The efficacy of tea tree face wash, 1, 2-Octanediol and microblepharoexfoliation in treating Demodex folliculorum blepharitis

Published:October 23, 2017DOI:https://doi.org/10.1016/j.clae.2017.10.012

      Highlights

      • Tea tree face wash and 1,2–Octanediol are effective at treating Demodex blepharitis.
      • Treatment of Demodex blepharitis reduces symptoms to normal levels.
      • BlephEx™ device helps further reduce symptoms and quantity of Demodex folliculorum.

      Abstract

      Purpose

      To compare the efficacy of Dr Organic Tea Tree Face Wash, OcuSoft Lids Scrub Plus and the BlephEx™ device at treating of Demodex folliculorum blepharitis.

      Methods

      Eighty-six subjects (33 males/36 females) were enrolled in a randomised controlled interventional treatment study. Subjects completed a dry eye symptom questionnaire and were assessed for presence of Demodex folliculorum. Subjects were divided into three groups according to treatment: Dr Organic Tea Tree Face Wash (A) (n = 28), OcuSoft Lid Scrub Plus (B) (n = 30), or in-house lid scrub with the BlephEx™ device before nightly lid scrubs with OcuSoft Lid Scrub Plus (C) (n = 28). Subjects were advised to clean their eyelids nightly for four weeks. Each subject was re-assessed for symptoms and Demodex folliculorum blepharitis after two weeks and four weeks of treatment.

      Results

      The quantity of Demodex folliculorum was significantly reduced after four weeks of treatment in all three groups (p < 0.05). Overall, there was no difference in efficacy between the three treatments (p > 0.1). Symptoms reported by subjects were significantly improved after two and four weeks of treatment (p < 0.05). Overall, there was no difference in efficacy between the three treatments to reduce symptoms after two or four weeks (p =  0.813 and p = 0.646 respectively).

      Conclusion

      All three methods tested have shown good ability to reduce Demodex folliculorum quantity, improve subjective symptoms and help treat Demodex folliculorum blepharitis.

      Keywords

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      References

        • Breckenridge R.L.
        Infestation of the skin with demodex folliculorum.
        Am J Clin Pathol. 1953; 23: 348-352
        • Coston T.
        Demodex folliculorum blepharitis.
        Trans Am Ophthalmol Soc. 1967; 65: 361-392
        • Lacey N.
        • Kavanagh K.
        • Tseng S.
        Under the lash: demodex mites in human diseases.
        Biochem (Lond). 2009; 31: 2-6
        • Gao Y.Y.
        • Di Pascuale M.A.
        • Li W.
        • Liu D.T.S.
        • Baradaran-Rafii A.
        • Elizondo A.
        • et al.
        High prevalence of Demodex in eyelashes with cylindrical dandruff.
        Invest Ophthalmol Vis Sci. 2005; 46: 3089-3094
        • Liu J.
        • Sheha H.
        • Tseng S.C.G.
        Pathogenic role of Demodex mites in blepharitis.
        Curr Opin Allergy Clin Immunol. 2010; 10: 505-510
        • Czepita D.
        • Kuźna-Grygiel W.
        • Czepita M.
        • Grobelny A.
        Demodex folliculorum and Demodex brevis as a cause of chronic marginal blepharitis.
        Ann Acad Med Stetin. 2007; 53 (Accessed 1 September 2016): 63-67
        • Kabataş N.
        • Doğan A.Ş.
        • Kabataş E.U.
        • Acar M.
        • Biçer T.
        • Gürdal C.
        The effect of demodex infestation on blepharitis and the ocular symptoms.
        Eye Contact Lens. 2017; 43 (Accessed 6 April 2017): 64-67
        • Rufli T.
        • Mumcuoglu Y.
        The hair follicle mites demodex folliculorum and demodex brevis: biology and medical importance.
        Dermatologica. 1981; 162: 1-11
        • Lacey N.
        • Ní Raghallaigh S.
        • Powell F.C.
        Demodex mites–commensals, parasites or mutualistic organisms?.
        Dermatology. 2011; 222: 128-130
        • Chen W.
        • Plewig G.
        Are Demodex mites principal, conspirator, accomplice, witness or bystander in the cause of rosacea?.
        Am J Clin Dermatol. 2015; 16: 67-72https://doi.org/10.1007/s40257-015-0115-y
        • Baima B.
        • Sticherling M.
        Demodicidosis revisited.
        Acta Derm Venereol. 2002; 82: 3-6
        • Elston C.A.
        • Elston D.M.
        Demodex mites.
        Clin Dermatol. 2014; 32: 739-743https://doi.org/10.1016/j.clindermatol.2014.02.012
        • Forton F.
        • Germaux M.-A.
        • Brasseur T.
        • De Liever A.
        • Laporte M.
        • Mathys C.
        • et al.
        Demodicosis and rosacea: epidemiology and significance in daily dermatologic practice.
        J Am Acad Dermatol. 2005; 52: 74-87
        • Schear M.J.
        • Milman T.
        • Steiner T.
        • Shih C.
        • Udell I.J.
        • Steiner A.
        The association of demodex with chalazia: a histopathologic study of the eyelid.
        Ophthal Plast Reconstr Surg. 2015; 32: 275-288https://doi.org/10.1097/IOP.0000000000000500
        • Guvendi Akcinar U.
        • Unal E.
        • Akpinar M.
        Demodex spp. infestation associated with treatment-Resistant chalazia and folliculitis.
        Turkish J Parasitol. 2017; 40: 208-210https://doi.org/10.5152/tpd.2016.4869
        • Liang L.
        • Ding X.
        • Tseng S.C.G.
        High prevalence of demodex brevis infestation in chalazia.
        Am J Ophthalmol. 2013; https://doi.org/10.1016/j.ajo.2013.09.031
        • Bonnar E.
        • Eustace P.
        • Powell F.C.
        The Demodex mite population in rosacea.
        J Am Acad Dermatol. 1993; 28: 443-448https://doi.org/10.1016/0190-9622(93)70065-2
        • Jarmuda S.
        • O’Reilly N.
        • Zaba R.
        • Jakubowicz O.
        • Szkaradkiewicz A.
        • Kavanagh K.
        Potential role of Demodex mites and bacteria in the induction of rosacea.
        J Med Microbiol. 2012; 61: 1504-1510
        • Karincaoglu Y.
        • Bayram N.
        • Aycan O.
        • Esrefoglu M.
        The clinical importance of Demodex folliculorum presenting with nonspecific facial signs and symptoms.
        J Dermatol. 2004; 31: 618-626https://doi.org/10.1111/j. 1346–8138.2004. tb00567. x
        • Kheirkhah A.
        • Casas V.
        • Li W.
        • Raju V.K.
        • Tseng S.C.G.
        Corneal manifestations of ocular demodex infestation.
        Am J Ophthalmol. 2007; 143: 743-749
        • Kamoun B.
        • Fourati M.
        • Feki J.
        • Mlik M.
        • Karray F.
        • Trigui A.
        • et al.
        [Blepharitis due to Demodex: myth or reality?].
        J Fr d’ophtalmologie. 1999; 22 (Accessed 13 January 2016): 525-537
        • English F.P.
        • Nutting W.B.
        Demodicosis of ophthalmic concern.
        Am J Ophthalmol. 1981; 91: 362-372
        • Seys F.
        • Song M.
        Demodex folliculorum and topical treatment: acaricidal action evaluated by standardized skin surface biopsy.
        Br J Dermatol. 1998; 22: 525-537https://doi.org/10.1046/j. 1365-2133.1998.02125. x
        • Hoekzema R.
        • Hulsebosch H.J.
        • Bos J.D.
        Demodicidosis or rosacea: what did we treat?.
        Br J Dermatol. 2017; (Accessed 13 April 2017): 294-299
        • Ashack R.J.
        • Frost M.L.
        • Norins A.L.
        Papular pruritic eruption of Demodex folliculitis in patients with acquired immunodeficiency syndrome.
        J Am Acad Dermatol. 1989; 21: 306-307https://doi.org/10.1016/S0190-9622(89)70182-1
        • Jansen T.
        • Kastner U.
        • Kreuter A.
        • Altmeyer P.
        Rosacea-like demodicidosis associated with acquired immunodeficiency syndrome.
        Br J Dermatol. 2001; 144 (Accessed 13 April 2017): 139-142
        • Dominey A.
        • Rosen T.
        • Tschen J.
        Papulonodular demodicidosis associated with acquired immunodeficiency syndrome.
        J Am Acad Dermatol. 1989; 20: 197-201https://doi.org/10.1016/S0190-9622(89)70021-9
        • Rufli Y.
        • Mumcuoglu A.
        • Cajacob S.
        Demodex folliculorum: aetiopathogenesis and therapy of rosacea and perioral dermatitis.
        Dermatologica. 1981; 162 (Accessed 13 April 2017): 12-26
        • Siddiqui K.
        • Stein Gold L.
        • Gill J.
        The efficacy, safety, and tolerability of ivermectin compared with current topical treatments for the inflammatory lesions of rosacea: a network meta-analysis.
        Springerplus. 2016; 5
        • Luo Y.
        • Sun Y.-J.
        • Zhang L.
        • Luan X.-L.
        Treatment of mites folliculitis with an ornidazole-based sequential therapy.
        Medicine (Baltimore). 2016; 95: e4173https://doi.org/10.1097/MD.0000000000004173
        • Gao Y.Y.
        • Di Pascuale M.A.
        • Li W.
        • Baradaran-Rafii A.
        • Elizondo A.
        • Kuo C.-L.
        • et al.
        In vitro and in vivo killing of ocular Demodex by tea tree oil.
        Br J Ophthalmol. 2005; 89: 1468-1473https://doi.org/10.1136/bjo.2005.072363
        • Tighe S.
        • Gao Y.Y.
        • Tseng S.C.G.
        Terpinen-4-ol is the most active ingredient of tea tree oil to kill demodex mites.
        Transl Vis Sci Technol. 2013; 2: 2https://doi.org/10.1167/tvst.2.7.2
        • Gao Y.Y.
        • Di Pascuale M.A.
        • Elizondo A.
        • Tseng S.C.
        Clinical treatment of ocular demodecosis by lid scrub with tea tree oil.
        Cornea. 2007; 26: 136-143
        • Koo H.
        • Kim T.H.
        • Kim K.W.
        • Wee S.W.
        • Chun Y.S.
        • Kim J.C.
        Ocular surface discomfort and Demodex: effect of tea tree oil eyelid scrub in Demodex blepharitis.
        J Korean Med Sci. 2012; 27: 1574-1579
        • Nicholls S.G.
        • Oakley C.L.
        • Tan A.
        • Vote B.J.
        Demodex treatment in external ocular disease: the outcomes of a Tasmanian case series.
        Int Ophthalmol. 2016; 36: 691-696https://doi.org/10.1007/s10792-016-0188-5
        • Holzchuh F.G.
        • Hida R.Y.
        • Moscovici B.K.
        M.B. villa albers, R.M., santo, N. kara-José, et al. clinical treatment of ocular demodex folliculorum by systemic ivermectin.
        Am J Ophthalmol. 2011; 151 (e1): 1030-1034https://doi.org/10.1016/j.ajo.2010.11.024
        • Filho P.A.N.
        • Hazarbassanov R.M.
        • Grisolia A.B.D.
        • Pazos H.B.
        • Kaiserman I.
        • Gomes J.Á.P.
        The efficacy of oral ivermectin for the treatment of chronic blepharitis in patients tested positive for Demodex spp.
        Br J Ophthalmol. 2011; 95: 893-895https://doi.org/10.1136/bjo.2010.201194
        • Salem D.A.-B.
        • El-Shazly A.
        • Nabih N.
        • El-Bayoumy Y.
        • Saleh S.
        Evaluation of the efficacy of oral ivermectin in comparison with ivermectin-metronidazole combined therapy in the treatment of ocular and skin lesions of Demodex folliculorum.
        Int J Infect Dis. 2013; 17: e343-e357https://doi.org/10.1016/j.ijid.2012.11.022
        • Lindsley S.
        • Matsumura E.
        • Hatef E.K.
        Interventions for chronic blepharitis.
        Cochrane Database Syst Rev. 2012; 5 (CD005556. pub2)https://doi.org/10.1002/14651858
        • World Medical Association
        World medical association declaration of helsinki ethical principles for medical research involving human subjects.
        JAMA. 2013; 310: 2191-2194
        • Burgess I.F.
        • Lee P.N.
        • Kay K.
        • Jones R.
        • Brunton E.R.
        1, 2-Octanediol, a novel surfactant, for treating head louse infestation: identification of activity, formulation, and randomised, controlled trials.
        PLoS One. 2012; 7: e35419https://doi.org/10.1371/journal.pone.0035419
        • Rynerson J.M.
        Method and device for treating an ocular disorder.
        2012 (US20140031845 A1 (Accessed 20 April 2017))
        • Rynerson J.M.
        • Perry H.D.
        DEBS − a unification theory for dry eye and blepharitis.
        Clin Ophthalmol. 2016; 10: 2455-2467https://doi.org/10.2147/OPTH.S114674
        • Schiffman R.M.
        • Christianson M.D.
        • Jacobsen G.
        • Hirsch J.D.
        • Reis B.L.
        • MA L.
        • et al.
        Reliability and validity of the ocular surface disease index, arch.
        Ophthalmol. 2000; 118: 615https://doi.org/10.1001/archopht.118.5.615
        • Walt J.
        Ocular Surface Disease Index (OSDI) Administration and Scoring Manual.
        2004
        • Lee S.H.
        • Chun Y.S.
        • Kim J.H.
        • Kim E.S.
        • Kim J.C.
        The relationship between demodex and ocular discomfort.
        Investig Ophthalmol Vis Sci. 2010; 51: 2906-2911
        • Sędzikowska A.
        • Osęka M.
        • Grytner-Zięcina B.
        Ocular symptoms reported by patients infested with Demodex mites.
        Acta Parasitol. 2016; 61: 808-814
        • Nicholls S.G.
        • Oakley C.L.
        • Tan A.
        • Vote B.J.
        Demodex species in human ocular disease: new clinicopathological aspects.
        Int Ophthalmol. 2017; 37: 303-312https://doi.org/10.1007/s10792-016-0249-9
      1. American academy of ophthalmology Cornea/External disease panel.
        Blepharitis, Prefer. Pract. Pattern® Guidel. 2013
      2. The college of optometrists, blepharitis (Lid margin disease).
        Clin. Manag. Guidel. 2016 (Accessed 12 April 2017)
        • Craig J.
        • Sung J.
        • Wang M.
        • Cheung I.
        • Sherwin T.
        • Ismail S.
        Commercial lid cleanser outperforms baby shampoo for management of blepharitis in randomized, double-masked clinical trial.
        Invest Ophthalmol Vis Sci. 2017; 58 (Meeting abstract (Program Number:2247))
        • Gao Y.Y.
        • Xu D.L.
        • Huang L.J.
        • Wang R.
        • Tseng S.C.G.
        Treatment of ocular itching associated with ocular demodicosis by 5%.
        Tea Tree Oil Ointment. 2012; https://doi.org/10.1097/ICO.0b013e31820ce56c
        • Burgess I.F.
        • Brunton E.R.
        • French R.
        • Burgess N.A.
        Prevention of head louse infestation: a randomised, double-blind, cross-over study of a novel concept product, 1% 1, 2-octanediol spray versus placebo.
        BMJ Open. 2014; 4 (e004634)https://doi.org/10.1136/bmjopen-2013-004634
        • Mastrota K.M.
        Method to identify demodex in the eyelash follicle without epilation.
        Optom Vis Sci. 2013; 90: e172-e174https://doi.org/10.1097/OPX.0b013e318294c2c0