Topical Benzyl Benzoate Plus Crotamiton Improves Symptoms, Normalizes Demodex Densities in Rosacea and Demodicosis

Facial mite
Facial mite
Topical treatment with benzyl benzoate and crotamiton may be an effective treatment for rosacea and demodicosis, indirectly supporting a key role of the mite in the pathophysiology of rosacea.

Topical benzyl benzoate (BB) and crotamiton is effective for controlling symptoms of rosacea and demodicosis, particularly when applied twice daily at 12% or once daily at 20%, a study in the Journal of the European Academy of Dermatology and Venereology reports.

A total of 117 patients with rosacea and 277 patients with demodicosis were included in this retrospective analysis of an earlier observational study. Patients received either once-daily BB and crotamiton at 12% (n=195), twice-daily BB and crotamiton at 12% (n=171), or once-daily BB and crotamiton at 20% (n=28). At initial consultation and follow up, researchers measured Demodex densities (Dds) with 2 consecutive standardized skin surface biopsies (superficial [SSSB1] and deep [SSSB2]). Treatment was considered effective if Dds normalized (SSSB1 ≤5 D/cm2 and SSSB2 ≤10 D/cm2) or if symptoms cleared, whereas treatment was considered curative if both of these 2 terms were met.

There was a 72.4±2.6% reduction in the total Dd (SSSB1 + 2) from initial consultation to the mean follow-up period of 2.7 months. Approximately 35% and 31% of patients experienced normalization of Dds and clearance of symptoms, respectively. In addition, treatment with BB plus crotamiton was considered effective in 46% and curative in 20% of patients, respectively. A higher proportion of men experienced symptom clearance than women (34% vs 20%, respectively; P =.041). The majority of patients (77%) complied with treatment, with few differences observed in those with rosacea and demodicosis. The once-daily 12% treatment regimen was less effective than the other 2 doses and was also associated with lower compliance than the twice-daily 12% dose.

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Limitations of the study included its retrospective design and the small number of patients in the once-daily 20% group.

The researchers concluded that their findings indirectly support “a key role of the mite in the pathophysiology of rosacea.”

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Forton FMN, De Maertelaer V. Treatment of rosacea and demodicosis with benzyl benzoate: effects of different doses on Demodex density and clinical symptoms [published online September 7, 2019]. J Eur Acad Dermatol Venereol. doi:10.1111/jdv.15938