Kara: When we say mites, what do we think of?

Amber: Dust mites.

Meagan: Dust mite.

Kara: Ah, But here's the twist. Today, if you know someone who lives with chronic eye issues, allergy symptoms, rosacea, go ahead, send this episode to them now, and we're gonna dig into how all these things are related to a different kind of mite, a type of mite you may not realize is worsening your allergies, and it's not 


What are Demodex Mites? (The Basics)
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Kara: dust mites.

Today on this episode of Allergy Actually, we are talking all about demodex mites. These are microscopic mites that live in our hair follicles, especially our eyelashes. And before you are totally grossed out, we are gonna dig into what these critters are, what they're responsible for, what they contribute to, and how we can approach knocking them back down a little bit into balance is it's part of our microbiome. 

But know, what I think is so fascinating is we're learning so much more about the role of our microbiome. And to be totally using the right terminology. I don't know that we could call demodex a microbiome 'cause they're small but they're not quite as small as bacteria viruses. But they are little critters that are a natural part of our flora.

And so, you know, when we think, and we've had a prior episode where we talked about like vaginal yeast infections when it's not that Candida yeast is not technically an infection. It's just part of our microbiome that's out of balance. And so, here is a similar situation that we can 


The "Overgrowth" Problem: When Natural Flora Causes Disease
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Kara: deal with.

And these little critters, they're almost nearly universal in all humans. Having them on their own does not mean that we have a disease or a diagnosis. And it's not a hygiene issue. It's not a failure. It's not something you can just rub away. So, you know, be gentle to your eye tissues. But this is something really important that ophthalmologists, allergists, dermatologists are really learning more about, and how they're impacting our health.

So, you know, what inspired this episode and I was texting to our little group chat is there was an article that came out the end of this past year that was hypothesizing that, goodness, if we knock down these demodex mites, do we then see improvement in some of the other inflammatory conditions that affect those parts of our body? I think it's really interesting if you think about this barrier hypothesis, how all these different parts and pieces go together.

Meagan: It is very fascinating and I'll confess anytime we start talking about the creepy crawleys that are part of our microbiome or that live around us and we really have no awareness of it, I sort of wish I didn't know anything about all of that so I could just work peacefully, right? I'm like let's just, let's just pretend there's no such thing, it's fine.

My family actually seems to deal with this quite a bit. My husband has these beautiful, huge long eyelashes and they're like daggers. And one of my children inherited them and they are both very prone to getting styes and blepharitis, which is an infection of the glands that are sort of on the inside of your eye, close to your eyeball that are sort of opposite through that tissue from your eyelash. That's where the meibomian glands are, and they produce oil that your eye needs because otherwise if we didn't have that oil layer, moisture would evaporate from there and our eyes essentially would not work. And trying to work on that area and trying to, a, decrease mites if you do have an overgrowth of the demodex.

And two, making sure that you do what you can to keep that gland sort of open and smoothly flowing that can help people who are specifically prone to styes for that. And so, I don't know if that's something you guys have dealt with in your family, but I have one of my kiddos deals with 


The Link Between Demodex, Rosacea & Dust Mite Allergy
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Meagan: that. 

Amber: I wanna point out a key word you guys are using is overgrowth. So we have a lot to learn about these demodex mites, which are different than the dust mites that we find like in our bedding and stuff. We don't really have a way to test for allergy to this. So, I guess we could say we don't really know if people are allergic to the demodex mite or not, but we do know that there is some cross reactivity, especially with troponins that are in demodex and the type of dust mites that we are allergic to.

So that's something that's still out there. But I think what we're talking about today is we know they exist. We know that some people have more of them than maybe should in terms of ratio of our microbiome. And current science leads us to believe that in those people, they may be more prone to size or dry eye or what have you. So what are you guys doing for these patients?

Kara: Well, and I'm gonna add one other diagnosis in there that I think gets missed a lot, which is rosacea, which is a huge thing that a lot of folks, we all strive to have, you know, beautiful, clear, even skin tone, all those things. And certainly rosacea is one of those things, it's just really sometimes hard to treat. 

Amber: Just for our audience, are you referring to when there's redness on the skin?

Kara: Yeah, redness and sometimes bumpiness, especially on the cheek area. Sometimes the nose. And rosacea can affect kind of the eye area too, although admittedly, that's getting out of my wheelhouse a little more. But one of the, you know, there are some new treatments that are available, prescription treatments that will kind of kill or kind of knock 


The Low-Hanging Fruit Fix: The Vaseline Method
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Kara: down demodex.

They're very expensive, sometimes really hard to get insurance to cover. But there's a really easy low hanging fruit option that most of us are gonna have already in our medicine cabinet or closet, which is Vaseline. We can kind of smother these little buggers at night, you know, putting right before we go to bed, a layer, a thin layer of Vaseline along our lash line. 

Amber: Put it on your finger and apply a bit along here. 

Kara: Yep, gently along the lashline. Nightly, for 20 for 28 days has really been shown to be pretty effective at knocking these back down. You know, most of my patients, they're always looking for something that is cheaper, easier, less toxic.

Meagan: That's a very good option. One of the things I also think of every time I think about Vaseline around the eyes, and this is from being a nineties girl growing up, and I learned a lot from Tyra Banks. And one of the things that she talked about as a beauty secret is that her mother had taught her when she was little to use Vaseline around her eyes. And I did that actually with Aquaphor, but I did that for many, many, many years, and so. It can also help just overall with your beauty routine, if you're already doing something like that, to put a little along those lash lines and to make sure that you 


The Importance of Diligent Lash-Line Cleansing
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Meagan: cleanse them. That has been one of the big things for, again, my kiddo that deals with this because to him he's like, "I take a bath."

And we're like, well, this is a special cleaning that you need to do, and it's not really all that special. You just need to remember to do it. And it's as easy as taking a washcloth and some people use things like, tea tree oil and things like that for this wiping. But yeah, Kara is demonstrating right now, but you literally just make sure that you wash your lash line. I do that whenever I take off my mascara every day. So if you're a mascara wearer, that might be something that you are fiddling with. But if you're not and you aren't having to take that kind of thing off, just remember to take your washcloths up there and wipe along your lash line to try to help decrease the literal debris from Demodex and any other sort of crusty that can get there during the day to keep those glands open.

Amber: So timing wise, especially for our teens and tweens that are working on hygiene habits, Megan, do you do that wash along the eyelashes before applying the Vaseline? Or is it like the Vaseline goes on at night and then in the morning when you wash that off, you're scrubbing? Or is it twice a day?

Meagan: Yes, wash before, and if you are using Vaseline, it may be helpful to wash again in the morning. Say from a derm standpoint, it's always recommended that we wash our face twice a day because believe it or not, we do accumulate a lot of yuck from our pillows, products, sweat, all that kind of stuff when we sleep. Even though I often wake up feeling fresh and clean, you may actually still need to wash your face. But following, like you would want to clean it to open up that area as much as you can from debris and then put on the vest to try to smother any 


Why Dust Mite Immunotherapy Could Help Demodex
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Meagan: leftover mites.

Amber: Well, I certainly am going to add this to my regimen and the patients I'm gonna pay closer attention now, if these patients with dry eye, rosacea, styes are also allergic to dust mite, just now I'm curious. 

Meagan: Immunotherapy, we know we can fix dust mite allergy with immunotherapy. All types, ILIT, SLIT, SCIT, OMIT, which is like a toothpaste. There's all sorts of things that can be done for that, a lot of options. And decreasing that inflammation there is cross reactivity in Terramycin between that and the demodex mite. So that could potentially even help with that as well. And now that we have sort of discovered that connection ourselves, we're gonna be looking for it.

Kara: This is, I think a future research project for all of us as part of the AUNI Learning Network. And one of the really cool things that we collaborate together. So, if this changed how you think about allergies, even just a little, go ahead and share it with someone who needs a better explanation for their chronic styes, they're rosacea, they're itchy, watery eyes and nose and not another quick fix. And until next time, this is Allergy Actually. 

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