There is a long purported anecdotal association between rosacea and gastrointestinal disease. The discovery that Helicobacter pylori cause gastritis and duodenal ulcer disease has led to a hypothesized role of this organism in the aetiology of rosacea.

In an experiment the potential association between severity of rosacea and direct serological evidence of H. pylori infection was assessed where suggestive evidence of a positive association between the severity of rosacea and the presence of H. pylori was reported [83(4)].

In another study depicting the link between H. pylori infection and rosacea it was found that rosacea is a disorder with various gastrointestinal symptoms closely related to gastritis especially involving the ant rum mucosa, the eradication of H. pylori infection leads to improvement of symptoms of rosacea and reduction in related gastrointestinal symptoms [105(2)].

However in another study the lack of improvement of cutaneous symptoms in rosacea after eradication of H. pylori from gastric mucosa could depend on bacteria in the oral cavity and thus rosacea could be considered as one of the extra gastric symptoms of H. pylori infection probably mediated by Helicobacter related cytotoxins and cytokines [16(4)].

These cytokines have been demonstrated to increase the synthesis of the inflammatory species nitric oxide (NO). However, the inflammatory species nitric oxide which has been hypothesized to be associated with H. pylori has no role in the inflammatory mechanism of acne rosacea [41(11)].

Nevertheless, there are debatable studies that suggest that H. pylori may not have any play in pathogenesis of rosacea. The studies reported no significant lessening of rosacea lesions by treating H. pylori infection which conclusively does not concur with a view that H. pylori may be related to rosacea [15(5)].

Treating H. pylori infection has no beneficial effect on symptoms of rosacea [135(6)].

Thus it remains to be proved that whether eradication of H. pylori infection is the successful treatment in rosacea or it is a myth.


Rosacea is a disease of multifactorial origin and individual properties may modify the severity of the inflammatory response to Demodex folliculorum. Demodex folliculorum has been reported in rosacea in number of clinical studies.

As the Demodex mite is also present in many healthy individuals it has been suggested that the mite might have a pathogenic role only when it is present in high densities. The density above 5 cm/2 cannot be criteria for diagnosis of inflammatory rosacea. Nevertheless, large numbers of D. folliculorum may have an important role in the pathogenesis of rosacea together with other triggering factors [37(6)].

In another study, Demodex folliculorum and its pathogenic role has been reported in papulopustular rosacea. The study also suggested that standardized biopsy is a useful diagnostic tool for papulopustular rosacea with a 98% specificity when Demodex density is higher than 5/cm2 [128(6)].

The hair follicle mite Demodex folliculorum is ubiquitous obligatory ectoparasite of man. The prevalence of this species increases with the age of man. The face gets most heavily infested with this species. However, males are more heavily infested than females [7(5)].

The infestation of Demodex folliculorum has also been associated with acquired immunodeficiency syndrome, it is suggested that D. folliculorum infestation does not manifest when local or systemic immune function is altered, leading to proliferation of the organism and subsequent disease [144(1)].

The treatment of Demodex infection associated with human immunodeficiency virus (HIV) has been successful with active antiretroviral therapy. The antiparasitic treatment with oral ivermectin associated with 5% permethrin cream has been successful [205(4)].

However, Demodex folliculorum which is a resident of human pilosebaceous follicles has been implicated in rosacea, blepharitis, pityriasis folliculorum, pustular folliculitis and skin lesions of immunosuppressed patients on chemotherapy or with acquired immunodeficiency syndrome (AIDS) but pregnancy does not have direct effect on mite density [39(10)].

The density of facial D. folliculorum infestation can be dropped remarkably by using camphor oil with no side effects [32(3)].

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