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Mange is caused by active reproduction of mites of the Demodex genus. These mites live in the skin of every second one of us but they liven up against the background of lowered general and local immunity. It is necessary to remember that Demodex mites are physiological representatives of skin microflora (obligate parasites) and normally do not get outside basic membrane of epidermis. However under certain conditions they destroy follicle epithelium and penetrate into derma. Inflammatory process begins as a response on mechanical damage and irritation of the skin with products of vital functions of the mites. The intensity of inflammation depends not on the density of mites’ population on the skin but on the type of individual immune reactions of the organism and the skin in particular.
Primary demodicosis is developed on the unchanged skin. In addition it often complicates the development of acne and especially rosacea.
Demodicosis is diagnosed on the basis of clinical presentation, patient’s complaints that are defined more exactly during thorough questioning. The diagnosis is proved by special analysis. If not less than 5 mites per cm2 are found, the pathogenicity is confirmed.
Demodicosis forms 2,1% out of total number of skin pathologies. It can develop at any age although it happens more often after 35 years. Women are more prone to the disease (women to men ratio is 5:1).
Demodicosis does not prefer a specific skin phototype. It implies presence of seborrhea because skin fat promotes active reproduction of the mites.
Localization and clinical presentation
Inflammatory glands are situated asymmetrically and often prevail on one side of the face. If skin rash appears on an unchanged skin this condition is called “primary demodicosis”. If the demodicosis is a complication of primary disease (acne, rosacea), it is called “secondary demodicosis”. 91% of patients note that the disease develops gradually and begins from itching, formication, and slight skin peeling.
Then small inflammatory elements appear in the form of small papulae. Demodicosis papulae are always small (1-2 mm) and of conical shape.
Demodicosis treatment
At the inflammatory stage the therapy can include antibiotics (tetracyclines still prevail); metronidazole or titeral; sedative preparations but not antidepressants; roalsutan in severe cases.
Individual immunocorrective therapy has gained big significance recently.
Topical treatment is aimed at effective skin clearing; pathogenetic aspects are necessarily taken into account. For the time of treatment contacts with water should be limited; special lotions and emulsions should be used for face washing.
Well-planned combined approach to demodicosis treatment should necessarily bring positive results. |
