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Demodicosis: A clinicopathological study - 08/08/11

Doi : 10.1016/j.jaad.2008.10.058 
Chao-Kai Hsu, MD a, b, Mark Ming-Long Hsu, MD a, Julia Yu-Yun Lee, MD a, c,
a Department of Dermatology, College of Medicine, University Hospital, Tainan, Taiwan 
c Department of Pathology, College of Medicine, University Hospital, Tainan, Taiwan 
b Institute of Clinical Medicine, National Cheng Kung University, Tainan, Taiwan 

Reprint requests: Julia Yu-Yun Lee, MD, Departments of Dermatology and Pathology, National Cheng Kung University College of Medicine and Hospital, 138 Sheng-Li Rd, Tainan, Taiwan.

Abstract

Background

Demodex mites are common commensal organisms of the pilosebaceous unit in human beings and have been implicated in pityriasis folliculorum, rosacea-like demodicosis, and demodicosis gravis.

Objective

We sought to describe the spectrum of clinicopathological findings and therapeutic responses of demodicosis in Taiwanese patients.

Methods

We conducted a retrospective study to review clinicopathologic findings and therapeutic responses of 34 cases of diagnosed demodicosis.

Results

Fifteen cases with positive results of potassium hydroxide examination, standardized skin surface biopsy specimen, and/or skin biopsy specimen, and resolution of skin lesions after anti-Demodex treatment were included for final analysis. Nineteen cases were excluded because of insufficient positive data to make a definite diagnosis. There were 4 male and 11 female patients (age 1-64 years, mean age 38.7 years). The disease was recurrent or chronic with a duration ranging from 2 months to 5 years (mean 15.7 months). The skin lesions were acne rosacea-like (n = 8), perioral dermatitis-like (n = 5), granulomatous rosacea-like (n = 1), and pityriasis folliculorum (n = 1). Skin biopsy was performed in 7 patients. Overall, the histopathology was characterized by: (1) dense perivascular and perifollicular lymphohistiocytic infiltrates, often with abundant neutrophils and occasionally with multinucleated histiocytes; (2) excessive Demodex mites in follicular infundibula; and (3) infundibular pustules containing mites or mites in perifollicular inflammatory infiltrate. The skin lesions resolved after treatment including systemic metronidazole, topical metronidazole, crotamiton, or gamma benzene hexachloride.

Limitations

Small sample size and a fraction of patients without long-term follow-up are limitations.

Conclusion

Demodicosis should be considered in the differential diagnosis of recurrent or recalcitrant rosacea-like, granulomatous rosacea-like, and perioral dermatitis-like eruptions of the face. Potassium hydroxide examination, standardized skin surface biopsy, skin biopsy, or a combination of these are essential to establish the diagnosis.

Le texte complet de cet article est disponible en PDF.

Key words : Demodex granuloma, demodicosis, pathology, perioral dermatitis, rosacea-like dermatitis


Plan


 Funding sources: None.
 Conflicts of interest: None declared.


© 2008  American Academy of Dermatology, Inc.. Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 60 - N° 3

P. 453-462 - mars 2009 Retour au numéro
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