Evaluation of Pruritus With Emphasis on the Role of Demodex


Pruritus, or itching, is an unpleasant skin condition that typically triggers an urge to scratch. Although all people experience it, those with chronic pruritus have a difficult time coping with life. Chronic itching is a nightmare and can lead to unpleasant events. Unbelievable as it may seem, Anne Louise Oaklander, MD, PhD, of the department of neurology at Massachusetts General Hospital and Harvard Medical School, reported a rare case of pruritus in a 39-year-old woman who developed severe itching above her eye after contracting shingles. Shingles can sometimes cause loss of peripheral sensory neurons, eliminating pain sensation that prevents such aggressive scratching. Due to lack of pain and severe itching, she continued scratching the site, resulting in Osteomyelitis, skull perforation, and severe brain damage.

What happened to this woman is an extreme example of the underrated dangers of itching and a stark reminder of why diagnosing and targeting the root of pruritus is so important.

Itching can be localised or generalised to several parts of the skin. Regardless of wherever and how severe it is, the first step in targeting itching is to identify the underlying cause. This article examines the causes of pruritus, emphasising the role of Demodex parasites.

Evaluation of Pruritus- Itching Causes

Tracking down the cause of itching can take a long time. Physical examinations, history of pruritus, as well as blood tests and diagnostic procedures are involved in finding the root cause. The latter two methods typically look for reasons that won’t get brought to light by clinical examinations.

Blood Tests

Dermatologists may request a complete blood test to look for potential causes of pruritus. Blood component changes can indicate complications that may lead to itching. We discuss some of them here:

  • Erythrocytes, Ferritin and Haemoglobin: These indicators are associated with iron deficiency anaemia. Erythrocytes carry oxygen to tissues using haemoglobin, an iron-containing protein. Lack of iron can cause haemoglobin and Erythrocyte deficiency, leading to a lack of oxygen in tissues, which may cause itching. On the other hand, people who have already been diagnosed with anaemia and are being treated for it may have an allergic reaction to iron supplements, such as ferrous sulphate, and develop itching.
  • Liver Enzymes: Elevated liver enzymes are critical indicators of liver disease, which can cause itchy skin. Furthermore, the elevation of some liver enzymes may suggest cholestasis, another cause of pruritus.
  • Urea, Creatinine and Uric Acid: Important indicators of kidney function which increase in people with kidney failure and cause itching.
  • Thyroid Hormones: Changes in thyroid hormones are associated with itching. People with hyperthyroidism usually undergo pruritus.
  • Antibody/AntigenTest or Nucleic Acid Test: A positive result shows an HIV infection, which can cause widespread itching in sufferers.
  • Blood Sugar: People with diabetes develop peripheral nerve damage that can cause itching.

Skin Biopsy

A skin biopsy can help doctors check the skin for disorders and parasitic infections that can cause itching. Some of these conditions are as follows:

  • Demodex mites: Demodex mites are microscopic parasites that usually hide in the skin’s pores. They can cause extensive and severe itching by producing provocative substances and aggravating other skin conditions.
  • Skin cancers: Some types of skin cancer, such as squamous cell carcinoma or, to a lesser extent, basal cell carcinoma, can cause itching.
  • Psoriasis: A chronic autoimmune disease that is associated with pruritus.

Paraclinical Measures

  • Chest x-ray: Enlarged lymph nodes can appear along itchy skin, and a chest x-ray can determine their size
  • MRI: MS is one of the issues that can provoke widespread itching, and an MRI helps doctors diagnose it.

Clinical Examinations

A careful history and physical examination can aid in finding other roots of pruritus, including: 

  • Atopic dermatitis
  • Allergic contact dermatitis
  • Hives
  • Dry skin
  • Advanced age
  • Sunburns or increased sensitivity to sunlight
  • Insect bites, or lice
  • Shingles
  • Substance abuse disorders or obsessive-compulsive disorder.

Demodex Mites and Chronic Pruritus

Demodex mites are tiny creatures similar to spiders, except they are much smaller and commonly hide themselves in the skin pores.  The mites are microscopic, meaning they are not detectable to the naked eye. Along the line of Candida and Malassezia fungi, Demodex mites are ordinary inhabitants of human skin and usually harmless unless you have too many of them. Some conditions, such as a weak immune system, can encourage them to proliferate and cause myriad skin and hair issues, one of which is itching.

Demodex usually penetrate into deep layers of skin through tiny pores on the surface and settle inside the skin’s follicles and sebaceous glands.

The Demodex mite’s life cycle is quick and takes only 14 to 16 days. They usually live for several weeks, thus have ample opportunity to reproduce. Each female Demodex can lay 15 to 20 eggs at a time. So if you ignore the subclinical infection, they can cause severe complications, including itching in a short time.

How Does Demodex Cause Itching?

Demodex mites can trigger or worsen itching in several ways:

  • Exacerbating underlying conditions: Studies show that large populations of Demodex can provoke or exacerbate skin issues responsible for pruritus. For example, seborrheic dermatitis is closely related to Demodex infection.
  • Production of inflammatory substances: Demodex secrete inflammatory substances, which can cause local inflammation and itching.
  • Provoking the immune system: The natural defence may target these parasites as foreigners. Cytokines, a kind of immune system mediator, can start an inflammatory cascade, leading to symptoms including itching.
  • Parasites crawling on the skin: Demodex mites have eight tiny, segmented feet and move at a speed of 8 to 16 cm on the skin. When large crowds of them wriggle simultaneously, the skin can become irritated and itchy.
  • Body decay: Demodex parasites do not have an anus, and whatever they eat remains inside their bodies. However, along with the decomposition of their bodies after death, the toxic substances they carry inside themselves, including bacteria, fungi, and viruses, gradually spill out on the skin and cause a variety of skin conditions, including severe itching.

What Causes Demodex to Overgrow?

As mentioned, almost any adult has a population of these mites on their skin. Still, some factors cause them to increase and exceed five per square centimetres of skin in number. This condition, which is usually associated with various skin conditions, is referred to as demodicosis. Factors that contribute to the Demodex overgrowth include:

  • Weak immune systems, such as in those with HIV.
  • Taking corticosteroids and other immunosuppressive drugs
  • Infections
  • Various skin concerns

Are Demodex Mites Contagious?

Yes, Demodex mites can quickly spread through contact from one host to another. Contaminated objects such as towels, combs and pillows are suitable carriers for these mites. To skip Demodex transmission, the following measures are recommended for individuals with a weak immune system or who are prone to Demodex infection for other reasons:

  • Do not share your personal belongings with others.
  • Avoid using other people’s personal belongings.
  • Avoid direct skin contact with different people as much as possible.
  • Wash your towel, comb, pillowcases and clothes regularly, then dry them in the sun.
  • Before using beauty salon and dermatology clinic equipment, spray a small amount of anti-Demodex products such as PDT on the surfaces to eliminate the mites.
  • Always observe your personal hygiene.

A Shortcut to Demodex Itching Diagnosis 

Due to the mites being microscopic, it is impossible to look for Demodex infection using a clinical examination. If your doctor suspects a Demodex infection, they confirm this hypothesis by sending a skin biopsy to the lab to count any Demodex mites under a lens. However, the Online Demodex Diagnostic Test is a non-invasive, more feasible way to diagnose Demodex pruritus. Although Demodex mites are invisible, you can trace their symptoms and available breaking out opportunities. This is an online microscopic testing site which uses these trackers to estimate the population of Demodex. The test is provided by Ungex Company, and our experts are the only authority capable of interpreting the results. Our R&D experts’ years of study and research support the online test result’s accuracy, precision, and reliability.

If you are suffering from chronic itching, it’s enough to spare five minutes and take the test for free. If the results report a significant number of Demodex, there is a chance your itching is related to these parasites. In the next step, the Ungex team will help you eliminate your mites and control the itching caused by them.

How to Soothe Demodex Itching?

Itching and other Demodex-related symptoms do not go away until you get the Demodex population under control. No matter how often you wash your skin, you cannot wipe them away by overwashing and may even worsen their symptoms. Repeated skin cleansing dries it out, damaging this crucial protective barrier. Broken skin can not protect the body against pathogens. Demodex parasites and other pathogenic microorganisms take advantage of this opportunity and grow.

Eradicating Demodex requires anti-parasitic products, which eliminate Demodex on the skin.

Ungex Anti-Demodex Products

Ungex is an Australian company, with experts skilled in producing anti-Demodex products. Our products can kill these parasites by direct contact. The most potent product of Ungex is PDT, which can destroy the mites both on the skin and in other immediate environments. It is enough to spray a small amount of PDT on the infected skin or surfaces. This measure gradually reduces the Demodex population and their symptoms.

SDT is another product of Ungex that works similar to PDT except that it is more suitable for sensitive skin. Using Ungex products for several months can help control the population of these mites and relieve the itching caused by them.

In addition to unique products, Ungex offers a particular protocol that helps you get the best results from the products. We have studied the lives of the Demodex well and found their weaknesses. Our consultants at Ungex provide free advice to clients during the treatment period and help them get the most out of these products


Preventing Postherpetic Itch in Patient with Shingles

Itchy skin (pruritus) – Diagnosis and treatment – Mayo Clinic

Pruritus: What Is It, Causes, Types, Treatment, and More | Osmosis

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