demodex

My skin biopsy came up with chronic follicular inflammation with demodex. I am now being treated for demodex mites for 4 weeks.If there is no improvement I will need to have a second biopsy done. Rosacea and  Lupus have been eliminated. I am wondering how long it will be before I see an improvement if I am suffering from mites, and also if I need another biopsy, what will they be looking for this time? The biopsy reads:
moderate perifundubular chronic inflammation and slight keratin plugging with several Demodex mites within the follicle. the surrounding skin shows actinic elastosis and some atrophy of the epidermis but no features to suggest Lupus or Rosacea.
The presence of the demodex in the follicle may be relevant here or may possibly obscure the underlying pathology. please consider follow up and further biopsy if clinically indicated.
My symptoms involve flushing as soon as I am in a warm environment across the cheeks, nose and forehead which can be reduced down to normal with cool packs. I have suffered bumps coming up which are not pustules and usually subside within 12 to 24 hours.Occasionally my skin tingles asif a fly is walking across my cheek but it soon subsides.  I am usually red cheeked first thing in the morning having been warm at night.

[Alan Rockoff, MD]

It has for many years been  subject of controversy whether the presence of Demodex mites in follicles is a cause of disease or just a normal finding.  Some doctors--yours is apparently one of them--try treating the mites in hopes of getting clinical improvement.  That's reasonable, since such treatment is safe and the worst that can happen is that it doesn't work.  If it doesn't, a trial of rosacea treatment might be worth considering (despite the biopsy report.)  Lupus does not seem worth considering as a possibility, since that condition has a pretty definitive pathologic picture that you don't have.

It my be that you just have sensitive skin that blushes and flushes and feels sensitive.  In that case, all you can do is do the best you can to avoid things that stimulate flushing, and use products that agree with you.  These maneuvers are never wholly successful, but they do help.  Often, it takes trial-and-error to determine which products re best, since almost all the ones you can buy re tested to be safe for the majority of people.

Best.

Dr. Rockoff