An Unusual Perioral Presentation of Pityriasis Folliculorum Mimicking Periorificial Dermatitis

Demodex mites are commonly found on human skin, but excessive proliferation can contribute to inflammatory eruptions. Pityriasis folliculorum is a Demodex‑associated condition characterized by follicular roughness and fine scale. Although it most often affects the cheeks, its presentation can vary and may resemble other papulopustular disorders. We describe a patient who developed a perioral papulopustular eruption with prominent follicular roughness. The condition persisted despite treatment with topical metronidazole, topical tretinoin, and topical antifungal therapy. Given the lack of response to topical therapies, a potassium hydroxide (KOH) skin scraping was performed and demonstrated numerous Demodex mites, with rapid resolution following the initiation of topical ivermectin. This case highlights the importance of considering Demodex‑related disease in the evaluation of perioral papulopustular eruptions when standard therapies are ineffective. Early recognition can help guide appropriate management and prevent prolonged symptoms.