Demodex-Rosacea Connection: Understanding and Managing Rosacea in 2024

As a clinician at the Tracey Bell Clinic, I am dedicated to providing the most up-to-date information to help you understand and manage your rosacea. In this article, we’ll explore the link between Demodex mites and rosacea, look into the connection with Helicobacter pylori, and dive into current research, controversies, and treatment options. This of course came about when trying to help a patient that didn’t respond to normal treatment

Understanding Demodex Mites and Rosacea


What are Demodex Mites?


Demodex mites are tiny, microscopic arachnids that naturally inhabit human skin’s hair follicles and sebaceous glands. Two primary species affect humans:

  • Demodex folliculorum: Found in hair follicles, primarily on the face.
  • Demodex brevis: Found in sebaceous glands.

These mites are usually harmless and are found on most people’s skin. However, when they increase excessively, they can contribute to skin conditions like rosacea.

What is Rosacea?

Rosacea is a chronic inflammatory skin condition that primarily affects the face. It presents with varying symptoms, including facial redness, visible blood vessels, and inflammatory papules and pustules.

Subtypes of Rosacea:

  1. Erythematotelangiectatic Rosacea (ETR): Persistent redness and visible blood vessels.
  2. Papulopustular Rosacea (PPR): Acne-like breakouts on a red background.
  3. Phymatous Rosacea: Thickened skin with a bumpy texture, often affecting the nose.
  4. Ocular Rosacea: Eye irritation, dryness, and redness.

Demodex and Rosacea – What’s the Connection?

Increased Demodex Mite Density in Rosacea Patients

One of the primary pieces of evidence linking Demodex mites to rosacea is the observation of higher mite densities in individuals with rosacea compared to those without the condition.

  • Journal of Medical Microbiology (2012):
    Researchers found that the density of Demodex mites was significantly higher in rosacea patients, particularly those with papulopustular rosacea (PPR), than in individuals without the condition. This suggests a correlation between Demodex mite density and rosacea severity.

The Inflammatory Response

The connection between Demodex mites and rosacea extends beyond mite density. Excessive proliferation of Demodex mites within hair follicles and sebaceous glands can trigger an immune response, leading to inflammation and characteristic rosacea symptoms.

  • Journal of Investigative Dermatology (2012):
    Researchers noted higher levels of inflammatory molecules in the skin of rosacea patients, which were associated with the presence of Demodex mites. This suggests that Demodex mites may provoke an inflammatory response in rosacea.

Demodex Mites and Skin Barrier Function

The skin’s barrier function protects the body from external threats like microorganisms. Disruptions can increase sensitivity and susceptibility to rosacea.

  • British Journal of Dermatology (2011):
    Researchers found that rosacea patients had impaired skin barrier function. They proposed that Demodex mites disrupt hair follicles and sebaceous glands, contributing to barrier dysfunction and exacerbating rosacea symptoms.

The Link Between Helicobacter pylori and Rosacea

Another intriguing potential contributor to rosacea is Helicobacter pylori (H. pylori), a bacterium associated with gastrointestinal disorders like gastritis and peptic ulcers.

What is Helicobacter pylori?

  1. pylori is a Gram-negative bacterium that colonises the stomach lining. It is linked to various gastrointestinal diseases and is believed to affect more than half of the global population.

The H. pylori-Rosacea Connection

Studies have explored the relationship between H. pylori infection and rosacea. Here are the key findings:

  1. Increased Prevalence of pylori in Rosacea Patients:
    Several studies have found a higher prevalence of H. pylori infection among rosacea patients than the general population.
  2. Impact of pylori Eradication on Rosacea:
    Some research suggests that rosacea symptoms improve after successfully eradicating H. pylori infection.

    • Journal of the American Academy of Dermatology (2005):
      A study found that 51% of rosacea patients showed improved symptoms following pylori eradication.
  3. Potential Mechanisms Linking pylori to Rosacea:
    • Immune Response: pylori infection may stimulate an immune response that triggers or exacerbates rosacea symptoms.
    • Toxins and Inflammatory Molecules: pylori produces toxins and inflammatory molecules that could contribute to systemic inflammation, affecting the skin.
    • Gut-Skin Axis: The gut-skin axis concept suggests a bidirectional relationship between gastrointestinal health and skin conditions.

Conflicting Evidence

Despite these findings, not all studies confirm the H. pylori-rosacea connection, highlighting the need for further research.

  • European Journal of Dermatology (2001):
    A study found no significant difference in the prevalence of pylori infection between rosacea patients and controls.

Controversy and Challenges in the Demodex-Rosacea and H. pylori-Rosacea Connections

Correlation vs. Causation

  • The main criticism of these connections is distinguishing correlation from causation. A higher prevalence of Demodex mites or pylori does not directly imply they cause rosacea.

Demodex Mites and H. pylori in Healthy Individuals

  • Demodex mites and pylori are commonly found in healthy individuals without rosacea, raising questions about why some individuals with these organisms develop rosacea while others don’t.

Other Factors in Rosacea

  • Genetics, environmental triggers, and immune dysfunction influence rosacea. Demodex mites and pylori may be contributing factors, but they are unlikely to be the sole cause.

Effectiveness of Treatments

  • The effectiveness of Demodex- and pylori-targeted treatments varies. Not all rosacea patients respond positively to treatments like topical metronidazole, ivermectin, or H. pylori eradication therapy.

Managing Rosacea – Treatment Strategies and Lifestyle Modifications

Demodex-Mite Targeted Therapies

Despite controversies, dermatologists have explored Demodex-targeted therapies to manage rosacea symptoms.


  • Topical Metronidazole: Antimicrobial with efficacy in reducing Demodex populations.
  • Topical Ivermectin: Effective against Demodex mites and inflammation.

Natural Remedies:

  • Tea Tree Oil: Exhibits acaricidal properties.
  • Honey: Anti-inflammatory and may reduce mite density.


A product gaining attention for reducing Demodex mite populations and alleviating redness and bumps.

H. pylori-Targeted Therapies

  1. pylori eradication therapy may benefit rosacea patients who test positive for the bacterium.


  • Triple Therapy: Combines a proton pump inhibitor with two antibiotics, amoxicillin and clarithromycin.

Skin Care and Hygiene Practices

Gentle cleansing and avoiding irritating products can benefit rosacea patients.

  • Cleansers: Mild, non-abrasive cleansers.
  • Moisturisers: Fragrance-free, soothing moisturisers.
  • Sun Protection: Broad-spectrum sunscreen (SPF 30+) daily.

Lifestyle Modifications

Identifying and avoiding triggers is crucial.

  • Diet: Avoid spicy foods, alcohol, and hot beverages.
  • Stress Management: Yoga, meditation, and deep breathing.
  • Sun Protection: Sunscreen and protective clothing.

Frequently Asked Questions

  • Can Demodex mites cause rosacea?
    While Demodex mites are linked to rosacea, they may not be the sole cause. They could contribute to inflammation and symptom severity.
  • Can H. pylori cause rosacea?
    H. pylori infection may exacerbate rosacea symptoms, but it is not the direct cause.
  • How can I reduce Demodex mites on my skin?
    Topical medications like metronidazole, ivermectin, and tea tree oil can help reduce mite populations.
  • Is rosacea curable?
    Rosacea is a chronic condition with no known cure, but it can be managed effectively with treatment and lifestyle modifications.
  • Can diet impact rosacea symptoms?
    Yes, certain foods like spicy dishes, alcohol, and hot beverages can trigger or exacerbate rosacea symptoms.
  • Are there any long-term complications of rosacea?
    Without treatment, rosacea can lead to permanent redness, visible blood vessels, and phymatous changes.
  • Does rosacea affect the eyes?
    Yes, ocular rosacea can cause dry eyes, irritation, and redness.
  • Can stress trigger rosacea?
    Stress is a known trigger for rosacea flare-ups. Managing stress through relaxation techniques can help.
  • Is rosacea more common in women than men?
    Yes, men are more likely to develop severe symptoms like rhinophyma (enlarged nose).
  • Does rosacea only affect fair-skinned individuals?
    No, rosacea can affect all skin types and tones.
  • What should I do if I suspect I have rosacea?
    Consult a with a professional

Download PDF – Guideline for the Treatment of Rosacea


The relationships between Demodex mites, H. pylori, and rosacea are complex and contentious topics. While there is evidence that Demodex mites and H. pylori may play a role in rosacea, many questions remain unanswered.

Rosacea is a multifactorial condition influenced by genetics, environment, and immune function. The management of rosacea should be holistic, addressing individual triggers, sensitivities, and the potential roles of Demodex mites and H. pylori.

Further research is needed to understand how these factors contribute to rosacea and to develop effective treatments.


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  11. *Inoue K, Saito J, Yanagida T, et al. High prevalence of Helicobacter pylori infection in patients with rosacea. Gut Pathogens. 2015;7:2
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