Rosacea-Like Demodeciasis

Abstract:  47 yo woman with ab 8 month history of a facial eruption
 

The patient is a 47 yo woman with a rosacea-like eruption for eight months.  Dr. Yoon Cohen suggested demodicosis and performed a scraping.  It was loaded with demodex mites.  We are considering this an example of rosacea-like demodexinfestation and treated the patient with ivermectin 250 microgram/kg x 2 a week apart and permethrin 5% cream 2 - 3 times a week. 

Photos:

 After one week:

Diagnosis:  Rosacea-like Demodeciasis (most probably)

Discussion: It seems that this acneiform eruption is due to Demodex, but we need more time to be certain. Since Samuel Ayers, Jr. described this entity in 1930 it has been in the literature but there are still doubters in the dermatologic community.

Reference:

1. Dermatol Online J. 2007 Oct 13;13(4):9.

Granulomatous rosacea-like demodicidosis. Free Full Text

Lee JY, Hsu CK.

Abstract

Demodicidosis may present as pityriasis folliculitis, papulopustular lesions, rosacea-like eruptions, and granulomatous rosacea-like eruptions. We report a case of demodex granuloma presenting with recurrent granulomatous rosacea-like papules on the face in a middle-aged woman. The diagnosis of demodicidosis was made by finding extrafollicular mites in the perifollicular inflammatory infiltrate. The papules resolved after 3 weeks of systemic and topical metronidazole, and low-dose oral prednisolone therapy. In summary, demodex granuloma may be mistaken for granulomatous rosacea-like papules. Correct diagnosis can be facilitated by finding extrafollicular demodex mites in skin biopsy specimens.

2.  Cutis. 2007 Aug;80(2):149-51.

Recalcitrant papulopustular rosacea in an immunocompetent patient responding to combination therapy with oral ivermectin and topical permethrin.  Full Text PDF

Allen KJ, Davis CL, Billings SD, Mousdicas N.

Abstract

A 68-year-old healthy man presented with papulopustular rosacea (PPR) recalcitrant to multiple therapies, including permethrin cream 5%. Histologic examination detected the presence of chronic folliculitis and numerous Demodex organisms. A diagnosis of rosacealike demodicidosis was rendered, and the patient was treated with oral ivermectin and permethrin cream 5%, resulting in resolution of the folliculitis. Demodex infestation should be considered in any patient with rosacealike dermatitis resistant to conventional rosacea therapies. If infestation is demonstrated in these patients, oral ivermectin in combination with topical permethrin is a safe and effective therapeutic option.

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Facial flush in a pregnant woman

Presented by Henry Foong

Ipoh, Malaysia

A 37 year old restaurant waitress had these rashes on the face for several years, but worse recently since her pregnancy. She is G2P1 at the end of her first trimester. The rash was described as itching, burning. She had seen a dermatologist in Japan and was diagnosed as rosacea. There was no fever or polyarthralgia. Family history was insignificant. Drug history nil.

She feels very uncomfortable. Examination was unremarkable except facial flushing with for bilateral and symmetrical erythematous papules on both cheeks with a mild involvement of the bridge of nose. There was no comedones. Her scalp was normal.
What do you think of the diagnosis? Do you think this is rosacea? What other differentials would you consider - lupus erythematosus, seborrheic dermatitis? How would you manage her remembering that she 3 months pregnant? Would you use topical metrondazole?

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