Increased Demodex Density and Risk of Demodicosis After Septorhinoplasty: A Prospective Cohort Study
Keywords:
Demodex, Demodicosis, Septorhinoplasty, Mite infestation, Prospective cohort studyAbstract
Introduction: Demodex mites reside in the hair follicles and sebaceous glands of the head and face. An increase in their population can lead to primary or secondary demodicosis. Septorhinoplasty is a frequently performed aesthetic surgical procedure that can cause various cutaneous complications in the facial area.
Objectives: This study aimed to investigate the density of Demodex mites and the prevalence of demodicosis following septorhinoplasty.
Methods: A total of 40 patients (29 females, 11 males) scheduled for septorhinoplasty, with a mean age of 26.25±7.47 years, were evaluated for clinical findings of demodicosis before and at the third month after surgery. Demodex density was assessed using the standardized skin surface biopsy technique, a noninvasive method involving cyanoacrylate adhesive, and microscopic evaluation of samples taken from the bilateral cheeks and nose.
Results: A statistically significant increase was observed in the number of Demodex mites in the malar and nasal regions and in the prevalence of demodicosis following septorhinoplasty. Additionally, the frequency of seborrhea and pustules showed a significant rise. Symptoms related to demodicosis were found to appear around the 22nd postoperative day and persisted up to the third month.
Conclusions: Demodicosis should be considered in the differential diagnosis of patients presenting with erythema, papules, and pustules in both the early and late postoperative periods following septorhinoplasty, and necessary diagnostic investigations should be performed. Further large-scale studies with a greater number of patients are required to support our findings.
References
Erdal B, Albayrak H. Investigation of the Prevalence of Demodex spp. in Dermatological Diseases. Turkiye Parazitol Derg. 2022;46(1):54-59. DOI:10.4274/tpd.galenos.2021.93685 PMID: 35232707
Chen W, Plewig G. Human demodicosis: revisit and a proposed classification. Br J Dermatol. 2014;170(6):1219-1225. DOI:10.1111/bjd.12850 PMID: 24471456
Akbaş Karabay E, Aksu Çerman A. Demodex folliculorum infestations in common facial dermatoses: acne vulgaris, rosacea, seborrheic dermatitis. An Bras Dermatol 2020;95:187-193. DOI:10.1016/j.abd.2019.08.023 PMID: 32113677
Forton FMN, De Maertelaer V. Which factors influence Demodex proliferation? A retrospective pilot study highlighting a possible role of subtle immune variations and sebaceous gland status. J Dermatol 2021; 48: 1210-20. DOI:10.1111/1346-8138.15910 PMID: 33969532
Koc EA, Buyuklu F, Koç B, Demirci GT. Skin problems following septorhinoplasty. Laryngoscope. 2015;125:1291-5. DOI:10.1002/lary.25073 PMID: 25476595
Erdur ZB, Öktem F, İnci E, Yener HM, Gözen ED, Birben AÖ, et al. Effect of Nasal Skin Type on Skin Problems following Rhinoplasty. Facial Plast Surg. 2020;36:643-649. DOI:10.1055/s-0040-1713792 PMID: 32717761
Nemati S, Golchay J, Alizadeh A. Frequency of minor skin and soft tissue complications in facial and periorbital area after septorhinoplasty. Iran J Otorhinolaryngol. 2012;24(68):119-124. PMID: 24303396
Nemati S, Golchay J, Iranfar K, Alizadeh A. Frequency of acne vulgaris and its exacerbation in facial and periorbital area after septorhinoplasty. Am J Otolaryngol. 2013;34(5):378-381. DOI:10.1016/j.amjoto.2013.01.012 PMID: 23415571
Rajabian MH, Sodaify M, Aghaei S. Severe facial dermatitis as a late complication of aesthetic rhinoplasty; a case report. BMC Dermatol. 2004;4:1. DOI:10.1186/1471-5945-4-1 PMID: 15056395
Taş S. Severe Facial Dermatitis Following Rhinoplasty due to an Unusual Etiopathogenesis: Rosacea. Arch Plast Surg. 2015;42:362-4. DOI:10.5999/aps.2015.42.3.362 PMID: 26015896
Keles H, Pancar Yuksel E, Aydin F, Senturk N. Pre-Treatment and Post-Treatment Demodex Densities in Patients under Immunosuppressive Treatments. Medicina (Kaunas). 2020;56:107. DOI:10.3390/medicina56030107 PMID: 32138191
Forton F, Seys B. Density of Demodex folliculorum in rosacea: a case-control study using standardized skin-surface biopsy. Br J Dermatol. 1993;128(6):650-659. DOI:10.1111/j.1365-2133.1993.tb00261.x PMID: 8338749
Yun CH, Yun JH, Baek JO, Roh JY, Lee JR. Demodex Mite Density Determinations by Standardized Skin Surface Biopsy and Direct Microscopic Examination and Their Relations with Clinical Types and Distribution Patterns. Ann Dermatol. 2017;29(2):137-142. DOI:10.5021/ad.2017.29.2.137 PMID: 28392639
Forton FM. Papulopustular rosacea, skin immunity and Demodex: pityriasis folliculorum as a missing link. J Eur Acad Dermatol Venereol. 2012;26(1):19-28. DOI:10.1111/j.1468-3083.2011.04310.x PMID: 22017468
Gazi U, Taylan-Ozkan A, Mumcuoglu KY. Immune mechanisms in human and canine demodicosis: A review. Parasite Immunol. 2019;41(12):e12673. DOI:10.1111/pim.12673 PMID: 31557333
Teraki Y, Hitomi K, Sato Y, Izaki S. Tacrolimus-induced rosacea-like dermatitis: a clinical analysis of 16 cases associated with tacrolimus ointment application. Dermatology. 2012;224(4):309-314. DOI:10.1159/000338693 PMID: 22626964
Lübbe J, Stucky L, Saurat JH. Rosaceiform dermatitis with follicular Demodex after treatment of facial atopic dermatitis with 1% pimecrolimus cream. Dermatology. 2003;207(2):204-205. DOI:10.1159/000071800 PMID: 12920379
Guzman AK, Gittler JK, Amin B, Srikantha R, Balagula Y. Acute inflammatory Demodex-induced pustulosis in an immunocompetent patient related to topical steroid use. Pediatr Dermatol. 2020;37(5):985-986. DOI:10.1111/pde.14315 PMID: 32729151
Jansen T., Kastner U., Kreuter A., Altmeyer P. Rosacea-like demodicidosis associated with acquired immunodeficiency syndrome. Br. J. Dermatol. 2001;144:139–142. DOI:10.1046/j.1365-2133.2001.03794.x PMID: 11167695
Ivy S.P., Mackall C.L., Gore L., Gress R.E., Hartley A.H. Demodicidosis in childhood acute lymphoblastic leukemia; an opportunistic infection occurring with immunosuppression. J. Pediatr. 1995;127:751–754. DOI:10.1016/s0022-3476(95)70168-0 PMID: 7472831
Demirbaş A, Bayramgürler D, Yaşar EK, Adak M, Demir Cİ. Relationship between surgical rhinoplasty and Demodex infestation: a case-control study. Turk J Med Sci. 2023;53(6):1738-1743. DOI:10.55730/1300-0144.5743 PMID: 38813499
Öner F, Öner Ü. A New Complication Reported for the First Time After Rhinoplasty: Demodicosis. Turkiye Parazitol Derg. 2024;48(2):133-134. DOI:10.4274/tpd.galenos.2024.91300 PMID: 38958492
Cansz H, Tahamiler R, Yener M, et al. Modified midfacial degloving approach for sinonasal tumors. J Craniofac Surg. 2008;19(6):1518-1522. DOI:10.1097/SCS.0b013e31818b2ceb PMID: 19098542
Baumann A, Ewers R. Midfacial degloving: an alternative approach for traumatic corrections in the midface. Int J Oral Maxillofac Surg. 2001;30(4):272-277. DOI:10.1054/ijom.2001.0106 PMID: 11518347
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