One of the more disturbing realities of the microbiome is that we're literally crawling with microbes. Bacteria, fungi, and viruses all live within the human body, and for the most part, co-exist with us in a symbiotic relationship. There's tons of research on why the microorganisms that exist on and inside our bodies could actually be key to good health and longevity, catalyzing everything from the proper immune responses to attacking harmful bacteria, and even preventing the onset of serious illness. Other types of microorganisms just hang out, and we haven't a clue that they're present. Such is the case with demodex, commonly known as face mites.
Sound creepy? Admittedly, it's not a pleasant thought. But demodex are actually quite harmless. They don't bite. You don't feel them crawling or laying eggs (though they do both, which, again, is unpleasant to think about). Face mites can, however, become a problem when they overpopulate and begin to accumulate in high density, causing red, itchy, bumpy skin. Demodex thrive in areas with increased oil production, like the t-zone, and some research suggests they are more likely to be present in people with suppressed immune response. With a lifespan of about two weeks, demodex are pretty easy to treat yourself at home with the proper skincare regimen. It's always a good idea, however, to consult with a dermatologist if you suspect you might be dealing with a case of face mites.
Ahead, three dermatologists offer at-home remedies to get rid of face mites.
Meet the Expert
- Marisa Garshick, MD, FAAD is a board-certified dermatologist at MDCS Dermatology: Medical Dermatology & Cosmetic Surgery, as well as an assistant clinical professor of dermatology at Cornell - New York Presbyterian Medical Center.
- Marina I. Peredo, MD, FAAD is a board-certified dermatologist and founder of Skinfluence NYC.
- Mamina Turegano, MD, FAAD board-certified dermatologist on the Dermatica Dermatology team.
What Are Demodex?
Two species of demodex, a parasitic microorganism, live on humans: Demodex folliculorum and Demodex brevis, both frequently referred to as face mites. Most people have them, and consistent facial hygiene will keep face mites under control. Resistant cases can be treated by a dermatologist.
Cleanse Your Face Twice Daily
The first step in getting rid of demodex is to wash your face twice daily. "In general, routine use of a gentle cleanser is recommended," says Garshick. Be careful not to overdo it as excess washing will dry out the skin and may lead to an overproduction of sebum, which is exactly what you're trying to avoid. "In general, mites or not," adds Garshick, "it is good to stick with a good basic skincare regimen including a gentle cleanser such as CeraVe or Cetaphil, as well as a gentle moisturizing lotion."
Consider Silk Pillowcases (and Wash Often)
Washing your face isn't the only preventative measure to take against the accumulation of face mites. Garshick says, "It is always important to remember to wash your sheets regularly to ensure a clean environment for your skin." Peredo suggests washing bedding on the highest setting to make sure you're killing any mites that might have embedded in your pillowcases.
Turegano suggests using silk pillowcases to help prevent the spread of microbes, and Peredo agrees. "I recommend a non-absorbent fabric bedding to help prevent the spread of face mites," she says, noting silk can help minimize the absorption oil and dirt on the skin.
Control Oil Production on Your Face
One of the best ways to control oil production on your face is to use products with tea tree oil, which has a host of bacteria-fighting properties to help rid the face of excess sebum. "Tea tree oil is known to have antibacterial, anti-fungal, and anti-inflammatory properties that help kill existing eggs and control the spread," explains Peredo.
Add Sulfur to Your Cleansing Routine
Turegano is a fan of sulphur-based cleansers to rid skin of demodex. Sulfur is a tried and true ingredient for getting rid of acne due to its antimicrobial properties, which make it effective against the accumulation of face mites. Again, you want to pay attention to the t-zone to target the niches in the face where oil proliferates.
Incorporate Salicylic Acid Into Your Routine
Another anti-acne staple known for its power to dissolve oil is salicylic acid, which is helpful in getting rid of demodex. An over-the-counter will suffice, though if you're not seeing an improvement in oil reduction consult your dermatologist, who can prescribe a higher concentration.
Avoid Harsh Scrubs
Resist the temptation to rid your face of mites with an intense mechanical cleanse. "No matter how many times you exfoliate or scrub your skin, they won't disappear," says Peredo. Harsh scrubs can also exacerbate inflammation and irritate the skin.
Cleanse the Space Between Your Eyebrows
When cleansing your face, be sure to target the area in between your eyebrows. "Demodex like to live in the pore or hair follicle, where there is an increased collection of sebum and dead skin cells," explains Turegano. Another fun fact about face mites is that they can be transferred between hosts through contact of hair, including the eyebrows.
Cleanse Eyelids Thoroughly
Demodex can often congregate in the eyelash region, so be sure to remove eye makeup religiously. "Mites can begin to cause eyelash conditions like hair loss, inflammation, or clumpy eyelashes," says Peredo.
Garshick notes that demodex "may be associated with irritation or itching of the eyelids, causing blepharitis," which is when the tiny oil glands of the eyelid become inflamed. This presents as itchy, scaly, or thin eyelid crusts. She suggests consulting a dermatologist if you think you may have this condition.
Check for Redness Around the Center of the Face
As aforementioned, face mites are a natural part of the skin biome. They become problematic when they begin to overpopulate and lay eggs, leading to more mites. As disturbing as this sounds, you can stop demodex from using your face as a breeding ground with a little facial monitoring. "Pay attention to increased redness on your face," says Turegano, "especially if it’s localized to the central face (cheeks, around the nose, between brows) or eyelids. You can also look for itching, mild scaling, papules, and pustules." This is a sign that the density of mites has become problematic, and requires more aggressive treatment. Time to call your dermatologist for a consult.
Monitor Itching and Scaling
In addition to checking your face for centralized redness, monitor itchy and scaly skin, as this might be a sign that you're dealing with a high concentration of demodex. Turegano says to look for "dryness, scaling, and roughness with or without papules and pustules." Pay special attention to the area around the nose, between the eyebrows, and around the mouth.
Consult with a Dermatologist (Especially if You Have Rosacea)
In resistant cases, or cases of high concentrations of demodex on the skin, a dermatologist can develop a thorough treatment plan, including prescription medication. Medications typically used to treat demodex include metronidazole (topical), ivermectin (topical and oral), crotamiton (topical), and permethrin (topical). "If you are experiencing bumps on the face that are not responding to your typical treatments, it is best to see a board-certified dermatologist to determine what treatments would be best," says Garshick. She adds that anyone can develop an overpopulation of face mites, however, "those who are immunosuppressed may be at greater risk."
Additionally, studies indicate that patients with rosacea have 15 to 18 times more face mites than people without the condition. Garshick notes that most people have a "small number of mites on skin," but that for those who develop an overpopulation of face mites, demodex may appear as rosacea. "If they are present in higher amounts," she says, "it can lead to inflammation which may appear as itchy red bumps or pustules, roughness of the skin and background redness." Peredo adds, "Face mites are most commonly seen in the setting of rosacea. The condition can exacerbate rosacea or present as a rosacea-like dermatitis."
Should you develop itchy acne-like lesions, it's also time to consult a dermatologist. Sometimes, overgrowth of demodex can lead to a condition called demodicosis, which Garshick says can present as "papules and pustules often centered around the hair follicle." She adds, "Unlike acne or bacterial folliculitis, these lesions may not respond to antibiotics such as doxycycline or clindamycin," something to consider if your acne isn't clearing up with antibiotics. A proliferation of demodex can trigger an immune response, resulting in red, inflamed skin. "It is thought that the demodex mite can be a vector for the bacteria bacillus oleronius," says Garshick, "which may induce the inflammation that can be seen with this condition," she says.
Respectively, Peredo adds that "weakened immune systems make it easier for face mites to populate on the skin." Symptoms of demodicosis include red-bumpy pimples, itchy skin, and dryness. "Demodicosis can be easily mistaken with acne, which is why I recommend scheduling a consultation with your dermatologist," she explains. Should you develop demodicosis, a dermatologist will prescribe an anti-parasite treatment.
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