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Iatrogenic Demodex folliculitis: A case report
Neha Deo1, Nasro A Isaq2, Margot S Peters2,3
1Mayo Clinic Alix School of Medicine, Rochester, Minnesota, USA.
Abstract:
Demodex folliculorum is a commensal mite that inhabits the orifices of cutaneous pilosebaceous follicles. Overgrowth of these organisms can lead to Demodex folliculitis, which typically presents as papules and pustules predominantly involving the temples, cheeks, and occasionally the chest. We present a 51-year-old woman with iatrogenic Demodex folliculitis secondary to immunosuppressive treatment for an autoimmune connective tissue disease. Histopathological exam of a skin biopsy, which revealed follicular Demodex mites, confirmed the diagnosis. The eruption was treated with oral ivermectin and topical metronidazole gel, and the patient's immunosuppressive regimen was decreased, resulting in marked improvement in the eruption within 6 weeks and no worsening of her underlying autoimmune disorder. This case emphasizes the importance of considering Demodex folliculitis in the differential diagnosis of a new onset rash in the context of immunosuppressive treatment.
Insights
Iatrogenic Demodex folliculitis, a skin condition caused by Demodex mites, can arise from immunosuppressive therapy. Early diagnosis and treatment with ivermectin and metronidazole, alongside adjusted immunosuppression, led to significant patient improvement.
Area of Science:
- Dermatology
- Immunology
- Microbiology
Background:
- Demodex folliculorum mites are normal inhabitants of pilosebaceous follicles.
- Overgrowth can cause Demodex folliculitis, presenting as papules and pustules on the face and chest.
- Immunosuppressive therapy can predispose individuals to Demodex overgrowth.
Observation:
- A 51-year-old woman developed iatrogenic Demodex folliculitis while undergoing immunosuppressive treatment for an autoimmune connective tissue disease.
- The rash manifested as papules and pustules on her face.
- Histopathological examination confirmed the presence of Demodex mites within the hair follicles.
Findings:
- The patient was treated with oral ivermectin and topical metronidazole.
- Her immunosuppressive regimen was carefully reduced.
- Significant clinical improvement of the folliculitis was observed within six weeks.
Implications:
- This case highlights the importance of considering Demodex folliculitis in patients on immunosuppressants presenting with new-onset rash.
- Management involves addressing both the mite overgrowth and the underlying immunosuppression.
- Successful treatment can improve skin condition without exacerbating the autoimmune disease.
