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. 2022 May;61(5):564-569.
doi: 10.1111/ijd.15992. Epub 2021 Dec 13.

Pigmented demodicidosis - an under-recognized cause of facial hyperpigmentation

Hana Feuerman  1   2 , Lihi Atzmony  1   2 , Mirit Glick  1 , Shany Sherman  1   2 , Igor Snast  1   2 , Emmilia Hodak  1   2 , Rina Segal  1   2
Affiliations

Pigmented demodicidosis - an under-recognized cause of facial hyperpigmentation

Hana Feuerman et al. Int J Dermatol. 2022 May.

Abstract

Background: There is a paucity of data regarding demodicidosis-associated facial hyperpigmentation.

Objective: To delineate the clinical, dermoscopic, and histopathologic features of demodicidosis-associated facial hyperpigmentation.

Methods: Clinical and diagnostic data were collected from the medical files of patients who were referred to our outpatient dermatology clinic in 2006-2019 for evaluation of facial hyperpigmentation and were diagnosed with demodicidosis.

Results: The cohort included 19 patients (13 male) aged 42-76 years, all with Fitzpatrick skin type 3-4. All presented with mostly asymptomatic dusky, brown-gray, facial pigmentation, localized or diffuse with background erythema in 36.8% of cases, and skin roughness in 26.3%. Dermoscopy yielded characteristic findings of white gelatinous or opaque protrusions from hair follicles or infiltration of follicular openings with an amorphic material. A specific finding was perifollicular and reticulated pigmentation of the affected areas. Findings were confirmed on microscopic (n = 7) and histopathologic (n = 5) studies. Anti-demodectic treatment led to complete (73.6%) or partial (23.4%) resolution of pigmentation within 2 years.

Conclusion: We describe unique clinicopathological and dermoscopic findings associated with an under-recognized type of facial hyperpigmentation caused by demodex for which we propose the term "pigmented demodicidosis." Demodicidosis should be added to the list of causes of facial hyperpigmentation.

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