Lately. I’ve had several patients come in with itching and rashes and reports of feeling and seeing parasites. All of them swear they’re not doing methamphetamine, which is notorious for causing delusional parasitosis.
Most people know about head lice, pubic lice, scabies and bed bugs, maybe even chiggers. A few search the web and know of other conditions, like Morgellons (whatever they really are) and demodex, which is a much more common mite than I would have guessed.
I’m trying to formulate a strategy for helping those who know more and will not accept the possibility that they just have dry, itchy skin. But, I’m thinking I might just make them worse if I tell them what my own research is telling me.
I think I’ll have to start with a reminder about everybody’s intestinal flora, our biome. There are many trillions of organisms living inside us.
Obviously, the bacteria in our intestines help us digest our food. We couldn’t live without them. Minor troubles caused by them might be our moods and appetite or cravings. Major troubles from unwanted intestinal bacteria includes diarrhea and death from dysentery or clostridium difficile.
Having said that, I guess I’ll go on to say that a lot of people have mites, but they’re too small to be what they’re seeing. And when it comes to some mites, they’re impossible to eradicate.
Demodex, also called face mites, live in our hair follicles and some sources say most people have them. Usually they cause no trouble. They may have a role in skin conditions like blepharitis, conjunctivitis, chalazions and also rosacea, sometimes referred to as adult acne. Treatment, when someone has many of these mites and bothersome symptoms, is usually only topical. Cliradex may be the best one but ordinary Tea Tree Oil, which it is derived from, is also effective.
As I’ve been reading up on face mites, I haven’t come across anything good they do for us. So I think I may be speaking for most of us when I say that I’m grateful for my intestinal flora for helping me get the nutrition out of the food I eat. And, those bacteria are, well, in my gut and not in my face, which is where my demodex freeloaders are literally hanging out.
A Country Doctor Writes: 
I’m an entomologist and once in a while I get a long email from the public about parasites crawling all over their skin. Some people send in “samples” collected in their houses, from their skin etc, but no insect is found. We are somehow and for some reason forbidden to advise them to look for a psychiatrist, ask if they take drugs, or make any suggestions that could be helpful. Gently suggesting to look for a dermatologist is allowed, and I only hope the dermatologist is allowed to make the proper referral? It strikes me the length of the letters these people write and the richness of details in their description.