Frequency of demodicosis in acne vulgaris patients

Abstract

Aim: Acne vulgaris is a common disease affecting the quality of life of many patients from different ages. Although it has been suggested that Demodex mites may play a role in the pathogenesis of acne by causing mechanical obstruction in pilosebaceous follicles and triggering an inflammatory response, the literature has limited data. Our study aimed to investigate the frequency of demodicosis in acne vulgaris patients and its relationship with disease severity. Material and Methods: This prospective study included patients with mild, moderate, and severe acne vulgaris aged 18- 40 years and age-matched healthy volunteers evaluated at the Pamukkale University dermatology clinic. The Investigator's Global Assessment (IGA) scoring system was used to assess the severity of acne vulgaris. Superficial skin biopsy technique was applied to detect demodex parasites. Demodex was considered positive if the count was greater than 5/cm2. Results: The study included 30 healthy controls and 90 patients with mild, moderate, and severe acne vulgaris. Demodex positivity was found in 20% (n=6) of the control group and 43.3% (n=39) of the acne vulgaris patients and this difference was statistically significant (p=0.03). When acne vulgaris patients were compared with the control group according to disease severity, demodex positivity was found in 12 (40%) of mild acne patients, 10 (33.3%) of moderate acne patients, and 17 (56.7%) of severe acne patients. Demodex positivity was significantly higher in severe acne patients than in the control group (p=0.003). Demodex positivity was 44.3% (n=43) in adolescent acne patients and 12.5% (n=2) in the post- adolescent group, this difference was statistically significant (p=0.002). Conclusion: The high frequency of demodicosis in acne vulgaris patients is noteworthy not only for its possible role in pathogenesis but also because it can be a companion or a mimic in patients. Especially in severe patients, if there is no response to acne treatment, investigating demodicosis will contribute to the management of the cases.

Keywords

• Acne vulgaris
• demodex
• demodicosis

Akne vulgaris hastalarında demodikozis sıklığı

Abstract

Amaç: Akne vulgaris farklı yaş gruplarından pek çok hastanın yaşam kalitesini etkileyen yaygın görülen bir hastalıktır. Demodeks akarları pilosebase foliküllerde mekanik tıkanmaya yol açabilmesi ve inflamatuar yanıtı tetikleyebilmesiyle akne patogenezinde rol oynayabileceği öne sürülmüş olsa da literatürde veriler kısıtlıdır. Çalışmamızda akne vulgaris hastalarında demodikozis sıklığını ve hastalık şiddetiyle ilişkisini araştırmayı amaçladık. Gereç ve Yöntemler: Bu prospektif çalışmaya Pamukkale Üniversitesi dermatoloji polikliniğinde değerlendirilen 18-40 yaş arası hafif, orta, şiddetli olmak üzere akne vulgaris hastaları ve yaşı eşleştirilmiş sağlıklı gönüllüler dahil edildi. Akne vulgarisin şiddetini değerlendirmek için Araştırmacının Genel Değerlendirmesi (IGA) skorlama sistemi kullanıldı. Demodeks parazitlerini saptamak amacıyla yüzeysel deri biyopsisi tekniği uygulandı. Sayı 5/cm2’den fazla ise demodeks pozitif kabul edildi. Bulgular: Çalışmaya 30 sağlıklı kontrol ve hafif, orta, şiddette toplam 90 akne vulgaris hastası dahil edildi. Kontrol grubunun %20’sinde (n=6), akne vulgaris hastalarının %43,3’ünde (n=39) demodeks pozitifliği saptandı ve bu fark istatistiksel olarak anlamlıydı (p=0.03). Akne vulgaris hastaları hastalık şiddetine göre kontrol grubuyla kıyaslandığında; hafif şiddetli akne hastalarının 12’sinde (%40), orta şiddetteki akne hastalarının 10’nunda (%33,3), şiddetli akne hastalarının 17’sinde (%56,7) demodeks pozitifliği saptandı. Şiddetli akne hastalarında demodeks pozitifliği kontrol grubundan anlamlı oranda yüksekti (p=0,003). Adolesan akne hastalarında demodeks pozitifliği %44,3 (n=43) iken post- adolesan grupta %12,5 (n=2) idi, bu fark istatistiksel olarak anlamlıydı (p=0,002). Sonuç: Akne vulgaris hastalarında demodikozis sıklığının yüksek olması patogenezdeki olası rolünün yanı sıra hastalarda eşlikçi veya taklitçi olabilmesi yönüyle dikkat çekicidir. Özellikle şiddetli hastalarda akne tedavisinden yanıt alınamadıysa demodikozis araştırılması vakaların yönetimine katkı sağlayacaktır.

Keywords

• Akne vulgaris
• demodeks
• demodikozis

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