Demodex Mites and the Skin
Demodex mites are tiny organisms that naturally live on human skin. They belong to the mite family and are part of the normal skin microbiome in many people. Two types are found on human skin: Demodex folliculorum and Demodex brevis. They feed on dead skin cells and oil from the sebaceous glands, which is why they are most commonly found in oilier areas such as the forehead, nose, chin, cheeks, scalp, and around the eyelashes.
In small numbers, Demodex mites are usually harmless. In fact, they are very common and may be present in a large part of the population, especially as we get older. Problems tend to happen when their numbers increase too much. Research suggests that skin changes linked to Demodex are more likely when there are more than 5 mites per 1 cm² of skin. Higher numbers have been associated with conditions such as rosacea, acne, seborrhoeic dermatitis, folliculitis, and inflammation around the eyelids.
What symptoms can Demodex overgrowth cause?
When Demodex mites become too numerous, they may contribute to skin irritation, inflammation, and barrier disruption. Common skin symptoms can include:
Redness and visible capillaries
Itching or a crawling or tickling feeling, often worse at night
Burning or stinging
Dryness and dehydration
Flaking or peeling skin
Increased sensitivity to skincare products
Blackheads, bumps, papules, and pustules
A warm or flushed feeling in the skin
If the eyelids are affected, symptoms may include:
Red, swollen eyelids
Crusting or lashes sticking together
Watery eyes
A gritty or sandy feeling in the eyes
Burning or irritation
Dry eye symptoms
Occasionally blurred vision
Because these symptoms can look similar to acne, rosacea, fungal skin issues, or perioral dermatitis, Demodex can sometimes be missed.
How is Demodex diagnosed?
Diagnosis is usually made through a microbiological test or by examining the skin or lashes closely with magnification. A professional may collect a skin sample using adhesive tape, a skin scraping, or another sampling method, and then examine it under a microscope. It is not just the presence of Demodex that matters, but whether the number of mites is higher than expected.
In some cases, especially when symptoms look very similar to rosacea, treatment may be started first and testing may only be done if the skin does not respond as expected.
How is it treated?
Treatment for Demodex overgrowth is usually long term and may take several weeks to a few months. Medical treatment is typically prescribed by a dermatologist and may include topical treatments such as ivermectin, metronidazole, permethrin, crotamiton, or sulphur-based preparations. If there is also a bacterial infection, treatment may need to be adjusted.
How can skincare and facials support the skin?
Alongside medical treatment, supportive skincare can make a real difference. The aim is usually to calm inflammation, support the skin barrier, regulate excess keratin build-up, and gently clear oil and debris from the follicles without over-stripping the skin.
Helpful ingredients may include:
Azelaic acid
Mandelic acid
Salicylic acid
Sulphur-based ingredients
Tea tree oil in the correct diluted concentration
Tansy extract
Gentle but thorough cleansing is especially important. Skin that is not cleansed properly, or is overloaded with heavy products, may become more prone to congestion and imbalance. In clinic, carefully chosen exfoliating and anti-inflammatory treatments may help support the skin alongside medical care.
Why this matters
As skin professionals, it is important to recognise when persistent redness, sensitivity, breakouts, or irritation may need a closer look. Demodex overgrowth is not the cause of every skin issue, but it can be one factor behind ongoing inflammation, especially in skin that looks like acne or rosacea but is not improving in the usual way.
If symptoms are persistent or worsening, referral to a GP, dermatologist, or eye specialist may be the right next step.
References
E. Kilian-Pięta, M. Kikowska, Demodecosis - characteristics and symptoms and care of skin infected with the use of mandelic acid, "Esthetic Cosmetology" 2018, vol. 7(6): 679.
Aktaş Karabay E, Aksu Çerman A. Demodex folliculorum infestations in common facial dermatoses: acne vulgaris, rosacea, seborrheic dermatitis. An Bras Dermatol. 2020 Mar-Apr;95(2):187-193. doi: 10.1016/j.abd.2019.08.023.
Jacob S, VanDaele MA, Brown JN. Treatment of Demodex-associated inflammatory skin conditions: A systematic review. Dermatol Ther. 2019 Nov;32(6):e13103. doi: 10.1111/dth.13103.
Paichitrojjana A. Demodicosis Imitating Acne Vulgaris: A Case Report. Clin Cosmet Investig Dermatol. 2022 Mar 19;15:497-501. doi: 10.2147/CCID.S358000.