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What Are Demodex Mites, and What Role Do They Play in Acne?

Demodex Mites Are Tiny Creatures That Live in Our Skin and May Contribute to Some Skin Diseases, but It Is Uncertain Whether They Affect Acne

By: Dan Kern, Acne.org Founder & CSO
Last updated: September 29, 2020

The Essential Information

Demodex mites are tiny, colorless creatures that live in our hair follicles and skin oil glands and usually move around only at night. Their entire lifecycle lasts only a few weeks. All people have these mites, though they are more abundant in some people than in others.

While Demodex mites are generally harmless, and may even benefit us by helping create an acidic environment in the skin where harmful bacteria can't survive, they can lead to skin diseases in some select people.

When it comes to acne, three initial studies show that people with acne may have more mites on their skin. However, we don't know whether the mites play a part in causing acne, or whether it's the other way around and having acne leads the mites to overgrow. In other words, whether Demodex mites might cause, worsen, or even reduce acne symptoms is still unclear.

Because these mites live on all humans, their sole presence is not a problem. However, for people who experience mite-related diseases or other reactions, medications such as ivermectin, permethrin, and metronidazole can eliminate them. Tea tree oil may also be a weapon in the arsenal against these mites.

The Science

Demodex mites are tiny, insect-like organisms that live in human hair follicles and sebaceous (skin oil) glands, where they lay their eggs and ultimately die. This entire life cycle is only a few weeks.1-4

They are technically visible, but we never see them because in addition to being extremely small, they are colorless. They also usually only move around at night, and they move extremely slowly, about 1 cm/hr.

Which Types of Demodex Mites Affect Humans?

There are more than 100 types of Demodex mites, but only two types are abundant on the human body.

  1. Demodex folliculorum (D. folliculorum) live in hair follicles. They are approximately 0.3 - 0.4 mm long.
  2. Demodex brevis (D. brevis) live in sebaceous (skin oil) glands. They are about half the size of D. folliculorum.1 - 4

Why Do Demodex Mites Live in Our Skin?

Demodex mites are present in the hair follicles and sebaceous glands of all humans, though some people have more mites than others.4

Researchers do not know exactly why these mites live in our skin. We most likely evolved in a symbiotic (mutually beneficial) relationship with the mites, and they have probably coexisted with us for a long time. One theory is that, along with beneficial bacteria that also live on the skin, Demodex mites may protect human skin against harmful bacteria. The mites contain an enzyme (substance that speeds chemical reactions) that breaks down various skin oils into acids. This creates a mildly acidic environment on the skin that makes it harder for harmful bacteria to thrive.4,5

Can Demodex Mites Cause Problems?

While Demodex mites are present on all humans and are generally not harmful, they can cause problems in some people.

Because the mites cannot digest what they consume, they rely on another symbiotic relationship with bacteria that help them digest their food. They also lack an anus and cannot eliminate their waste. Because of these peculiarities, Demodex mites release a large amount of bacteria and waste into the skin immediately when they die, and this may provoke an immune response and inflammation in their human host.

Demodex mites appear to contribute to several skin diseases, and researchers call such skin diseases caused by these mites demodicoses, the singular of which is demodicosis.3,4,6 Acne is not a demodicosis. However, acne is an inflammatory disease, so there is some speculation that in certain cases, Demodex mites might add to the severity of acne symptoms.

Why Demodex mites cause problems in some people but not in others remains unknown. However, this is what research is pointing toward:

  • When people have an excess of mites in their skin, this leads to more skin diseases.
  • In people who develop demodicoses, the mites often penetrate deeper into the skin, rather than staying closer to the surface.
  • There may be a relationship with immune system function: people with impaired immune systems are more prone to developing demodicoses than people with healthy immune systems.4

Scientists have proposed several ways in which Demodex mites might contribute to skin diseases:

  • They might block hair follicles and skin oil gland ducts.
  • They may provoke an immune reaction and inflammation. In some people, the immune system might regard the mites as "invaders" and attack them.
  • They may transmit a type of bacteria called Bacillus oleronius. This bacteria produces substances that can cause inflammation. When the Demodex mites die, the bacteria and the substances it produces are released into the hair follicles or sebaceous glands and may cause skin inflammation.6 - 9

Can Demodex Mites Cause Problems?

Do Demodex Mites Contribute to Acne?

Although Demodex mites appear to play a role in other skin diseases, it is uncertain whether they contribute to acne.

One study, which looked at D. folliculorum mites in 102 young adults, found no relationship between the number of these mites on a person's skin and acne. In other words, having more mites on the skin did not translate into having acne or having more severe acne.10

However, three other studies, one published in China, one in Poland, and one in Brazil, did find an association between Demodex mites and acne.11-13 In those three studies, having more mites on the skin did seem to correlate with having acne. However, this finding presents a chicken-or-egg problem: Did the overgrowth of the mites contribute to acne, or did the acne allow the mites to overgrow? We simply don't know yet. 

As it often goes with emerging science, we will need more research before we can draw any conclusions.

Expand to read details of studies

The Journal of the European Academy of Dermatology and Venereology (JEADV)

A 2006 study in the Journal of the European Academy of Dermatology and Venereology found no relationship between acne and D. folliculorum mites: in 102 young adults the prevalence of D. folliculorum was not significantly different between groups with and without acne, and there were actually more mites in the people who were not affected by acne. There was no significant difference between the prevalence of these mites and the severity of acne lesions either. The authors concluded, "[T]he presence of D. folliculorum does not appear to be related to acne vulgaris."10 This study did not consider D. brevis, so we cannot draw conclusions regarding its relationship to acne.

Journal of Zhejiang University Science

On the other hand, a 2012 meta-analysis (an analysis of several studies in an attempt to draw one conclusion) in the Journal of Zhejiang University SCIENCE B found an association between Demodex mites and acne, though this connection was not as strong as that between Demodex mites and rosacea.11 This study did not indicate whether D. folliculorum or D. brevis mites were investigated.

Advances in Dermatology and Allergology

A study published in the Polish journal Advances in Dermatology and Allergology in 2018 also found a connection between Demodex mites and acne. The researchers looked for Demodex mites in 108 people with acne and 65 people without acne. They found that 43%, or nearly half, of people with acne had Demodex mites in their skin, compared to only 12% of people without acne.

However, the study found no connection between the presence of mites and acne severity. In other words, the people with acne who also had Demodex mites in their skin did not necessarily have more severe acne compared to people with acne but no Demodex. Still, the researchers believed that they might have seen a connection between Demodex mites and acne severity if they had included more people with severe acne in their study.

The scientists concluded that Demodex mites might contribute to acne and suggested that for people whose acne proves difficult to treat, targeting Demodex mites might help. They wrote, "[W]e suggest that when regular treatments for acne vulgaris are ineffective, examination for Demodex mites and therapy for Demodex should be considered."12

Anais Brasileiros de Dermatologia

A study published in the journal Anais Brasileiros de Dermatologia in 2020 looked for the presence of Demodex mites in the skin of 43 people with acne, 43 people with rosacea, 41 people with seborrheic dermatitis, and 77 people without any skin conditions. The researchers found that the people with acne had significantly more Demodex mites in their skin than people without skin conditions. Likewise, people with rosacea and people with seborrheic dermatitis had more Demodex mites than people with healthy skin.

The study authors wrote, "The findings of the present study emphasize that acne vulgaris…[is] significantly associated with Demodex infestation." However, they cautioned that their study only included a small number of people with each condition and noted the need for larger studies to confirm their findings.13

What Treatments Are Available for Demodex Mites?

Everyone's skin contains Demodex mites, and the mere presence of the mites is not a problem.

However, for people who experience demodicoses like the ones described above, there are several treatments that can eliminate them. Treatment usually includes medications with antiprotozoal (protozoa are single-cell organisms), insecticide (poisonous to a variety of insects), and/or acaricide (poisonous to mites and ticks) properties. The most common medications for eliminating these mites are:

  • Ivermectin (an acaricide medication that is effective against many kinds of parasites)
  • Permethrin (an insecticide medication)
  • Metronidazole (an antibiotic and antiprotozoal medication)6,14,15

Treatments for Demodex Mites

Several studies suggest that treatment with these medications help clear Demodex-related skin diseases. In addition, some research indicates that tea tree oil is effective against Demodex mites. Tea tree oil is also moderately effective against acne.

A few studies conducted between 1999 and 2009 report cases in which acaricides, insecticides, antiprotozoals, and tea tree oil successfully eliminated skin diseases caused by Demodex mites.6,14,16

Expand to read details of studies

Journal of the American Academy of Dermatology (JAAD)

A 1999 study in the Journal of the American Academy of Dermatology found that a combination of ivermectin and permethrin successfully treated a case of rosacea-like demodicosis.14

Journal of the American Academy of Dermatology (JAAD)

A 2009 study in the Journal of the American Academy of Dermatology found that a combination of acaricides and antiprotozoals cleared up various demodicoses.6

British Journal of Ophthalmology

A 2005 study in the British Journal of Ophthalmology found that tea tree oil was effective in eliminating ocular (eye) Demodex mites.16

The Bottom Line

While it's interesting to learn about Demodex mites, it is best not to look to them as a primary concern when it comes to acne. There are other proven treatments for acne that address the real concerns regarding acne and consistently work to help clear the skin.

References:

  1. Rufli, T. & Mumcuoglu, Y. The hair follicle mites Demodex folliculorum and Demodex brevis: biology and medical importance. A review. Dermatologica 162, 1 - 11 (1981). https://www.ncbi.nlm.nih.gov/pubmed/6453029
  2. Spickett, S. G. Studies on Demodex folliculorum Simon (1842). I. Life history. Parasitology 51, 181 - 192 (1961). https://www.cambridge.org/core/journals/parasitology/article/studies-on-demodex-folliculorum-simon-1842-i-life-history/64E8970C538F2C31A5ADC9B49E74B18D
  3. Nutting, W. B. Hair follicle mites (Acari: Demodicidae) of man. Int. J. Dermatol. 15, 79 - 98 (1976). https://www.ncbi.nlm.nih.gov/pubmed/767268
  4. Rather, P. A. & Hassan, I. Human Demodex mite: The versatile mite of dermatological importance. Indian J. Dermatol. 59, 60 - 66 (2014). https://www.ncbi.nlm.nih.gov/pubmed/24470662
  5. Namazi, M. A possible role for human follicle mites in skin's defense against bacteria. Indian J. Dermatol. Venereol. Leprol. 73, 270 (2007). http://www.ijdvl.com/article.asp?issn=0378-6323;year=2007;volume=73;issue=4;spage=270;epage=270;aulast=Namazi
  6. Hsu, C. K., Hsu, M. M. & Lee, J. Y. Demodicosis: A clinicopathological study. J. Am. Acad. Dermatol. 60, 453 - 462 (2009). https://www.ncbi.nlm.nih.gov/pubmed/19231642
  7. Lacey, N., Delaney, S., Kavanagh, K. & Powell, F. C. Mite-related bacterial antigens stimulate inflammatory cells in rosacea. Br. J. Dermatol. 157, 474 - 481 (2007). https://www.ncbi.nlm.nih.gov/pubmed/17596156
  8. Lacey, N., Kavanagh, K. & Tseng, S. C. Under the lash: Demodex mites in human diseases. Biochem. (Lond) 31, 2 - 6 (2009). https://www.ncbi.nlm.nih.gov/pubmed/20664811
  9. Casas, C. et al. Quantification of Demodex folliculorum by PCR in rosacea and its relationship to skin innate immune activation. Exp. Dermatol. 21, 906 - 910 (2012). https://www.ncbi.nlm.nih.gov/pubmed/23171449
  10. Okyay, P., Ertabaklar, H., Savk, E. & Ertug, S. Prevalence of Demodex folliculorum in young adults: relation with sociodemographic/hygienic factors and acne vulgaris. J. Eur. Acad. Dermatol. Venereol. 20, 474 - 476 (2006). https://www.ncbi.nlm.nih.gov/pubmed/16643160
  11. Zhao, Y. E., Hu, L., Wu, L. P. & Ma, J. X. A meta-analysis of association between acne vulgaris and Demodex infestation. J. Zhejiang Univ. Sci. B 13, 192 - 202 (2012). https://www.ncbi.nlm.nih.gov/pubmed/22374611
  12. Akçınar, U. G., Ünal, E. & Doğruman, Al. F. Demodex spp. as a possible aetiopathogenic factor of acne and relation with acne severity and type. Postepy Dermatol. Alergol. 35, 174 - 181 (2018). https://www.ncbi.nlm.nih.gov/pubmed/29760618
  13. Aktaş Karabay, E. & Aksu Çerman, A. Demodex folliculorum infestations in common facial dermatoses: acne vulgaris, rosacea, seborrheic dermatitis. An. Bras. Dermatol. 95, 187 - 193 (2020). https://www.ncbi.nlm.nih.gov/pubmed/32113677
  14. Forstinger, C., Kittler, H. & Binder, M. Treatment of rosacea-like demodicidosis with oral ivermectin and topical permethrin cream. J. Am. Acad. Dermatol. 41, 775 - 777 (1999). https://www.ncbi.nlm.nih.gov/pubmed/10534645
  15. Korting, H. C. & Schöllmann, C. Tetracycline actions relevant to rosacea treatment. Skin Pharmacol. Physiol. 22, 287 - 294 (2009). https://www.ncbi.nlm.nih.gov/pubmed/19786821
  16. Gao, Y. Y. et al. In vitro and in vivo killing of ocular Demodex by tea tree oil. Br. J. Ophthalmol. 89, 1468 - 1473 (2005). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1772908/

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