Article

Demodex folliculorum palpebrarum.

Canadian Journal of Ophthalmology (Impact Factor: 1.15). 02/1969; 4(1):3-15.
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    ABSTRACT: Demodex mites are common commensal organisms of the pilosebaceous unit in human beings and have been implicated in pityriasis folliculorum, rosacea-like demodicosis, and demodicosis gravis. We sought to describe the spectrum of clinicopathological findings and therapeutic responses of demodicosis in Taiwanese patients. We conducted a retrospective study to review clinicopathologic findings and therapeutic responses of 34 cases of diagnosed demodicosis. Fifteen cases with positive results of potassium hydroxide examination, standardized skin surface biopsy specimen, and/or skin biopsy specimen, and resolution of skin lesions after anti-Demodex treatment were included for final analysis. Nineteen cases were excluded because of insufficient positive data to make a definite diagnosis. There were 4 male and 11 female patients (age 1-64 years, mean age 38.7 years). The disease was recurrent or chronic with a duration ranging from 2 months to 5 years (mean 15.7 months). The skin lesions were acne rosacea-like (n = 8), perioral dermatitis-like (n = 5), granulomatous rosacea-like (n = 1), and pityriasis folliculorum (n = 1). Skin biopsy was performed in 7 patients. Overall, the histopathology was characterized by: (1) dense perivascular and perifollicular lymphohistiocytic infiltrates, often with abundant neutrophils and occasionally with multinucleated histiocytes; (2) excessive Demodex mites in follicular infundibula; and (3) infundibular pustules containing mites or mites in perifollicular inflammatory infiltrate. The skin lesions resolved after treatment including systemic metronidazole, topical metronidazole, crotamiton, or gamma benzene hexachloride. Small sample size and a fraction of patients without long-term follow-up are limitations. Demodicosis should be considered in the differential diagnosis of recurrent or recalcitrant rosacea-like, granulomatous rosacea-like, and perioral dermatitis-like eruptions of the face. Potassium hydroxide examination, standardized skin surface biopsy, skin biopsy, or a combination of these are essential to establish the diagnosis.
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    ABSTRACT: The lower lids of 274 normal subjects have been examined in the slit-lamp for expressibility of secretion from the Meibomian glands. Secretion could be expressed from on an average 10 glands (median 11), dependent on age, decreasing with increasing age (from 14.5 glands at about the age of 20 to 7 glands above the age of 80). The expressibility was seen to be positively correlated to the thickness of the lipid layer of the precorneal film, estimated by the semiquantitative interference method. It was positively correlated to pigmentation and to ordinary greasy scales on the lid margin. The expressibility negatively correlated to retraction of the Meibomian orifices. The expressibility was found not to be correlated to elevated orifices, foam formation in the external part of the eye, cysts in the tarsus, nor with casts round the eyelashes. It is important to distinguish between cylindric casts (Demodex-induced) and ordinary greasy scales on eye lashes and lid margin.
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