Our Philosophy, Background & Approach to Medicine

Innovative Solutions for Demodex Issues

Physicians are handcuffed in some ways in their practice of medicine. They must prescribe within the "standard of care" - or, if they do not, and something goes awry, they will be sued - and it's easy to lose an expensive, career-destroying lawsuit. On the other hand, if they prescribe only FDA-approved medications - drugs which have hundreds of millions of dollars behind their development, approval and distribution - they'll be "safe." Will their patients be better served? Good question. Will patients pay for those millions of dollars of development and approval? Yes.

I have (personally) spent half-a-lifetime defending doctors from unreasonable lawsuits. Every doctor lives in fear of being sued. The only "safe path" is to always prescribe the drugs that are FDA-approved, or are OTC (over-the-counter). If they do NOT prescribe "properly," they can be sued, and are likely to lose a career-destroying lawsuit.

Our approach is somewhat different. We must be quite careful about what we "claim." "Claims" must be proven by clinical trials specific to the company and the product. We try to allow OTHER institutions speak for the validity of "not-yet-FDA-approved" products. So we curate relevant clinical studies, and provide them for YOUR judgement.

Our U.S. medical system is far from perfect. Physicians strive for perfection. One thing is certain, and I can speak from having doctors in my family, and in my companies, and in my active life of insuring and defending them: Every doctor, without exception, wants to help patients towards a cure, and a better life. There are, simply, contravening forces. And every fine and high-minded physician I know struggles with these issues. It isn't easy.

Scalp Care - Consider Anti-Demodex Shampoo

Our Anti-Demodex shampoo combines five elements, each with proven anti-demodex activity: iodine (as PVPI 1%); DMSO; Tea Tree Oil; Selenium sulfide; and Permethrin (0.1% ).

Since the scalp is the reservoir for the vast majority of Demodex, without treating the scalp it is impossible to eliminate rampant Demodex infestation. It is extremely important to eliminate Demodex from the eye, since the progression of the disease and infestation can lead to blindness. Once under control, it's time to attach Demodex where they live and proliferate: on the scalp.

PREVALENCE & SIGNIFICANCE: Demodex mites are among the most prevalent ectoparasites found on humans, yet their significance as potential human pathogens has been largely overlooked due to their widespread presence. While these mites typically coexist harmlessly in various areas of the body, an overabundance, often indicated by the presence of collarettes on eyelashes, can transition them from benign to inflammatory agents, contributing to a range of conditions. These include acne vulgaris, folliculitis, rosacea, seborrheic dermatitis, and even hair loss. In the context of ocular health, Demodex mites have been linked to eyelid and lid margin diseases such as blepharitis and meibomian gland dysfunction (MGD).

WHAT THE RESEARCH SHOWS: Research conducted in 2022 involving over 1,000 eyecare patients revealed that 57.7% of them exhibited Demodex blepharitis. Furthermore, studies have suggested an age-related increase in Demodex blepharitis, peaking between ages 20 and 30, likely due to heightened sebum secretion during this period. Another peak occurs in individuals over 60, possibly related to dermatochalasis and changes in skin pH. Additionally, Demodex blepharitis in children under five may be attributed to their frequent facial touching, which introduces bacteria to the skin. The initial exposure to Demodex typically occurs shortly after birth through skin-to-skin contact between parent and newborn. Factors such as increased sebum secretion in young adults, dermatochalasis in older individuals, and frequent facial touching in young children all contribute to an elevated risk of Demodex overpopulation, affecting individuals across all age groups. Moreover, Demodex overpopulation is more prevalent in patients with rosacea.

WHO THEY ARE & HOW THEY BEHAVE: Two primary species of Demodex affect the eye: Demodex folliculorum and Demodex brevis. Demodex folliculorum, ranging from 0.30mm to 0.40mm in length, typically form clusters around lash roots and follicles, feeding on sebum and follicular epithelial cells. On the other hand, Demodex brevis, slightly smaller at 0.15mm to 0.20mm, usually inhabit the meibomian glands individually. Both species possess elongated, semi-translucent bodies with two segments and eight legs equipped with short claws, facilitating movement at a rate of 8mm to 16mm per hour, predominantly active during nighttime. They anchor into hair follicles using scales and feed on skin cells, oils, and bacteria with their pin-like mouths.

BEHAVIOR & LIFESPAN: Demodex mites typically mate within the openings of hair follicles and deposit their eggs within the follicle or sebaceous gland. After three to four days, the larvae hatch and mature into adults within seven days. Their entire lifecycle spans approximately 14 days, with a total lifespan of two to three weeks. Dead mites decompose within the follicle or sebaceous gland.

The infestation of Demodex mites exacerbates ocular surface disease and meibomian gland dysfunction through mechanical, bacterial, and inflammatory mechanisms. As the mites consume epithelial cells at the hair follicle, they can cause follicular distention. Microabrasions from their claws induce epithelial hyperplasia and reactive hyperkeratinization.

DRY EYE DISEASE & INFLAMMATION: D. brevis, which favor the meibomian glands, can block their orifices, and their chitinous exoskeleton acts as a foreign body, triggering a granulomatous reaction. This process is a potential contributor to chalazia and meibomian gland dysfunction. Demodex mites carry bacteria in their gut, which are released through excrement and upon death, in addition to harboring bacteria on their surface, leading to infection. An inflammatory response is triggered by delayed hypersensitivity to proteins carried within the mites’ debris and waste.

Manifestations of infestation commonly include itching, burning, tearing, redness, crusting, or stickiness of the eyelids in patients, although many remain asymptomatic. Relying solely on patient complaints for diagnosis can result in significant misdiagnosis and inadequate treatment.

DETECTION & CONTACT LENS PROBLEMS: Collarettes, which are transparent waxy plugs situated at the lash bases, are a distinctive indicator of an excessive presence of Demodex mites. According to one clinical investigation, Demodex mites were detected on all lashes bearing collarettes. These structures consist of regurgitated and undigested material, epithelial cells, keratin, mite eggs, and digestive enzymes.

A slit lamp examination is the most effective method for identifying collarettes. During lid examination, it's essential to perform thorough maneuvers including looking, lifting, pushing, and pulling. Instructing the patient to gaze downward during lid margin inspection can reveal diffuse collarettes and aberrant or absent lashes that might otherwise be overlooked. Subsequent examination of the lid margin should involve assessing for saponification, debris or biofilm accumulation, telangiectasia, and lid margin thickening. Meibomian glands should be compressed to assess expressibility and meibum quality, as studies have demonstrated a notably higher prevalence of meibomian gland dysfunction (MGD) in association with Demodex infestations.

It is notable that an overabundance of Demodex and blepharitis can lead to increased rates of contact lens intolerance and subsequent discontinuation among patients. A study conducted in 2015 revealed that 90% of contact lens users tested positive for Demodex, compared to only 65% of non-users. Additionally, a separate investigation found that approximately 93% of patients experiencing contact lens intolerance also tested positive for Demodex.

MANAGEMENT OF DEMODEX PROBLEMS: Management strategies for Demodex blepharitis currently center around enhancing eyelid hygiene to control bacterial overgrowth, which can serve as a food source for the mites. Effective lid hygiene using lid sprays or wipes containing hypochlorous acid helps maintain control over bacterial, fungal, and viral pathogens on the eyelids. Oral doxycycline and azithromycin are recognized for their limited efficacy in treating meibomian gland dysfunction (MGD).

Tea tree oil has been a focal point for managing active Demodex infestations for several years. Despite the mites' resistance to many antiseptic agents like alcohol and erythromycin, tea tree oil or iodine (1%) is often used due to the absence of FDA-approved treatments, making these a good choice. Tea tree oil in conjunction with DMSO, and iodine in conjunction with DMSO, helps remove collarettes from eyelash roots, eliminates most mites, and prompts buried mites to migrate to the skin surface.

DIET & HYGIENE: There are several individual behaviors which can improve and almost eliminate Demodex infestation. First, restriction of unnecessary dietary fats helps to reduce sebum production - and sebum is a key food for these mites. Second, changing the pillow-case daily is important, since the mites falling off the scalp can readily reinfest the eyes and face. Third, shampooing with our iodine/DMSO/Tea Tree Oil/Selenium sulfide/Permethrin shampoo routinely for at least one month will substantially reduce the pool of available mites and inhibit reproduction, spread and proliferation. Maintenance of control is best obtained with alternating our 1% PVPI solution roll-on or drops with our PVPI+Tea Tree Oil + DMSO roll-on or drops. These two products should be used a few times a day, but most certainly morning and night, before bed. It is also a prudent practice to clean the comb and brush used, with bleach spray or dipping, which rapidly kills the mites and their larvae.

I've struggled with Demodex infestation for years, but thanks to Everything Demodex, I finally found relief. Their products are amazing!

Customer Reviews

After using Everything Demodex products, my scalp feels so much healthier. No more itchiness or hair loss. I highly recommend them!