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Refractory Demodex folliculitis in five children with acute lymphoblastic leukemia
Mark D Herron1, Margretta A O'reilly, Sheryll L Vanderhooft
1Department of Dermatology, University of Utah School of Medicine, Salt Lake City, Utah 84132, USA.
Abstract:
We report five children with acute lymphocytic leukemia on maintenance chemotherapy who had Demodex folliculitis. None experienced complete clearing when treated with permethrin 5% cream. Topical metronidazole helped to lessen the eruption in four, but did not provide full clearing. The one child who was treated with sodium sulfacetamide 10%, sulfur 5% formulation had resolution of the eruption. We suggest that treatment of Demodex folliculitis in children with acute lymphocytic leukemia is more difficult than is suggested in the literature. Newer sodium sulfacetamide/sulfur formulations should be considered when treating this condition, particularly in children with acute lymphocytic leukemia.
Insights
Treatment for Demodex folliculitis in children with acute lymphocytic leukemia (ALL) is challenging. While permethrin and metronidazole showed limited success, a sodium sulfacetamide/sulfur formulation effectively resolved the eruption in one case.
Area of Science:
- Dermatology
- Pediatric Oncology
Background:
- Demodex folliculitis is a common skin condition.
- Children with acute lymphocytic leukemia (ALL) undergoing chemotherapy may be susceptible to skin infections.
- Standard treatments for Demodex folliculitis may have variable efficacy in immunocompromised patients.
Observation:
- Five children with ALL on maintenance chemotherapy presented with Demodex folliculitis.
- Patients were treated with permethrin 5% cream, topical metronidazole, or a sodium sulfacetamide 10%, sulfur 5% formulation.
- Permethrin 5% cream did not result in complete clearing for any patient.
- Topical metronidazole lessened the eruption in four patients but did not achieve full resolution.
Findings:
- A single child treated with a sodium sulfacetamide 10%, sulfur 5% formulation experienced complete resolution of Demodex folliculitis.
- Treatment of Demodex folliculitis in pediatric ALL patients appears more challenging than typically reported.
- The efficacy of standard treatments like permethrin and metronidazole may be limited in this specific patient population.
Implications:
- Sodium sulfacetamide/sulfur formulations should be considered for treating Demodex folliculitis in children with ALL.
- Further research is warranted to determine optimal treatment strategies for Demodex folliculitis in immunocompromised pediatric patients.
- Clinicians should be aware of the potential difficulties in managing Demodex folliculitis in children undergoing chemotherapy.