Biologic therapy increases Demodex density in psoriasis patients.

BACKGROUND: Demodex density is known to increase in various immunosuppressive conditions. The relationship between biologic therapy and Demodex density remains unknown. We aimed to investigate whether the density of Demodex mites is higher in psoriasis patients treated with biologic agents compared to treatment-naive or topically treated patients. METHODS: A cross-sectional study was conducted, comparing psoriasis patients receiving biologic therapy (n = 34) with controls (n = 33). Demodex density was assessed using the standardized skin surface biopsy technique (SSSB). Statistical analysis was performed to compare the densities and prevalence of demodicosis between the two groups. RESULTS: Demodex density was significantly higher in the biologic therapy group compared to the control group on the right cheek (7.29 vs. 0.12/cm2; P = 0.001), left cheek (8.15 vs. 0.24/cm2; P = 0.002), and whole face (average of all four regions: 5.50 vs. 0.80/cm2; P = 0.001). The prevalence of demodicosis was significantly higher in the biologic therapy group on the forehead (35.3% vs. 12.1%; P = 0.043), right cheek (41.2% vs. 0%; P < 0.001), and left cheek (44.1% vs. 0%; P < 0.001). The frequency of cases with demodicosis in at least one localization was higher in the biological therapy group compared to the control group (61.8% vs. 15.2%; P < 0.001). CONCLUSIONS: Psoriasis patients receiving biologic therapy had a higher Demodex density and prevalence of demodicosis compared to controls. Biologics may lead to an increase in Demodex density by blocking specific cytokines, such as interleukin-17 and tumor necrosis factor-α, which play a role in immunity against Demodex. Further research is needed to explore the impact of different biological agents on Demodex density.

The effect of phototherapy on Demodex density: a case-control study.

BACKGROUND: Human Demodex mites, Demodex folliculorum and Demodex brevis, are microorganisms that reside in the pilosebaceous units, usually without causing symptoms. Phototherapy has been linked to demodicosis in previous studies. We aimed to determine whether there was an increase in the frequency of demodicosis and Demodex density after 20 phototherapy sessions. METHODS: A case-control study was conducted with 32 participants who received narrowband ultraviolet B or ultraviolet A-1 therapy for various dermatological indications. Standardized skin surface biopsies were performed before and after phototherapy to assess Demodex density. The presence of Demodex-related skin conditions was assessed before phototherapy. A statistical analysis was performed to compare the Demodex densities and prevalence of demodicosis between the baseline and 20th session of phototherapy. RESULTS: No significant change was observed in Demodex density after 20 sessions of phototherapy. The average Demodex density before treatment was 2.75 ± 4.48 (/cm2 ), and after treatment, it was 2.85 ± 4.81 (/cm2 ), indicating no significant difference (P = 0.879). The percentage of patients with demodicosis in at least one region of the face was 28.1% (9/32) before treatment, and after treatment, it was 31.3% (10/32), with no significant difference (P = 1.00). CONCLUSIONS: Our findings contradict previous studies that suggested an increased Demodex density and demodicosis prevalence after phototherapy. The data from previous studies are open to debate due to their selected samples, designs, and interpretations regarding the phototherapy-immunosuppression-Demodex relationship. Larger-scale longitudinal studies conducted on a homogeneous sample are warranted to better understand the relationship between phototherapy and demodicosis.

Rates of skincare product and cosmetic procedure use in patients with acne vulgaris and the effective factors: A multicenter study with 1,755 patients.

BACKGROUND: Skincare products and cosmetic procedures are used as an adjunct or complementary to conventional drug therapy for acne vulgaris (AV). OBJECTIVE: To evaluate the use of skincare products and the frequency of cosmetic procedures in AV treatment. METHODS: A total of 1,755 patients with AV completed the survey prepared by the researchers and the Cardiff Acne Disability Index (CADI) questionnaire. The clinical findings and the Food and Drug Administration (FDA) severity scores were recorded by the dermatologists. RESULTS: For AV, 66.7% of the patients stated that they used skincare products and 26.7% had undergone cosmetic procedures. The use of skincare products was statistically significantly higher in women (female: 74.5%, male: 57.7%, p < 0.0001); older people (users: 22 ± 7.6years, non-users: 21.2 ± 5.7 years, p < 0.0001); patients with a higher CADI score (users: 7 ± 3.7, non-users: 6.9 ± 4.3, p = 0.010); FDA severity score 2 and 3 (FDA-1: 58.1%; FDA-2: 72.4%, FDA-3: 73%, FDA-4: 67%, p < 0.0001); long-term disease (users: 57 ± 43 months; non-users: 47.7 ± 42.3 months, p < 0.0001); facial involvement (present: 70.2%, absent: 51.4%, p = 0.017); high income levels (users: 73.5%; non-users: 26.5%, p = 0.001); and graduate or post-graduate degrees (undergraduate≤%62.8, graduate≥%76.8, p < 0.0001). The rate of cosmetic procedures was higher in those with higher CADI scores (users: 7.8 ± 3.8; non-users: 7.1 ± 3.96, p < 0.0001); older patients (users: 22.7 ± 10.7 years; non-users: 21.3 ± 5 years, p < 0.0001); high school (25.6%); and graduate (28.9%) education (p = 0.043), those with lower disease severity (FDA-1: 31.1%; FDA-2: 28.5%, FDA-3: 27.1%, FDA-4: 20.4%, p = 0.022); smokers (smokers: 32.5%; non-smokers: 25.5%, p = 0.020), and those with AV in the family (present: 29.8%; absent: 24.2%, p = 0.009). The patients most frequently used cleansers (85.2%) as cosmetic products, and most commonly underwent skincare treatment (71%) as an interventional procedure. They mostly learned about such products and methods from the Internet, and 33.3% of the participants had undergone procedures performed by non-physicians. CONCLUSION: The patients generally choose skincare products as a result of their Internet search and sometimes have these procedures performed by non-physicians. Dermatologists should be aware of this situation and inform their patients about appropriate products and procedures.

Social media use in patients with acne vulgaris: What do patients expect from social media?

BACKGROUND: Acne vulgaris (AV) may affect external appearance and significantly deteriorate the quality of life of patients. Therefore, patients make various inquiries about their disease and seek treatment options. AIMS: To investigate the social media usage habits of patients with AV concerning their diseases, and their recommendations for dermatologists related to social media use. METHODS: A total of 1609 patients with AV completed the survey prepared by the authors and the Cardiff Acne Disability Index questionnaire. The Food and Drug Administration severity scores and clinical information of the patients were noted by their physicians. RESULTS: Of the 1,489 patients who stated that they used social media, 46.31% regularly and 28.77% sometimes referred to these sources to make inquiries about AV. Social media usage for AV was statistically significantly higher in women, participants with short term and severe disease, those with a moderate income level, and those using topical treatment and cosmetics. They mostly used Google (67%), Instagram (54%), and YouTube (49%). While 76% of the participants stated that they did not share what they saw on the Internet with their doctor. Of the respondents, 18.5% were trying to contact their dermatologists through the Internet, and 69.73% would prefer experts such as dermatologists to post-AV-related content. CONCLUSIONS: Our study shows that patients frequently resort to social media to seek information about AV. In the changing digital world order, it is observed that there is a need for dermatologists to use social media more actively to share accurate information about AV.