cases, central infiltration in 2 cases, and diffusive superficial punctuate keratopathy in 1 case. Superficial corneal vascularization was also noted in 13 cases. Meibomian gland morphologic changes such as gland drop out and orifice manifestation as well as disturbed lipid image was also revealed in all cases. After tea tree oil treatment, all patients showed dramatic resolution of ocular inflammation while Demodex counts dropped. All corneal signs resolved within 2 weeks except for residual stromal scar in 4 eyes. Improved lipid tear images were also revealed after treatment in all cases. During a follow-up period, 1 patient showed recurrent inflammation, which was successfully managed by a second round of tea tree oil treatment."

There are many more studies linking meibomian gland dysfunction or MGD to demodex infestation. In the 2022 study Demodex Folliculorum Infestation in Meibomian Gland Dysfunction Related Dry Eye Patients, the authors concluded: "Demodex folliculorum is possibly one of the key contributors in the pathogenesis of MGD related dry eye, and a higher prevalence of chalazion was found in Demodex folliculorum infected patients." The authors found that "the scores for ocular surface disease index, corneal fluorescein staining, lid margin abnormalities, meibum expression, and meibomian gland dropout were significantly higher, while tear break up time was significantly shorter in the Demodex positive group compared to the Demodex negative group."

The 2019 study The Correlation between the Microstructure of Meibomian Glands and Ocular Demodex Infestation found that of the 52 patients tested with MGD, 89.32% were positive for demodex infestation. "Demodex can cause microstructural changes of meibomian glands, which can cause or aggravate MGD, and the more the number of Demodex infestation, the more serious the structural damage."

The 2020 study Association between recurrent corneal erosion syndrome and Demodex infestation or meibomian gland dysfunction found "The infection rate of Demodex palpebralis and the degree of meibomian gland dysfunction are obviously elevated in recurrent corneal erosion syndrome patients, and are associated with the relapse frequency of recurrent corneal erosion syndrome."

The 2017 study Do Demodex Mites Play a Role in Pterygium Development? found: "This suggests that demodicosis could be one of the factors causing pterygium and significantly contribute to its development...The proportion of subjects with both pterygia and Demodex presence is high at 93.33%."

The 2018 study In-Vitro Demodicidal Activity of Commercial Lid Hygiene Products found "Cliradex effectively killed all adult mite samples within 40 minutes of exposure. In contrast, the demodicidal activity of Avenova was comparatively similar to the negative control, 100% mineral oil." The 2015 paper Pure 0.01% Hypochlorous Acid Cleaner without Sodium Hypochlorite Impurities for Treating Demodex Blepharitis found that Avenova does completely kill bacterial strains S. aureus, S. epidermidis, S. haemolyticus, B. oleronius and P. acnes in less than one minute. So while Avenova isn't that effective at killing the mites, it does very effectively kill the bacteria that the mites carry. The 2018 paper Quantitative Analysis of the Bacteria in Blepharitis with Demodex Infestation demonstrates additional evidence that the demodex mite is a vector for bacteria and further details the role of demodex infestation in both blepharitis and rosacea.

Recent reports are detailing Demodex infestation in children, who typically have little, if any, Demodex colonization in their microbiome and a greatly decreased risk of infestation.

The 2022 study The Association of Demodex Infestation with Pediatric Chalazia concluded "Demodex infestation was more prevalent in pediatric chalazia patients than healthy children, and was associated with recurrent and multiple chalazia. Demodicosis should be considered as a risk factor of chalazia. In children with chalazia, Demodex examination and comprehensive treatment of Demodex mites should be applied to potentially prevent recurrence."

The 2013 paper Pediatric Demodex: A Case Series concluded that "Demodex blepharitis can be present in young patients and may be more common than conventional wisdom suggests."

The 2020 study Demodex Blepharokeratoconjunctivitis Affecting Young Patients: A Case Series (very important paper!) found that "Demodex infestation of eyelids can lead to chronic blepharokeratoconjunctivitis in healthy pediatric and young adult patients who otherwise have good lid hygiene, which can be overlooked or misdiagnosed. Viral keratitis and allergic conjunctivitis are common misdiagnoses and demodicosis can be confirmed by simple epilation. Early diagnosis and treatment can prevent long-term steroid use and its related complications." The young patients in this study were treated with two doses of oral ivermectin and tea tree oil lid scrubs. At the end of three months all patients showed clinical improvement in signs and symptoms. Some of these patients had been suffering for a decade of their childhood, some had permanent corneal scarring and others had developed glaucoma and cataracts from chronic steroid use. Prior to treatment, cylindrical dandruff was present in only six patients and eyelashes were clean in the rest of them. The notion that cylindrical dandruff must be present to diagnosis demodex infestation is incorrect. This study states that demodex brevis in particular is difficult to isolate with the standard epilation technique as they are buried deep within the sebaceous glands. Demodex infestation may be more common in hot, humid climates, or during the summer months. This may be due to seasonal activation of sebum production. Interestingly, vernal keratoconjunctivitis is greatly seen in warmer weather climates. "Before the diagnosis of demodicosis was made, all the patients had multiple misdiagnoses such as vernal keratoconjunctivitis, viral keratitis, phlyctenular KC, limbal stem cell deficiency, superior limbic keratitis, episcleritis, Terrien's degeneration, dry eye, acanthamoeba keratitis, bacterial keratitis and microsporidiosis. Three patients had facial rosacea. As they were misdiagnosed earlier, they had received various other treatments such as topical or oral steroids, oral azathioprine, topical ciclosporin, topical tacrolimus, antivirals, antibiotics, antifungals, antiamebicidal, and oral antitubercular therapy. All patients had received chronic steroid therapy, with four patients manifesting steroid-induced side effects with advanced glaucoma and cataract (one operated). Three patients were using scleral contact lenses, one of whom had developed giant papillary conjunctivitis due to chronic use." 

The 2017 study Significant Correlation Between Meibomian Gland Dysfunction and Keratitis in Young Patients with Demodex Brevis Infestation found: "There is a significant correlation between MGD and keratitis in young patients with ocular demodicosis, especially inflicted by Demodex brevis."

The 2020 paper Age Differences in Ocular Demodicosis: Demodex Profiles and Clinical Manifestations states: "Our results showed that there was no significant difference in Demodex counts between young and elderly patients, which was inconsistent with previous studies showing that demodicosis is highly age-dependent. We further discovered that the D. brevis counts and D. brevis percentage of the younger group were higher than that of the elderly group. We speculate that this may be closely related to the parasitic environment of D. brevis and the more active meibum secretion in young individuals, which is beneficial to D. brevis parasitism...It has been exhibited that Demodex plays an important role in blepharitis and ocular surface irritation. Herein, we noted that elderly patients with ocular demodicosis often complain of eye dryness, eye fatigue, and itching. On the contrary, blurred vision and eye pain are more common in young patients, perhaps because eye dryness and MGD are the main manifestations in elderly patients, and mainly cause ocular surface discomfort. However, in young patients, severe MGL (meibomian gland loss), corneal changes, and even visual impairment are the dominant manifestations...In the present study, it can be clearly seen that the young group had a higher prevalence of corneal changes involving the stroma, such as infiltration or ulceration, while SPK (superficial punctate keratitis) was the main corneal change in elderly people." 

The 2016 case report Man presents with persistent foreign body sensation and swollen eyelids examined a 39 year-old with dry eye, meibomian gland dysfunction, blepharitis, hordeolum in the left lower lid and pinguecula in the left eye. Anterior segment revealed anterior blepharitis, eyelid notching, lid margin telangiectasia and cylindrical collarettes. Meibomian glands were blocked and tear breakup time measured 2 seconds with superficial punctate keratitis in both eyes. The MDs prescribed a low dose of 3mg oral ivermectin along with lid scrubs. Partial improvement was seen. Oral ivermectin at the 3mg low dose was repeated twice and patient had significant improvement of symptoms and decreased demodex burden. This study shows that a low dose of ivermectin can be effective in even an adult male if repeated over an appropriate period of time. Concerns of toxicity or Mazzotti reaction are highly unlikely to be seen at this dose.

The 2012 study Demodex-Associated Bacillus Proteins Induce an Aberrant Wound Healing Response in a Corneal Epithelial Cell Line: Possible Implications for Corneal Ulcer Formation in Ocular Rosacea found: "These results indicate that exposure of corneal epithelial cells to Bacillus proteins results in an aberrant wound healing response as visualized using a scratch wound assay. These results suggest a possible link between the high density of Demodex mites on the eyelashes of ocular rosacea patients and the development of corneal ulcers."

Presently, Tarsus Pharmaceuticals is waiting on FDA approval for their TP-03 Demodex-zapping eyedrop. I am intensely curious to see how many people will be cured of a multitude of eye ailments should it be approved (I sincerely hope so!). 

Lastly, a few more studies:

The 2022 study Demodicosis Associated with Wearing a Face Mask: A Case Report described a 46-year-old female with demodicosis due to wearing a surgical face mask for eight hours a day over a three week period. "Even after switching to a cloth mask and using topical steroid, the rash improved slightly and recurred after discontinuation of the treatment. The diagnosis of demodicosis was made by relevant correlation of clinical skin lesions, along with standardized skin surface biopsy results that detected abnormal proliferation of Demodex mites and clinical cure after oral ivermectin therapy." The study concluded: "Demodicosis should be considered in the differential diagnosis in patients with facial rash from wearing face masks during the COVID-19 outbreak."

The 2021 study Increased Incidence of Chalazion Associated with Face Mask Wear During the COVID-19 Pandemic found: "In San Francisco, the incidence of chalazion rose significantly in June through August of 2020 when compared to the same interval in 2016, 2017, 2018, and 2019. In Los Angeles, the rise in chalazion incidence was also statistically significant when compared to data from the years 2018 and 2019. Widespread mask wear does appear to correspond to an increased incidence of chalazion."

The 2021 study Face Mask-Related Ocular Surface Modifications During COVID-19 Pandemic: A Clinical, In Vivo Confocal Microscopy, and Immune-Cytology Study found: "Use of face mask increases ocular surface inflammation and negatively impacts the quality of life in patients with dry eye disease."

The abstract of the 2021 study Chitin-Lipid Interactions and the Potential Relationship between Demodex and SARS-CoV-2 is as follows: "Already from the early days of the COVID-19 pandemic, regulatory agencies have attempted to ascertain the possible routes of SARS-CoV-2 viral transmission. It is hypothesized that the lipid bi-layer that surrounds the SARS-CoV-2 improves its ability to remain stable on sebum-rich skin and serves as another possible route of contracting the virus. One possible aspect of these observations that has yet to be explored in detail is what role arthropods that have been associated with human skin infestation, such as Demodecidae or Pyemotidae species, play in viral transmission. It seems likely that arthropod-coronavirus interactions may take place through the molecular attraction forces between the chitin found on the exoskeleton of mites commonly found on human skin and the lipids present on the viral envelope of the SARS-CoV-2. We believe this may mean that arthropods are currently an overlooked co-factor in viral infection which may have some important biomedical implications for both prevention and treatment." The study adds: "Keeping this in mind, we propose that through its chitin exoskeleton, Demodex folliculorum may act as a reservoir that binds SARS-CoV-2 viral particles, allowing them to remain stable on the surface of the skin for a longer duration, and therefore might represent an overlooked co-factor in viral transmission, especially in those who are already in close contact."

As I've stated numerous times already on this blog, the CDC predicts 1 in 3 Americans will be full-blown diabetic by 2050. The 2017 study Diabetes 2030: Insights from Yesterday, Today, and Future Trends determined that just between 2015 and 2030, diabetes in America will skyrocket 54% and annual costs related to diabetes will increase to more than $622 billion. These numbers may now be conservative post-pandemic. What does this mean for the future of the human species if that many people have very weakened immunity?

I love to read, I always have. The Lion, the Witch and the Wardrobe was I think the first little novel I read after children's books. I remember sitting by my Smith Corona typewriter with it next to me. Nothing's changed! Anyways, I sometimes think of when Edmund was lost and alone in Narnia and encounters the White Witch, who has cursed the land to eternal winter with no Christmas, and is despised by all the creatures in Narnia. She feeds Edmund enchanted Turkish Delight candy, which he cannot resist, and his temptation for more causes him to seek to betray his siblings by luring them to the wicked witch's castle. He is later saved and redeemed by Aslan and joins the fight against the witch.

Can Edmund's downfall for sugar mimic our own? As far as consequences go, we're talking, just to name a few, the nightmare of Alzheimer's disease, blindness, amputation, severe depression and anxiety, suicide, schizophrenia, tinnitus, cancer, thyroid failure, cardiovascular disease, kidney failure requiring dialysis...I can go on and on, unfortunately. I always invite anyone to Google what health condition they have and put "glucose" “glycemic” “insulin" "metabolic" or "diabetes" next to it and see what comes up. 

With so many succumbing to devastating disease and restriction, we must open our eyes to the true calamity consuming sugar and unhealthy, processed carbohydrates has brought us. Tradition calls for celebrating nearly every occasion, for both adults and children, with insulin-spiking foods and hundreds of grams of sugar. In a sick way, looking at it from my perspective and all the research I've done, it's like we're unconsciously celebrating our demise, our ensured slavery to pharmaceutical companies. And yet, oftentimes no occasion is needed for many to feed themselves and their children 100+ grams of sugar and processed carbs a day, easy. There's this Radiohead song I Might be Wrong where Thom Yorke is singing, "I used to think there was no future left at all..." and I, with every fiber of my soul, want to believe that I might be wrong. The time for healing is now.