Viêm da gây ngứa và dị ứng do một loài ký sinh trùng nhỏ thuộc nhóm chân khớp Demodex spp lây truyền từ động vật sang người. Demodex là một giống các con vật ký sinh trùng rất nhỏ (tiny parasitic mites) sống trên hoặc gần các nang lông của động vật. Hơn một trăm loài khác nahu của Demodex được biết đến là các động vật chân khớp nhỏ nhất.

Hai loài đang sống trên người được xác định là Demodex folliculorum và Demodex brevis, cả hai thường ưa ký sinh ở vùng quanh mắt hoặc cơ quan mắt nên xem là các loại mite ưa vùng lông mi (eyelash mites). Demodex canis sống trên các con chó nhà. Nhiễm trùng với Demodex thường xảy ra nhưng thường không gây ra các triệu chứng, mặc dù một số bệnh lý da có thể gặp do loài ký sinh trùng này. Demodex spp thuộc giới Animalia, ngành Arthropoda, lớp Arachnida, phụ lớp Acari, bộTrombidiformes, họ Demodicidae (Nicolet, 1855), giống Demodex (Owen, 1843), cùng nhiều loài khác nhau trong giống Demodex gồm Demodex aries, Demodex aurati, Demodex brevis, Demodex bovis, Demodex canis, Demodex caprae, Demodex caballi, Demodex cati, Demodex cornei, Demodex criceti, Demodex equi, Demodex folliculorum, Demodex gapperi, Demodex gatoi, Demodex injai, Demodex ovis, Demodex phyloides, Demodex zalophi phân loại theo cách ký sinh trên các động vật khác nhau của chúng.

Bệnh da do loài D. folliculorum và D. brevis

Demodex folliculorum (D. folliculorum) và Demodex brevis (D. brevis) thường được phát hiện nhiễm trên người. Loài D. folliculorum lần đầu tiên được mô tả vào năm 1842 bởi tác giả Simon; D. brevis được xác định như một loài riêng biệt vào năm 1963 do tác giả Akbulatova. D. folliculorum được tìm thấy trên các nang chân tóc hoặc nang lông, trong khi đó loài D. brevis lại sống trong các tuyến bả nhờn liên kết với nang lông. Cả hai loài đầu tiên phát hiện trên mặt, gần cánh mũi, lông mi và lông mày nhưng cũng có thể phát hiện một số nới nào đó trên cơ thể người. Việc chẩn đoán nhiễm Demodex spp. trên người không phải là quá khó khăn vì kỹ năng xét nghiệm đối với loài động vật chân đốt này hiện tại đã thành thường quy xét nghiêm tại các cơ sở khám và điều trị bệnh chuyên khoa, nhất là các bệnh lý viêm da do Demodex spp. Gần đây, nhiều công trình nghiên cứu chuyên sâu về chẩn đoán, sinh lý bệnh và điều trị về các loài Demodex spp. cũng như phòng bệnh rất nhiều.

Loài Demodex canis sống chủ yếu trên các con chó nhà, nhưng có thể thỉnh thoảng gây nhiễm trên con người. Mặc dù phần lớn nhiễm trùng do hội sinh (commensal) và do đó biểu hiện dạng tiền lâm sàng, chúng có thể phát triển thành một tình trạng goi là bệnh ghẻ lở do Demodex (demodectic mange). Do thói quen của chúng sống sâu trên các lớp bì, sự lan truyền thường chỉ có thể xảy ra thông qua con đường tiếp xúc và phơi nhiễm kéo dài, như lây truyền giữa chó mẹ và con qua trong quá trình bú sữa. Kết quả, các vị trí thường gặp nhất cho xuất hiện sớm các thương tổn do Demodex (demodicodic lesions) là trên mặt, mõm, chân trước và vùng quanh mắt. Bệnh Demodicosis có đặc điểm thương tổn gồm hai loại: Dạng có vảy (squamous) gây ra rụng tóc, rụng lông khô và dày da và dạng mụn mủ (pustular) thể này nghiêm trọng hơn, gây nen nhiễm trùng thứ phát (thường do tụ cầu) Staphylococcus có đặc trưng da đỏ, mụn mủ và nhiều nếp da gấp.

Sự leo thang của hội sinh nhiễm trùng D. canis cần chú ý về mặt lâm sàng thường liên quanđến các yếu tố của phức hợp miễn dịch. Bệnh demodicosis có thể theo sau một tình trạng ức chế miễn dịch hoặc điều trị thuốc ức chế miễn dịch, hoặc có thể liên quan đến thiếu hụt miễn dịch di truyền. Điều này rất phức tạp vì bản thân Demodex được xem là ức chế đáp ứng miễn dịch T-lymphocyte bình thường. Cũng như thế, một số giống như là Dalmatian, loại chó American Bulldog và American Pit Bull Terrier dễ nhạy cảm với nhiễm loài này. Nhân đây, chúng tôi xin chia sẻ một số công trình nghiên cứu trên phạm vi toàn cầu về bệnh lý này để quý đồng nghiệp và bạn đọc theo dõi và rút kinh nghiệm.

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Kemal M, Sümer Z, Toker MI, Erdoğan H, Topalkara A, Akbulut M.

Ophthalmic Epidemiol. 2005 Aug;12(4):287-90.

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Arrúa M, Samudio M, Fariña N, Cibils D, Laspina F, Sanabria R, Carpinelli L, Mino de Kaspar H.

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Hervás o­ntiveros A, Hurtado-Sarrió M, Udaondo P, García-Delpech S, Salom D, Díaz-Llopis M.

Arch Soc Esp Oftalmol. 2014 Feb;89(2):85-6. doi: 10.1016/j.oftal.2013.06.004. Epub 2013 Oct 7. Spanish. No abstract available.

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Gao YY, Di Pascuale MA, Li W, Liu DT, Baradaran-Rafii A, Elizondo A, Kawakita T, Raju VK, Tseng SC.

Invest Ophthalmol Vis Sci. 2005 Sep;46(9):3089-94.

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Demodex mites as a cause of human disease.

Elston DM.

Cutis. 2005 Nov;76(5):294-6. No abstract available.

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What is the importance of Demodex folliculorum in Behçet's disease?

Emre S, Aycan OM, Atambay M, Bilak S, Daldal N, Karincaoglu Y.

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[Human demodicidosis in Sfax area (Tunisia)].

Cheikhrouhou F, Makni F, Neji S, Sellami H, Masmoudi A, Turki H, Ben Zina Z, Fki J, Ayadi A.

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The hair follicle mites Demodex folliculorum and Demodex brevis: biology and medical importance. A review.

Rufli T, Mumcuoglu Y.

Dermatologica. 1981;162(1):1-11. Review. No abstract available.

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The relationship between demodex and ocular discomfort.

Lee SH, Chun YS, Kim JH, Kim ES, Kim JC.

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Demodex sp. as a Potential Cause of the Abandonment of Soft Contact Lenses by Their Existing Users.

Tarkowski W, Moneta-Wielgoś J, Młocicki D.

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López García JS, García Lozano I, Martínez Garchitorena J.

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High prevalence of Demodex spp. infestation among patients with posterior blepharitis: correlation with age and cylindrical dandruff.

López-Ponce D, Zuazo F, Cartes C, Salinas-Toro D, Pérez-Valenzuela C, Valenzuela F, Traipe-Castro L, López-Solís RO.

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Demodex mites.

Elston CA, Elston DM.

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[Anti-mite activities of 25 kinds of traditional Chinese medicines for Demodex folliculorum].

Tian Y, Li CP.

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[Demodex folliculorum: Following the trail to chronic blepharitis].

Sánchez España JC.

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Clinical and immunological responses in ocular demodecosis.

Kim JH, Chun YS, Kim JC.

J Korean Med Sci. 2011 Sep;26(9):1231-7. doi: 10.3346/jkms.2011.26.9.1231. Epub 2011 Sep 1.

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Dhingra KK, Saroha V, Gupta P, Khurana N.

Pathol Res Pract. 2009;205(6):423-6. doi: 10.1016/j.prp.2008.11.013. Epub 2009 Jan 23. Review.

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Demodex infestation in a child with leukaemia: treatment with ivermectin and permethrin.

Damian D, Rogers M.

Int J Dermatol. 2003 Sep;42(9):724-6.

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Demodex: a cause of blepharitis in Australia.

English FP.

Med J Aust. 1969 Jun 28;1(26):1359-60. No abstract available.

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Demodex sp. in California ground squirrels.

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Demonstration of Demodex Folliulorum.

Canti G.

Cytopathology. 2010 Oct;21(5):347-8. doi: 10.1111/j.1365-2303.2010.00752.x. Epub 2010 May 18. No abstract available.

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The efficacy of oral ivermectin for the treatment of chronic blepharitis in patients tested positive for Demodex spp.

Filho PA, Hazarbassanov RM, Grisolia AB, Pazos HB, Kaiserman I, Gomes JÁ.

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Do Demodex mites play a role in pterygium development?

Tarkowski W, Moneta-Wielgoś J, Młocicki D.

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Current and Emerging Therapeutic Strategies for the Treatment of Meibomian Gland Dysfunction (MGD).

Thode AR, Latkany RA.

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[Efficiency and application safety of Cepan cream. Observation of a new indication].

Stozkowska W, Raczyńska K.

Przegl Lek. 2008;65(5):241-3. Review. Polish.

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[Chronic blepharitis caused by mite Demodex folliculorum].

Gerkowicz M, Baltaziak L, Puacz E.

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[Experimental and clinical studies o­n the effect of sodium dodecylbenzene sulfonate in in vitro killing Demodex and in treating demodicidosis].

Zang Ys, Wu DJ, Song JB.

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Tear cytokines and chemokines in patients with Demodex blepharitis.

Kim JT, Lee SH, Chun YS, Kim JC.

Cytokine. 2011 Jan;53(1):94-9. doi: 10.1016/j.cyto.2010.08.009. Epub 2010 Nov 2.

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Ocular symptoms reported by patients infested with Demodex mites.

Sędzikowska A, Osęka M, Grytner-Zięcina B.

Acta Parasitol. 2016 Dec 1;61(4):808-814. doi: 10.1515/ap-2016-0112.

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Demodex (follicular mite) infesting a boy and his pet dog.

Morsy TA, el Okbi MM, el-Said AM, Arafa MA, Sabry AH.

J Egypt Soc Parasitol. 1995 Aug;25(2):509-12.

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Demodex - an old pathogen or a new o­ne?

Rusiecka-Ziółkowska J, Nokiel M, Fleischer M.

Adv Clin Exp Med. 2014 Mar-Apr;23(2):295-8. Review.

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[Primary human demodicosis. A disease sui generis].

Hsu CK, Zink A, Wei KJ, Dzika E, Plewig G, Chen W.

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[Eyelash mite infestation].

Vasallo F, Martín-Rabadán P.

Enferm Infecc Microbiol Clin. 1995 Feb;13(2):121-2. Spanish. No abstract available.

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Demodex mite infestation in patients with and without rheumatoid arthritis.

Garbacewicz A, Jaworski J, Grytner-Zięcina B.

Acta Parasitol. 2012 Mar;57(1):99-100. doi: 10.2478/s11686-012-0009-6. Epub 2012 Feb 25.

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[A new classification for meibomian gland diseases with in vivo confocal microscopy].

Randon M, Liang H, Abbas R, Michée S, Denoyer A, Baudouin C, Labbé A.

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Uyttebroeck W, Nijs I, Maudgal PC, Missotten L.

Bull Soc Belge Ophtalmol. 1982;201:83-7. No abstract available.

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[Revisiting meibomian gland dysfunction].

Baudouin C.

J Fr Ophtalmol. 2014 Dec;37(10):757-62. doi: 10.1016/j.jfo.2014.10.001. Epub 2014 Nov 15. French.

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[Investigation of the prevalance of Demodex folliculorum and Demodex brevis in rosacea patients].

Yücel A, Yilmaz M.

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Demodex in an aerobic environment o­n the eyelashes.

Nath AK, Timshina DK, Thappa DM, Sinclair R.

Australas J Dermatol. 2012 May;53(2):159-60. doi: 10.1111/j.1440-0960.2012.00880.x. No abstract available.

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[Demodex folliculorum: aetiopathogenesis and therapy of rosacea and perioral dermatitis (author's transl)].

Rufli T, Mumcuoglu Y, Cajacob A, Büchner S.

Dermatologica. 1981;162(1):12-26. German.

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The effect of blood glucose regulation o­n the presence of opportunistic Demodex folliculorum mites in patients with type 2 diabetes mellitus.

Gökçe C, Aycan-Kaya Ö, Yula E, Üstün I, Yengil E, Sefil F, Rizaoglu H, Gultepe B, Bayram F.

J Int Med Res. 2013 Oct;41(5):1752-8. doi: 10.1177/0300060513494730. Epub 2013 Aug 9.

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[Chronic blepharitis and blepharoconjunctivitis of parasitic etiology].

Ploshinskaia NV.

Voen Med Zh. 1982 Jan;(1):69. Russian. No abstract available.

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[Diagnostic criteria of demodex blepharitis].

Liang LY, Li J, Liu Y.

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Wesolowska M, Knysz B, Reich A, Blazejewska D, Czarnecki M, Gladysz A, Pozowski A, Misiuk-Hojlo M.

Arch Med Sci. 2014 May 12;10(2):319-24. doi: 10.5114/aoms.2014.42585. Epub 2014 May 13.

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Significant correlation between meibomian gland dysfunction and keratitis in young patients with Demodex brevis infestation.

Liang L, Liu Y, Ding X, Ke H, Chen C, Tseng SCG.

Br J Ophthalmol. 2017 Oct 21. pii: bjophthalmol-2017-310302. doi: 10.1136/bjophthalmol-2017-310302. [Epub ahead of print]

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Demodicosis of ophthalmic concern.

English FP, Nutting WB.

Am J Ophthalmol. 1981 Mar;91(3):362-72.

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Ocular Demodicosis as a Potential Cause of Ocular Surface Inflammation.

Luo X, Li J, Chen C, Tseng S, Liang L.

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Terpinen-4-ol is the Most Active Ingredient of Tea Tree Oil to Kill Demodex Mites.

Tighe S, Gao YY, Tseng SC.

Transl Vis Sci Technol. 2013 Nov;2(7):2. Epub 2013 Nov 13.

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Gutgesell VJ, Stern GA, Hood CI.

Am J Ophthalmol. 1982 Sep;94(3):383-7.

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[Development of a PCR for the detection and quantification of parasitism by Demodex folliculorum infestation in biopsies of skin neoplasms periocular area].

Tenorio-Abreu A, Sánchez-España JC, Naranjo-González LE, González-Gallego MC, Hidalgo-Grass C, Ruíz-Frutos C.

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A Clinical Scoring System for Diagnosis of Ocular Demodicosis.

Alver O, Kıvanç SA, Akova Budak B, Tüzemen NÜ, Ener B, Özmen AT.

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Evolution of host range in the follicle mite Demodex kutzeri.

Palopoli MF, Tra V, Matoin K, Mac PD.

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Auw-Haedrich C, Reinhard T.

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Hu Y, Yang T, Xin JM, Luo HY.

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DEBS - a unification theory for dry eye and blepharitis.

Rynerson JM, Perry HD.

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Human Permanent Ectoparasites; Recent Advances o­n Biology and Clinical Significance of Demodex Mites: Narrative Review Article.

Litwin D, Chen W, Dzika E, Korycińska J.

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Demodex spp. Infestation in a breast-cancer patient: A case report.

Olt S, Yalçın GG, Uysal OS, Karakeçe E, Ciftci IH.

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Demodex musculi Infestation in Genetically Immunomodulated Mice.

Smith PC, Zeiss CJ, Beck AP, Scholz JA.

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Pediatric blepharokeratoconjunctivitis: is there a 'right' treatment?

Rousta ST.

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Abu-Samra MT, Shuaib YA.

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Demodex Blepharitis Treated with a Novel Dilute Povidone-Iodine and DMSO System: A Case Report.

Pelletier JS, Capriotti K, Stewart KS, Capriotti JA.

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Demodex folliculorum in renal transplant patients revisited.

Aydingöz IE, Dervent B.

Dermatology. 2001;203(3):272-3. No abstract available.

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Mostovoy D, Vinker S, Mimouni M, Goldich Y, Levartovsky S, Kaiserman I.

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Chemical blepharitis following drug treatment.

Kaufman HE.

Am J Ophthalmol. 1983 May;95(5):703. No abstract available.

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Smartphone-based Video of Demodex folliculorum In Biopsied Human Eyelash Follicles.

Vahedi M, Davis G, Coleman MJ, Garrett BS, Eghrari AO.

Med Hypothesis Discov Innov Ophthalmol. 2015 Summer;4(2):36-8.

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Demodex Species Infestation in Patients with Ear Itching and Its Relationship to Itch Severity.

Bilal N, Kirişci Ö, Özkaya E.

Turkiye Parazitol Derg. 2017 Jun;41(2):87-91. doi: 10.5152/tpd.2017.5070.

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Demodex infestation of the sebaceous gland.

English FP, Cohn D.

Am J Ophthalmol. 1983 Jun;95(6):843-4. No abstract available.

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Increased Density of Demodex Folliculorum May be Related to Additional Risk Factors.

Unal E, Akcinar UG, Basaran Y.

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Oral azithromycin and blepharitis: symptoms and signs improve, so where are the publications?

Lockington D.

Clin Exp Ophthalmol. 2016 Dec;44(9):866-867. doi: 10.1111/ceo.12799. Epub 2016 Aug 4. No abstract available.

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Blepharitis: remains a diagnostic enigma. A role for tea tree oil shampoo?

Hossain P, Konstantopoulos A.

Eye (Lond). 2015 Dec;29(12):1520-1. doi: 10.1038/eye.2015.139. Epub 2015 Aug 21. No abstract available.

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Short-Term Comfort Responses Associated With the Use of Eyelid Cleansing Products to Manage Demodex folliculorum.

Ngo W, Jones L, Bitton E.

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Pampín A, Floristán U, Gamo R, Ascanio ML, López-Estebaranz JL.

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[The value of reflectance confocal microscopy in detection of Demodex mites].

Harmelin Y, Le Duff F, Passeron T, Lacour JP, Bahadoran P.

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Demodex mites in lymph nodes.

Nashat MA.

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Jiang J, Shen T, Hong CY.

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Blepharitis With Facial Numbness and Ocular Pain.

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