A striking case of pigmented demodicosis

Abstract

This case report presents a rare occurrence of pigmented demodicosis in a 59-year-old woman with Fitzpatrick skin type IV, who presented with pruritic and progressively pigmented plaques over her cheeks and eyelids. Dermoscopic examination and skin biopsy confirmed the presence of Demodex mites in the hair follicles. Treatment with topical ivermectin led to marked improvement, highlighting the importance of considering this condition in cases of facial hyperpigmentation and the efficacy of antidemodectic therapies.

Figure 1

Clinical pictures of the face and cheek of a 59-year-old Malay woman with pigmented demodicosis before and after treatment. (a) Initial presentation, front view; (b) initial presentation, side view; (c) 7 months after treatment with topical ivermectin 1% cream once daily, front view; (d) 7 months after treatment with topical ivermectin 1% cream once daily, side view.

Figure 2

Dermoscopic image of the left cheek. Dermoscopic image (magnification ×10) showing conical-shaped filaments protruding from follicular openings suggestive of Demodex ‘tails’ (circles) and follicular scaling (arrows), on a background of non-specific brownish-yellow scale-crust.

Figure 3

Histopathology sample of skin punch biopsy from left cheek. Haematoxylin and eosin (magnification ×200): high-power view demonstrating Demodex organisms in one of the hair follicles. The dermis shows a mild lymphohistiocytic infiltrate admixed with a few eosinophils around the superficial dermal vessels.