Demodex Mites and Rosacea: Treatment Methods and Causes

Demodex mites in rosacea - it's confirmed by scientific information [5] that Demodex mites play an important role in rosacea! Anyone with rosacea knows how frustrating the condition is and how few good treatment options there are to sustain a remission. I’ve long been treating my rosacea patients by combining medicines and skin care recommendations to help heal rosacea prone skin and prevent reoccurance by ‘covering all the bases’ we know play a role in rosacea - including addressing mites.

Knowledge is power. This guide helps you to gain control of rosacea and the notorious Demodex mites. We look into treatment plans, the best routines and most effective products, and the very nature of these pesky microscopic foes. You’ll be equipped to successfully conquer facial mites and facial redness, skin sensitivity, rosacea bumps, and achieve a radiant, healthy complexion.

Scientists Have Been Rethinking the Significance of Mites in Rosacea!

Researchers continue to unravel the complex relationship between Demodex mites and rosacea.

We've long known that:

• Every person has Demodex mites in their skin pores (yes, it's unsavory but true).
• People with rosacea have even more mites in their pores than normal.

Because everybody has Demodex mites, tiny creatures that live naturally in our pores, doctors have ignored their presence. I haven’t. Over many years, I'd see mite stuffed pores under the microscope as an incidental finding on skin biopsies. I'd noted that it often correlated with run-away rosacea [6] including pustules, red sensitive skin, and often patches of skin with small spikes of whitish scale sticking out of facial pores that were surrounded by redness (pityriasis folliculorum). Because of this, I’ve been treating Demodex mites for decades and found that my rosacea patient’s skin improves when I do!

I'm thrilled that recent scientific studies are giving us some interesting information that supports my treatment methods. 

Results of more and more scientific papers are suggesting a significant role for Demodex mites in driving rosacea of both facial skin and the eyes. In fact, authors of a scientific review paper [7] on rosacea and Demodex say this about the role of Demodex in rosacea:

“Rosacea favors the proliferation of Demodex, and the over-proliferation of Demodex aggravates the symptoms of rosacea, thus forming a vicious circle.”

We look deeper into the relationship between mites and rosacea, including causes, bacteria on mites, skin problems, eyelash mites, mites on scalps, and other facts below. But first let’s look at your Demodex mites and rosacea treatment options:

What is the Treatment for Demodex Mites and Rosacea

The care guidelines for rosacea are constantly evolving. In the 35+ years that I've practiced dermatology, the standard rosacea therapies have relied on oral and topical antibiotics. We don’t know entirely why antibiotics helped rosacea. It may be by targeting bacteria that are present in the skin or on the mites. Some antibiotics also have anti–inflammatory effects separate from their antibacterial properties.

Many of my patients are unwilling to use antibiotics long term so I’ve worked hard to find alternative treatments - including addressing mites.

Dr. Bailey’s Skin Care Strategy

Science and Decades of Experience Backed Ingredients and Method

I developed my recommendations based on what worked for my many rosacea patients and observations I made under the microscope on skin biopsies. When I have a suspicion that mites are playing a role in a patient’s rosacea symptoms, my strategy includes two key components:

1. I include specific topical anti-mite prescription medicines (more on this below)
2. Because mite re-infestation is the norm, I also recommend specific skin care steps and products to discourage mites from coming back and thriving in abundance

The approach works synergistically to eliminate and control Demodex mites, soothe inflammation, and reveal a healthier, calmer complexion.

4-Step Skin Care Routine to Treat Rosacea and Demodex Mites

Take control of rosacea and pesky Demodex mites with my Complete Skin Care Routine™ which consists of 4 essential steps: Cleanse, Correct, Hydrate, Protect. As a dermatologist, I've seen its transformative power firsthand. 

This routine tackles both rosacea and its mitey culprits, leaving you with a calmer, clearer complexion, free from redness, bumps, and breakouts. Your skin will feel soothed, with minimized pores and reflect a healthy, radiant glow.

Remember, consistency and expert guidance are key for optimal results!

The core of this routine is my Rosacea Therapy Kit, and I've strategically added the Benzoyl Peroxide Cream and Omega Enriched Face Booster Oil to treat Demodex mites with rosacea.

Let’s look at how to use and layer these products with the 4-step routine:

1. Cleanse

Surface cleansing can wash off Demodex mites outside the pores, along with skin yeast. Facial skin cleansing twice daily is important for controlling Demodex mites. [12]

• Cleanse skin with a 2% pyrithione zinc fortified soap (Calming Zinc) twice a day.
• This helps balance a skin yeast germ called Pityrosporum/Malassezia that also grows abundantly on rosacea-prone complexions.
• Sensitive complexions do best alternating the 2% Calming Zinc soap in the morning with pH balanced soapless Extremely Gentle Foaming Facial Cleanser at night.
• For non-allergic patients, I may choose a prescription skin cleanser with sulfa drugs if necessary.

Always rinse skin really well after cleansing because retained cleanser will irritate skin and continue to pull skin lipids out of skin layers.

2. Correct

Successfully treating facial mites and rosacea isn't just about cleansing away mites, bacteria, yeast and impurities such as dead skin cells and excess sebum. Science has unlocked a treasure trove of targeted corrective ingredients and potent treatments, waiting to be combined and layered into a personalized routine that unleashes their true potential.

• To correct out of balance skin inflammation, I always have my patients apply Green Tea Antioxidant Skin Therapy first, right after the cleansing and towel drying the skin.
• This soothing cream contains pharmaceutically pure and stable green tea polyphenols equivalent to what is extracted in 500 cups of green tea.
• This popular topical product loads the skin's antioxidant reserve to help fight skin stressors.
• For oily pustular rosacea and inflammation, try applying Benzoyl Peroxide Cream twice a day to active areas. It can be irritating but can often also be very uniquely appropriate and can possibly address mites.
• If topical medicines are being used, such as metronidazolel, Finacea or ivermectin/Soolantra (which specifically kills Demodex mites), I have my patients layer those on top of the Green Tea cream.

Pro-tip: I prescribe the very economical permethrin cream to my rosacea patients and have them use it on their face and neck twice a day for a week and then twice a day for 1 to 2 days every month to control Demodex mites. This is a unique treatment that I developed so ask your dermatologist if this might be right for you.

3. Hydrate

The hydrate step is important because barrier integrity is weak in rosacea-prone skin. Your skin won't heal if it is not properly hydrated.

• Hydrate your skin with Daily Moisturizing Face Cream applied over the products you used above.
• Enrich the Daily Moisturizing Face Cream with a few drops of the Omega Enriched Face Booster Oil to benefit from the essential oils (such as sea buckthorn) and castor seed oil.
• At night, you may even want to replace the Moisturizing Cream with the Omega Oil. directly to your face.

4. Protect

The protect step is really important for controlling rosacea because UV exposure can trigger rosacea flares. My top choice for daily sun protection for rosacea prone complexions is a mineral zinc oxide broad spectrum sunscreen.

• Apply the non-irritating Sheer Strength Physical Matte Tinted SPF 50+ Sunscreen during the day - every day - to prevent UV triggering of rosacea.
• It is lightly tinted with iron oxide to help hide complexion flaws. It blends in well to all complexion skin tones, including really fair skin.
• Men love it too because it does NOT look like makeup.
• The matte texture helps hide oily shine.
• The iron oxide helps filter visible and blue screen light known to cause skin damage.

It's that simple! This non-prescription dermatologist's Complete Skin Care Routine covers all of the main factors that cause rosacea, trigger rosacea, or are the consequences of rosacea, complete with targeted products that control Demodex mites. If necessary, I combine these targeted skin care products with topical prescription medicines to treat rosacea.

Follow the 4-Step Routine with the Rosacea Therapy Kit

I created my Rosacea Therapy Kit to take the guesswork out of building a healing skin care routine for those suffering from rosacea. The above steps add in the  Benzoyl Peroxide Cream and Omega Enriched Face Booster Oil to effectively fight demodex mites with rosacea.

If you already have a pH balanced cleanser (used in step 1) and an SPF (used in step 4) that you love, my Facial Flaking and Redness Solution Kit combine the key non-prescription products I use to target driving factors behind rosacea inflammation.

How the Routine Works

This carefully curated selection of compatible products works together to heal rosacea, boost your skin's resilience against inflammation and mite overgrowth, and ultimately support sustained remission. For a temperamental condition like rosacea, this comprehensive approach delivers the best possible results.

This routine:

• Fights inflammation with antioxidants from green tea
• Includes ingredients that may fight mites and bacteria such as benzoyl peroxide, castor seed oil and sea buckthorn
• Incorporates zinc pyrithione to fight skin yeast that we have long known contribute to facial redness from rosacea
• Supports the fragile skin barrier to heal with a lipid replenishing facial moisturizer
• Prevents UV ray exposure that can trigger rosacea using a non-irritating zinc oxide sunscreen

Medical Treatments Used by Dermatologists to Treat Demodex Mites in Rosacea

How I've Been Treating Facial Demodex Mites in Rosacea Patients

Here, I list some of the Demodex mites treatment options I go over with my rosacea patients. It is important to discuss these with your treating physician to see if they are right for you.

• Oral ivermectin. The mites may come back easily, so repeated treatments over time may be necessary to control Demodex. Oral treatment will penetrate both skin and the eyelash area.
• Topical ivermectin creams, such as Soolantra can treat demodex mites. This can not be used in the eye area. It tends to be an expensive medicine, unfortunately.
• Treatment with permethrin (an off-label approach for Demodex) prescription cream nightly for a week. I have my patients repeat this as necessary. This also can not be used to treat the eye area.
• Topical metronidazole may reduce skin inflammation. Oral metronidazole may have some efficacy against mites though I prefer to rely on topical medicines to treat rosacea.
• IPL (intense pulsed light) also helps reduce the mite population [4]. It also diminishes the blood vessel capillaries and, in my experience, helps reduce skin inflammation in rosacea.
• Natural options include tea tree oil, peppermint oil, salvia oil, bergoment oil, black seed oil and castor seed oil. Of these, I have used castor seed oil in my Omega Enriched Face Oil. All the others are known skin irritants - something we want to avoid in rosacea - and can cause skin allergy.
• Hygiene steps to discourage mite reinfection and overgrowth include keeping skin clean, frequent washing of linens including bed linens, avoiding sharing makeup and facial sponges.
• Following my proven Complete Skin Care Routine for a successful treatment. See the details and steps in the 4-Step Skin Care Routine section of this guide.

My Rosacea Therapy Kit is the core of a skin care routine that supports prescription care so that your rosacea heals. To address Demodex mites, my 4-step skin care routine adds in Benzoyl Peroxide Cream and Omega Enriched Face Booster Oil. (Of course, discuss your skin care routine with your prescribing doctor if you are receiving prescription medicines.)