Demodex Folliculitis

Overview of Demodex Folliculitis

Demodex Folliculitis is an acne rosacea-like eruption on the face triggered by an overgrowth of a common facial mite called demodex. Demodex mite is a normal resident of the skin in most people, however on occasion it can become overrepresented resulting in an inflammatory response from the body presenting as inflamed pustules and papules. The differential includes acne, bacterial folliculitis, acne rosacea, and perioral dermatitis. It may sometimes first be suspected when it fails to respond well to traditional treatments of those conditions. In addition, it may also appear unilateral instead of the more symmetric presentation of acne and rosacea.

Diagnosis of Demodex Folliculitis

Diagnosis can be suspected based on clinical appearance and history but it is easy to confirm with a standard mineral oil prep. A pustule is superficially scraped with a small blade (painless) and the contents are evaluated under the microscope in the office. The mites are easy to visualize on the slide confirming the diagnosis.

Treatment of Demodex Folliculitis

The treatment involves controlling the mite population and the resulting inflammation. Topical ivermectin 1% cream once or twice daily is first line. Sometimes we will also use oral ivermectin 200mcg/kg once, repeating in one week, especially in more severe cases. In addition to the ivermectin, we may also recommend other rosacea treatments like metronidazole cream or doxycyline.