Why The Red Face - Could It Be Demodex?
- sarah8648
- 13 hours ago
- 4 min read
Photo Credit: NANOCLUSTERING / SCIENCE PHOTO LIBRARY / Getty Image
By Sarah Bersey BSc Hons Pg Dip
We all get itchy sometimes, due to weather, seasonal factors like pollen and dust or reactions to clothing, cosmetics or jewelry. However, if you suffer from skin reddening and prolonged itching, burning or tingling on your face or scalp, or a "gritty" feeling in the eyes, it could be time to consider Demodex as a cause.
What are Demodex?
Demodex (or face mites) refers to a genus of microscopic, eight‑legged mites that inhabit human hair follicles and sebaceous glands, most commonly on the face. They are present on most people – research suggests that they are present on all adults over the age of 18 (National Rosacea Society 2025) and researchers have been aware of Demodex mites for more than 150 years. (National Rosacea Society 2025). Two species are regularly found on humans: Demodex folliculorum, which lives primarily in hair follicles, and D. brevis, which dwells deeper in the sebaceous glands. (Cleveland Clinic 2022) Demodex mites are a natural part of this human microbiome, and they may serve a useful function by consuming dead skin cells to help rid the face of waste. (National Rosacea Society 2025)
In healthy individuals the mites coexist harmlessly with the skin and are un-noticed by their host. But when their numbers proliferate, they can become pathogenic, or disease-causing, a condition known as demodicosis. This can lead to both dermatological and ophthalmological problems (Chudzicka-Strugała et al 2023) and is thought to happen more often in immunocompromised individuals (those undergoing active cancer treatment, transplant recipients, those taking immunosuppressing drugs, those living with HIV/AIDS, SCID AND CVID, those with chronic dysfunction of the kidney, liver and spleen, malnourished individuals and those living with age-related immunosenescence.
(Cleveland Clinic 2022)
Problems that can also be attributed to Demodex:
An overgrowth of Demodex mites has been linked to several skin and eye disorders. These include:
· Chronic blepharitis (inflammation of the eyelid margins)
· Chalazia (eye cysyts)
· Meibomian (oil producing) gland dysfunction
· Keratitis (inflamed eye cornea)
· Rosacea‑like facial eruptions (linked to 15 to 18 times greater numbers than normal)
· Folliculitis‑type skin lesions
· Acne
(Fischer et al 2025, Chudzicka-Strugała et al 2023, Kern 2025)
A recent meta-analysis of 48 studies on Demodex found a significant association between the relative density of Demodex and the development of rosacea (National Rosacea Society 2025). Researchers also associate high mite densities with non‑specific facial dermatitis, acneiform eruptions, and that in the eye, the ocular surface inflammation can exacerbate dry‑eye symptoms (Chudzicka-Strugała et al 2023)
Symptoms of Demodex Overgrowth:
While generally too microscopic to feel, a high concentration of Demodex mites can cause sensations of crawling, itching, or tingling on the skin, especially around the nose, cheeks, and forehead. Additional signs include a bumpy rash, scaling, and occasional secondary bacterial infection if the skin barrier is compromised. (Fischer et al 2025)
Symptoms are usually only felt if the mites multiply excessively due to a weakened immune system, causing conditions like blepharitis or rosacea.
Ocular involvement often presents as red, swollen eyelids, white, crusty debris on lashes, crusty deposits at the base of eyelashes and loss of eyelashes or eyebrows (madarosis) (Fischer et al 2025).
Key Details About Feeling Demodex Mites:
Treatment of Demodex Overgrowth:
The search for the most effective treatment has been ongoing for years. In the case of ocular demodicosis, standard eyelid hygiene was used, sometimes with sulfur ointment, yellow mercury ointment, pilocarpine gel or local antibiotics, and anthelmintics. (Chudzicka-Strugała et al 2023)
These days, therapeutic strategies aim to reduce mite load and to alleviate inflammation:
· First‑line topical agents include insecticidal creams such as permethrin or crotamiton, which directly kill the mites. (Fischer et al 2025)
· Oral or topical metronidazole is frequently prescribed for its anti‑inflammatory and anti‑mite effects. (Fischer et al 2025)
· Adjunctive measures—warm compresses, lid hygiene with tea‑tree‑oil–containing wipes, and gentle exfoliation—help remove debris and improve drug penetration. (Fischer et al 2025)
· Emerging evidence suggests that castor oil may also provide symptomatic relief for eyelash loss associated with demodicosis.
These are summarised in the following table:
https://pmc.ncbi.nlm.nih.gov/articles/PMC9961532/ (Chudzicka-Strugała et al 2023)
https://pmc.ncbi.nlm.nih.gov/articles/PMC9961532/ (Chudzicka-Strugała et al 2023)
https://pmc.ncbi.nlm.nih.gov/articles/PMC9961532/ (Chudzicka-Strugała et al 2023)
https://pmc.ncbi.nlm.nih.gov/articles/PMC9961532/ (Chudzicka-Strugała et al 2023)
In conclusion, it is clear that Demodex can turn from a beneficial passenger on your body that helps out with the housekeeping to a disease-causing problem, purely due to the numbers present. It is possible to treat some effects of an overgrowth with essential oils and improved hygiene, but as antibiotics may be called for, it is advisable to seek help from your healthcare professional.
Useful Sources Cited
Cleveland Clinic (2022) Demodex (Face Mites): Folliculorum, Brevis & Treatment [online] https://my.clevelandclinic.org/health/diseases/22775-demodex-face-mites
Chudzicka-Strugała I, Gołębiewska I, Brudecki G, Elamin W, Zwoździak B. (2023) Demodicosis in Different Age Groups and Alternative Treatment Options-A Review. J Clin Med. 12(4):1649 [online]https://pmc.ncbi.nlm.nih.gov/articles/PMC9961532/
Jacob S, Van Daele MA, Brown JN. (2019) Treatment of Demodex-associated inflammatory skin conditions: A systematic review. Dermatol Ther. 2019 Nov;32(6):e13103. [online] https://pubmed.ncbi.nlm.nih.gov/31583801/
Kern, D (2025) WHAT IS ACNE: What Are Demodex Mites, and What Role Do They Play in Acne?[online] https://www.acne.org/what-are-demodex-mites-and-what-role-do-they-play-in-acne
Medical News Today (2023) Demodex folliculorum: Causes, symptoms, and treatment [online] https://www.medicalnewstoday.com/articles/321831
National Rosacea Society (2025) The Ecology Of Your Face: Demodex Rosacea And You [online] https://www.rosacea.org/patients/the-ecology-of-your-face-demodex-rosacea-and-you
Fischer, K., Tudor, M.A., Matini, M. (2025) What Are Demodex Mites? [online] https://www.webmd.com/skin-problems-and-treatments/what-are-demodex-mites
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