Determination of Demodex Density by Superficial Skin Biopsy Technique

Superficial skin biopsy is a non-invasive technique used to confirm the diagnosis of skin infestations caused by Demodex spp parasites (Demodex folliculorum and Demodex brevis). Parasites live in the normal flora without causing any disease symptoms in most of us. However, in rosacea disease, it is known that these parasites increase in number in hair follicles and sebaceous glands, cause acne-like inflammation and cause persistent redness, itching and burning sensation on the skin surface.

Determination of Demodex density is necessary before treatment. In addition, demodex screening is often performed to evaluate treatment effectiveness.


The patient is seated in a chair. An area of ​​1 cm2 is drawn on the slide with a ruler. 1 drop of cyanoacrylate is applied to this area. The slide is adhered to the skin area where the agent is desired to be investigated. Samples should be taken from the forehead, cheeks, nose and chin, where the parasite is most commonly located. After approximately one minute, the slide is slowly removed. Microscopic examination of the material should be done within 1 hour.

The number of parasites within the marked area will give the demodex density. Two species of Demodex spp, Demodex folliculorum and Demodex brevis, should be sought in microscopic examination. After the treatment, a sample should be taken from the same area, the number of the parasite and whether it is alive should be evaluated. The effectiveness of the treatment is determined by the number of parasites and whether the parasite is alive or not. If there are less than 5 parasites in 1 cm2 and they are non-viable, the treatment is successful.

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