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While this is usually tolerated at some level, researchers believe that Demodex mite infestations cause inflammation in papulopustular rosacea.[ref] A study of 242 patients with face papulopustules showed that the density of Demodex mites was associated with facial redness and papulopustules.[ref] Other studies point to a combination of Demodex mites along with certain bacteria that live on the mites.[ref] Demodex mites can also be a trigger for ocular rosacea, causing immune activation on the ocular surface and surrounding eyelid area.[ref] Skin mites and bacteria on the skin are normal (whether we like to think about it or not)