Effectiveness of benzyl benzoate treatment on clinical symptoms and Demodex density over time in patients with rosacea and demodicosis: a real life retrospective follow-up study comparing low- and high-dose regimens

Abstract

Background

Patients with rosacea and demodicosis have high facial skin Demodex densities (Dds), which decrease with benzyl benzoate (BB) treatment.

Objectives

To evaluate the impact of topical BB (+crotamiton) treatment on Dds and clinical symptoms during prolonged follow-up and to compare low (12% once daily) and high (12% twice daily or 20–24% once daily) BB dose regimens.

Methods

This retrospective study included 344 patients (103 rosacea, 241 demodicosis) observed for 7.1 ± 0.5 months. Dds were measured on two consecutive standardized skin surface biopsies and symptoms evaluated using investigator global assessment. Compliance was considered good if patients correctly followed treatment instructions.

Results

At final follow-up, in the 248 patients with good compliance, Dd had normalized in 217 (88%) and symptoms cleared in 204 (82%). The high dose was associated with better compliance and faster results than the low-dose. The higher the initial Dd, the longer it took to normalize. In the 96 poorly compliant patients, treatment was less effective and slower.

Conclusions

These findings indirectly support a key role of the mite in rosacea and suggest that topical treatment with BB (+crotamiton), especially the higher dose, may be a useful alternative treatment for rosacea as well as for demodicosis.

Keywords:

• Demodex
• rosacea
• demodicosis
• benzyl benzoate

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Acknowledgements

The authors thank Prof M Parmentier, Prof V del Marmol and Prof C Verhoeven, for their constructive remarks, Dr K Pickett for proofreading, and our patients for agreeing to participate in the study.

Disclosure statement

This article has no funding sources. Dr Forton occasionally worked as a consultant for Galderma. Prof De Maertelaer has no conflict of interest to declare. Contents of the manuscript have not been previously published and are not currently submitted elsewhere.