What Are Face Mites?

Face mites, also known as Demodex folliculorum (D. folliculorum) are microscopic tick-like organisms. These demodex mites aren't visible on the face. They live in the hair follicles in your skin, especially around the eyelids and lashes, and feed on dead skin cells and oils.  Demodex brevis (D. brevis), a second type, usually lives on thin, wrinkled skin.

Research suggests that with age, the mites are found in essentially 100% of all adults. Everyone has face mites, but they become problematic when they overgrow—a condition known as demodicosis. This can cause symptoms like itching and sores, as well as trigger or aggravate skin conditions like eczema or rosacea. Demodicosis requires treatment. 

This article looks at symptoms and complications of face-mite overgrowth, how it's diagnosed and treated, and how you can keep these organisms in check.

Types of Demodex Mites

D. folliculorum is one of the two known types of Demodex mites in humans. The other is D. brevis, and there are some differences in how they spread and the areas they affect.

D. Folliculorum Mites

These mites usually appear just on the face, especially around the eyelids and eyelashes. In addition to being known as face mites, you may hear them called eyelash mites.

D. Brevis Mites

D. brevis mites usually live on skin that's thin and wrinkled. That includes the elbows, knees, shoulder blades, around the penis, and under the breasts. They're a little bit shorter than D. folliculorum are, at about 0.2 to 0.3 millimeters (mm) long compared with 0.3 to 0.4 mm.

Face mites can only survive on human skin. While they usually stay inside the hair follicle, mites come out to the surface of the skin to mate while you sleep. Females then burrow tunnels into your skin. They lay their eggs one to five millimeters below the surface.

The period from hatching to adulthood lasts about two weeks. Their life span is about one to two months. 

Researchers believe other types of Demodex mites exist, but among 140 species of mites these are the only two that are known to affect humans. They may vary depending on geographic location.

Face Mite Symptoms

Because face mites are small, there typically are no visible demodex mites on the face. Normal levels of face mites don't cause any symptoms. However, demodicosis can.

Signs of demodicosis can come on quickly, even overnight. You may notice a patch of tiny whiteheads resembling acne around your eyes or nose. 

Other symptoms include:

• Dryness
• Itchy, scaly skin
• Redness and irritation 
• Red or white pustules
• Acne-like eruptions
• Sores from scratching
• Lines (burrow marks) on the face 
• Eczema
• Loss of eyelashes
• Eye inflammation
• Decreased vision

Complications

Demodicosis is usually easily treated and doesn't cause further complications thereafter.

But when it is left untreated, it can sometimes lead to skin conditions such as:

• Rosacea: A skin condition that causes inflammation, redness, and pustules on the face
• Blepharitis: An inflammation of the eyelids that causes redness and watering
• Dermatitis: Sensitive, irritated skin with symptoms like redness, itching, and pain

People with rosacea typically have higher amounts of face mites. Researchers have debated whether demodicosis causes rosacea or is a result of it.

Demodicosis may make acne, eczema, rosacea, and dermatitis symptoms more severe.

What Causes Face Mites?

Face mites are a normal part of healthy skin. They can be passed from one person to another through close contact, like sleeping in the same bed. But they're more likely to be passed when faces touch, such as during a kiss.

The immune system is usually able to keep the number of face mites on the skin under control. It's when the immune system stops functioning properly that face mites have a chance to multiply and spread.

Risk Factors

Some people are at greater risk for face-mite overgrowth than others.

This includes people with conditions affecting the immune system, such as HIV or AIDS.

Medications like chemotherapy or topical steroids can also impair the immune response and put you at higher risk of overgrowth. 

Other risk factors of demodicosis include:

• Age: Demodicosis usually doesn’t present before age 40 and is much more common in the elderly.
• Sex: Biological males are more likely than biological females to experience D. folliculorum or D. brevis overgrowth.

How Are Face Mites Diagnosed?

You do not need to see a healthcare provider for face mites unless you have symptoms.

Your provider may be able to diagnose face mites based on the appearance of your skin. Demodicosis often causes a white sheen to the skin, known as Demodex frost. 

If you're being evaluated for overgrowth, your healthcare provider may gently scrape skin cells from an oily patch of skin, such as around the nose or mouth—a ripe feeding ground for face mites. Alternatively, they may remove some tissue in what's known as a standardized skin surface biopsy (SSSB).

The samples will then be examined under a microscope and the mites are counted to see if there are more than is considered normal.

How to Get Rid of Face Mites

Self-care strategies like exfoliation and over-the-counter solutions like tea tree oil are typical suggestions for how to get rid of face mites. More serious cases may require a prescription. Note, however, that you don't actually need treatment unless there's an overgrowth.

Even then, the sensitivity of facial skin can make eliminating the mites challenging.

Your healthcare provider can help guide you as to where to start.

Self Care

You can do some things at home to help treat and prevent demodicosis:

• Wash your hair and eyelashes daily with a mild shampoo.
• Use a cleanser on your face twice a day.
• Avoid oil-based/greasy personal care products.
• Exfoliate regularly to remove dead cells.
• Avoid scratching or rubbing your face as much as possible.

Over-the-Counter Options

There are many over-the-counter (OTC) options for treating demodicosis at home:

• Tea tree oil: The best treatment overall, according to 2020 research
• Topical permethrin: Can reduce the number of mites when used for two weeks
• Cliradex wipes: Contain 4-Terpineol, the key component of tea tree oil; use around the eyes for six to eight weeks

Prescription Drugs

In more serious cases, a doctor can prescribe medications to get rid of face mites. Direct treatment usually isn't necessary unless a person shows signs of overgrowth.

Your healthcare provider can help you choose a treatment with the least amount of side effects.

• Metronidazole: This antibiotic may help by hampering the mites' movement and potentially even killing them. It comes in oral tablet and topical cream forms. Possible side effects of tablets include nausea, vomiting, diarrhea, and stomach pain.
• Crotan (crotamiton): This is a topical cream used to treat mites and itching. Apply after washing your face. Mild skin irritation is possible.
• Stromectol (ivermectin): This oral tablet can be used for face mites that don't respond to other treatments. It is most commonly used in those with compromised immune systems. Possible side effects include dizziness, nausea, and vomiting.
• Xdemvy (lotilaner): This eye drop is an antiparasitic approved by the Food and Drug Administration (FDA) to treat Demodex blepharitis.
  

How To Prevent Face Mites

Though all adults are considered to have face mites, it's best to avoid spreading more to someone else if you have an overgrowth.

You can do this by:

• Removing excess oil on your skin by washing your face twice daily
• Never sharing makeup or face products with anyone else
• Washing potentially shared items like bedding and towels regularly

Summary

Face mites are microscopic organisms that live in the hair follicles in your face and eat dead skin. They're usually not noticeable but sometimes overpopulate and make you break out in tiny white bumps that can be itchy or even painful.

Mites are contagious through close contact. A weak immune system can allow them to get out of control.

They're diagnosed with skin scrapings or biopsies. Extra cleansing, tea tree oil, topical products, or prescription medications may be needed to get rid of an outbreak.

To prevent a recurrence or spreading them, try not to touch your face, wash frequently, and don't share face products with anyone. Exfoliating may also help since it removes the dead skin cells that mites feed on.