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Chudzicka-Strugała I, Gołębiewska I, Brudecki G, Elamin W, Zwoździak B. Demodicosis in Different Age Groups and Alternative Treatment Options-A Review. J Clin Med 2023; 12:jcm12041649. [PMID: 36836184 PMCID: PMC9961532 DOI: 10.3390/jcm12041649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 01/26/2023] [Accepted: 02/01/2023] [Indexed: 02/22/2023] Open
Abstract
Infestation with Demodex mites is a common occurrence, especially in adults and the elderly. More recent attention has been paid to the presence of Demodex spp. mites in children, even ones without comorbidities. It causes both dermatological and ophthalmological problems. The presence of Demodex spp. is often asymptomatic, thus it is suggested to include parasitological investigation tests in dermatological diagnostics, in addition to bacteriological analysis. Literature reports show that Demodex spp. are related to the pathogenesis of numerous dermatoses, including rosacea or demodicosis gravis, and common eye pathologies reported by patients such as dry eye syndrome or ocular surface inflammatory conditions, such as blepharitis, chalazia, Meibomian gland dysfunction, and keratitis. Treatment of patients is a challenge and is usually prolonged, therefore it is important to carefully diagnose and properly select the therapy regimen for the treatment to be successful, and with minimal side effects, especially for young patients. Apart from the use of essential oils, research is ongoing for new alternative preparations active against Demodex sp. Our review was focused on the analysis of the current literature data on the available agents in the treatment of demodicosis in adults and children.
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Affiliation(s)
- Izabela Chudzicka-Strugała
- Department of Medical Microbiology, Poznan University of Medical Sciences, Rokietnicka 10, 60-806 Poznan, Poland
| | - Iwona Gołębiewska
- Earth and Life Institute (ELI), Université Catholique de Louvain, Croix du Sud 2, 1348 Louvain-La-Neuve, Belgium
- Correspondence:
| | - Grzegorz Brudecki
- Group 42 (Healthcare), Masdar City, Abu Dhabi P.O. Box 112778, United Arab Emirates
| | - Wael Elamin
- Group 42 (Healthcare), Masdar City, Abu Dhabi P.O. Box 112778, United Arab Emirates
| | - Barbara Zwoździak
- Department of Medical Microbiology, Poznan University of Medical Sciences, Rokietnicka 10, 60-806 Poznan, Poland
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Amitay‐Laish I, Solomon‐Cohen E, Feuerman H, Didkovsky E, Davidovici B, Leshem YA, Pavlovsky L, Reiter O, Mimouni D, Hodak E, Segal R. Facial demodicosis in the immunosuppressed state: a retrospective case series from a tertiary referral center. Int J Dermatol 2022; 61:1245-1252. [DOI: 10.1111/ijd.16162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 01/18/2022] [Accepted: 03/04/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Iris Amitay‐Laish
- Division of Dermatology Rabin Medical Center – Beilinson Hospital Petach Tikva Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Efrat Solomon‐Cohen
- Division of Dermatology Rabin Medical Center – Beilinson Hospital Petach Tikva Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Hana Feuerman
- Division of Dermatology Rabin Medical Center – Beilinson Hospital Petach Tikva Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Elena Didkovsky
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
- Institute of Pathology Rabin Medical Center – Beilinson Hospital Petach Tikva Israel
| | - Batya Davidovici
- Division of Dermatology Rabin Medical Center – Beilinson Hospital Petach Tikva Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Yael A. Leshem
- Division of Dermatology Rabin Medical Center – Beilinson Hospital Petach Tikva Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Lev Pavlovsky
- Division of Dermatology Rabin Medical Center – Beilinson Hospital Petach Tikva Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Ofer Reiter
- Division of Dermatology Rabin Medical Center – Beilinson Hospital Petach Tikva Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Daniel Mimouni
- Division of Dermatology Rabin Medical Center – Beilinson Hospital Petach Tikva Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Emmilia Hodak
- Division of Dermatology Rabin Medical Center – Beilinson Hospital Petach Tikva Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Rina Segal
- Division of Dermatology Rabin Medical Center – Beilinson Hospital Petach Tikva Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
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Forton FM. Rosacea, an infectious disease: why rosacea with papulopustules should be considered a demodicosis. A narrative review. J Eur Acad Dermatol Venereol 2022; 36:987-1002. [DOI: 10.1111/jdv.18049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 02/22/2022] [Indexed: 11/28/2022]
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The Pathogenic Role of Demodex Mites in Rosacea: A Potential Therapeutic Target Already in Erythematotelangiectatic Rosacea? Dermatol Ther (Heidelb) 2020; 10:1229-1253. [PMID: 33095403 PMCID: PMC7649190 DOI: 10.1007/s13555-020-00458-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Indexed: 12/15/2022] Open
Abstract
Rosacea is a common facial dermatosis but its definition and classification are still unclear, especially in terms of its links with demodicosis. Triggers of rosacea (ultraviolet light, heat, spicy foods, alcohol, stress, microbes) are currently considered to induce a cascading innate and then adaptive immune response that gets out of control. Recent histological and biochemical studies support the concept that this inflammatory response is a continuum, already present from the onset of the disease, even when no clinical signs of inflammation are visible. The Demodex mite is beginning to be accepted as one of the triggers of this inflammatory cascade, and its proliferation as a marker of rosacea; moreover, the papulopustules of rosacea can be effectively treated with topical acaricidal agents. Demodex proliferation appears to be a continuum process in rosacea, and may not be clinically visible at the onset of the disease. Molecular studies suggest that Demodex may induce tolerogenic dendritic cells and collaborate with vascular endothelial growth factor (VEGF) to induce T cell exhaustion and favor its own proliferation. These interactions among VEGF, Demodex, and immunity need to be explored further and the nosology of rosacea adapted accordingly. However, treating early rosacea, with only clinically visible vascular symptoms, with an acaricide may decrease early inflammation, limit potential flare-ups following laser treatment, and prevent the ultimate development of the papulopustules of rosacea. The effectiveness of this approach needs to be confirmed by prospective controlled clinical trials with long-term follow-up. Currently, the evidence suggests that patients with only vascular symptoms of rosacea should be carefully examined for the presence of follicular scales as signs of Demodex overgrowth or pityriasis folliculorum so that these patients, at least, can be treated early with an acaricidal cream.
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Comparison of the efficacy of tea tree ( Melaleuca alternifolia) oil with other current pharmacological management in human demodicosis: A Systematic Review. Parasitology 2020; 147:1587-1613. [PMID: 32772960 DOI: 10.1017/s003118202000150x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Various treatments are found to be moderately effective in managing Demodex-related diseases except tea tree oil (TTO) and terpinen-4-ol (T4O), which showed superior miticidal and anti-inflammatory effects in numerous clinical studies. Their possible effects include lowering mite counts, relieving Demodex-related symptoms, and modulating the immune system. This review summarizes the current clinical topical and oral treatments in human demodicosis, their possible mechanisms of action, side-effects and resistance in treating this condition. TTO (especially T4O) is found to be the most effective followed by metronidazole, ivermectin and permethrin in managing the disease. This is because TTO has anti-parasitic, anti-bacterial, anti-fungal, anti-inflammatory and wound-healing effects. Furthermore, nanoTTO can even release its contents into fungus and Pseudomonas biofilms. Combinations of different treatments are occasionally needed for refractory cases, especially for individuals with underlying genetic predisposal or are immuno-compromised. Although the current treatments show efficacy in controlling the Demodex mite population and the related symptoms, further research needs to be focused on the efficacy and drug delivery technology in order to develop alternative treatments with better side-effects profiles, less toxicity, lower risk of resistance and are more cost-effective.
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Luo X, Li J, Chen C, Tseng S, Liang L. Ocular Demodicosis as a Potential Cause of Ocular Surface Inflammation. Cornea 2018; 36 Suppl 1:S9-S14. [PMID: 28902017 DOI: 10.1097/ico.0000000000001361] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Among different species of mites, Demodex folliculorum and Demodex brevis are the only 2 that affect the human eye. Because demodicosis is highly age-dependent and can be found in asymptomatic adults, the pathogenicity of these mites has long been debated. In this study, we summarize our research experience including our most recent study regarding Demodex infestation as a potential cause of ocular inflammatory diseases. Specifically, we describe the pathogenesis of demodicosis and then discuss the results of work investigating the associations and relationships between ocular demodicosis and blepharitis, meibomian gland diseases, and keratitis, in turn. This is followed by some discussion of the diagnosis of demodicosis and concludes with a brief discussion of evidence for different treatments for ocular demodicosis. Collectively, our studies suggest a strong correlation between ocular demodicosis and ocular surface inflammatory conditions, such as blepharitis, chalazia, meibomian gland dysfunction, and keratitis. Further investigation of the underlying pathogenic mechanism is warranted.
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Affiliation(s)
- Xiaohui Luo
- *State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Ocular Surface Center, Sun Yat-sen University, Guangzhou, China;†Ocular Surface Center, Miami, FL; and‡Tissue Tech Inc, Miami, FL
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Marciano-Fellous L. [Cutaneous infections: Pathologist's role in unusual or atypical situations]. Ann Pathol 2017; 38:20-30. [PMID: 29287934 DOI: 10.1016/j.annpat.2017.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 10/26/2017] [Indexed: 11/16/2022]
Abstract
In infectious pathology, the gold standard consists of the detection of the pathogen within the sample. Identification of the pathogen is often difficult despite the presence of few and inexpensive tools, such, as special stain, immunohistochemistry, or in situ hybridization specific of the pathogen. In infectious pathology, there are morphological signs, which can guide us towards an etiology. We present some clinicopathological examples illustrating rare or unusual situations in cutaneous infectious pathology.
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Affiliation(s)
- Léa Marciano-Fellous
- Département de pathologie, groupe hospitalier Henri-Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France.
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Murphy O, O'Dwyer V, Lloyd-McKernan A. The efficacy of tea tree face wash, 1, 2-Octanediol and microblepharoexfoliation in treating Demodex folliculorum blepharitis. Cont Lens Anterior Eye 2017; 41:77-82. [PMID: 29074306 DOI: 10.1016/j.clae.2017.10.012] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 10/12/2017] [Accepted: 10/13/2017] [Indexed: 01/08/2023]
Abstract
PURPOSE To compare the efficacy of Dr Organic Tea Tree Face Wash, OcuSoft Lids Scrub Plus and the BlephEx™ device at treating of Demodex folliculorum blepharitis. METHODS Eighty-six subjects (33 males/36 females) were enrolled in a randomised controlled interventional treatment study. Subjects completed a dry eye symptom questionnaire and were assessed for presence of Demodex folliculorum. Subjects were divided into three groups according to treatment: Dr Organic Tea Tree Face Wash (A) (n=28), OcuSoft Lid Scrub Plus (B) (n=30), or in-house lid scrub with the BlephEx™ device before nightly lid scrubs with OcuSoft Lid Scrub Plus (C) (n=28). Subjects were advised to clean their eyelids nightly for four weeks. Each subject was re-assessed for symptoms and Demodex folliculorum blepharitis after two weeks and four weeks of treatment. RESULTS The quantity of Demodex folliculorum was significantly reduced after four weeks of treatment in all three groups (p<0.05). Overall, there was no difference in efficacy between the three treatments (p>0.1). Symptoms reported by subjects were significantly improved after two and four weeks of treatment (p<0.05). Overall, there was no difference in efficacy between the three treatments to reduce symptoms after two or four weeks (p= 0.813 and p=0.646 respectively). CONCLUSION All three methods tested have shown good ability to reduce Demodex folliculorum quantity, improve subjective symptoms and help treat Demodex folliculorum blepharitis.
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Chronic lymphocytic lymphoma presenting with recurrent demodicidosis. Ann Allergy Asthma Immunol 2015; 114:426-7. [PMID: 25707323 DOI: 10.1016/j.anai.2015.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 01/19/2015] [Accepted: 01/21/2015] [Indexed: 11/22/2022]
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Liang L, Ding X, Tseng SC. High prevalence of demodex brevis infestation in chalazia. Am J Ophthalmol 2014; 157:342-348.e1. [PMID: 24332377 DOI: 10.1016/j.ajo.2013.09.031] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Revised: 09/26/2013] [Accepted: 09/27/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE To investigate the correlation between demodicosis and chalazia in patients with the latter. DESIGN Prospective, observational, comparative study. METHODS Forty-four adult and 47 pediatric patients with chalazia and 34 adult and 30 pediatric age- and sex-matched patients without chalazia treated at an institutional referral eye center were included. All 155 patients underwent lash sampling followed by microscopic identification and counting of Demodex mites. All 91 patients with chalazia underwent surgical removal, and among them, 74 were followed up for 18 ± 4.3 months after surgery. Statistical correlation between ocular demodicosis and chalazia and its postoperative recurrence was performed. RESULTS Demodicosis was significantly more prevalent in chalazia patients than in control patients as a group (69.2% vs 20.3%) and when separated into pediatric (70.2% vs 13.3%) and adult (68.2% vs 26.5%) subgroups (all P < .001). Demodicosis was associated strongly with chalazia (odds ratio, 4.39; 95% confidence interval, 2.17 to 8.87; P < .001). D. brevis was significantly more prevalent (odds ratio, 18.21; 95% confidence interval, 2.22 to 149.74; P = .01) than D. folliculorum (odds ratio, 2.82; 95% confidence interval, 1.16 to 6.84, P = .02) in patients with chalazia. Patients with demodicosis tended to demonstrate recurrence (33.3% vs 10.3%; P = .02), especially in those with D. brevis (35.1% vs 13.5%; P = .03). CONCLUSIONS There is a high prevalence of demodicosis, especially cases of caused by D. brevis, in adult and pediatric patients with chalazia, suggesting that ocular demodicosis is a risk factor for chalazia.
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Salem DAB, El-Shazly A, Nabih N, El-Bayoumy Y, Saleh S. Evaluation of the efficacy of oral ivermectin in comparison with ivermectin-metronidazole combined therapy in the treatment of ocular and skin lesions of Demodex folliculorum. Int J Infect Dis 2013; 17:e343-7. [PMID: 23294870 DOI: 10.1016/j.ijid.2012.11.022] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 11/09/2012] [Accepted: 11/18/2012] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To evaluate the efficacy of ivermectin and combined ivermectin-metronidazole therapy in the treatment of ocular and skin lesions of Demodex folliculorum. METHODS One hundred twenty patients with skin lesions and anterior blepharitis, whose infestation was treatment-resistant and who had a Demodex count >5 mites/cm² for skin lesions or ≥ 3 mites at the root of each eyelash, were recruited. The treatment regimens were ivermectin and ivermectin-metronidazole combined therapy. We enrolled 15 patients from each of four groups for each treatment regimen. Demodex was detected by standardized skin surface biopsy for skin lesions. Three eyelashes from each affected lower eyelid were epilated and examined. The study subjects were followed-up once a week for four visits. RESULTS There was a difference in the mite count between the subgroups taking ivermectin and combined therapy during all follow-up visits. At the last visit, in the combined therapy subgroup, 1.7% of patients showed no clinical improvement, 26.7% showed a marked clinical improvement, and 71.6% showed complete remission. In those on the ivermectin regimen, 27 patients had a mite count >5 mites/cm², 21.7% showed no clinical improvement, 33.3% showed a marked improvement, and 45% showed complete remission. CONCLUSIONS Combined therapy was superior in decreasing the D. folliculorum count in all groups and in reducing the mite count to the normal level in rosacea and in anterior blepharitis. On the other hand, the two regimens were comparable in reducing the mite count to the normal level in acne and peri-oral dermatitis lesions.
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Affiliation(s)
- Doaa Abdel-Badie Salem
- Medical Parasitology Department, Faculty of Medicine, Mansoura University, Gomhoria Street, Mansoura City, Egypt.
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Abstract
PURPOSE To report Demodex infestation in pediatric blepharoconjunctivitis. METHODS A retrospective review of 12 patients, with ages from 2.5-11 years, with chronic blepharoconjunctivitis who failed to respond to conventional treatments. Demodex was detected by lash sampling and microscopic examination. Patients were treated with 50% tea tree oil (TTO) eyelid scrubs or 5% TTO ointment eyelid massages for 4-6 weeks. RESULTS Demodex mites were found in all, but 1 case had cylindrical dandruff in the lashes. After 1 week of TTO treatment, all patients showed dramatic resolution of ocular irritation and inflammation while Demodex counts dropped. All corneal signs resolved within 2 weeks except for a residual anterior stromal scar in 1 eye. During a follow-up period of 8.3 ± 4.6 months, 1 patient showed recurrent inflammation, which was successfully managed by a second round of TTO treatment. CONCLUSIONS Demodicosis should be considered as a potential cause of pediatric refractory blepharoconjunctivitis. Eyelid scrubs or massage with TTO could be an effective treatment regimen in these cases.
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Hsu CK, Hsu MML, Lee JYY. Demodicosis: A clinicopathological study. J Am Acad Dermatol 2009; 60:453-62. [DOI: 10.1016/j.jaad.2008.10.058] [Citation(s) in RCA: 117] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2008] [Revised: 10/29/2008] [Accepted: 10/29/2008] [Indexed: 11/30/2022]
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Handa S, Narang T, Wanchu A. Dermatologic Immune Restoration Syndrome: Report of Five Cases from a Tertiary Care Center in North India. J Cutan Med Surg 2008; 12:126-32. [DOI: 10.2310/7750.2008.07017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Dermatologic conditions are often an early clue to human immunodeficiency virus (HIV) infection. As the disease progresses and the host immunity fails, patients may develop a number of skin conditions. At this point, they have a dominant T helper 2 immunologic response. After the initiation of antiretroviral therapy, the T helper 1 response is restored, and some skin problems, paradoxically, make their appearance then. Conclusion: Herpes zoster, mucocutaneous herpes, eosinophilic folliculitis, and mycobacterial infections have been known to occur at this stage. This may be because immune restoration of a host's immunity causes recognition of silent or latent infection and results in development of the condition. We report five cases that were seen at our center during a 2-year period.
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Affiliation(s)
- Sanjeev Handa
- From the Department of Dermatology, Venereology and Leprology and Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Tarun Narang
- From the Department of Dermatology, Venereology and Leprology and Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajay Wanchu
- From the Department of Dermatology, Venereology and Leprology and Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Yagdiran Düzgün O, Aytekin S. Comparison of Demodex folliculorum density in haemodialysis patients with a control group. J Eur Acad Dermatol Venereol 2007; 21:480-3. [PMID: 17373974 DOI: 10.1111/j.1468-3083.2007.01926.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Demodex folliculorum (DF) is resident in human pilosebaceous follicles. Mite density is low in healthy skin. Many cases of demodicosis in association with immunosuppression have been reported. Patients undergoing haemodialysis are also immunosuppressed. OBJECTIVE We aimed to compare the Demodex folliculorum density in haemodialysis patients and healthy subjects. METHODS Mite density of 87 patients undergoing haemodialysis was compared with that of age- and sex-matched controls. Two samples of standardized skin surface biopsies were taken from each subject from the forehead, cheek and nose. The number of mites counted on the surface area of 1 cm2 was accepted as the density of DF. The length and width of mites were measured by oculometer. RESULTS DF density was found in 17 (19.54%) of the 87 dialysis patients and in 9 (10.34%) of 87 controls. A mean mite density of 5.11+/-5.65 was found in dialysis patients and of 2.55+/-1.6 in controls. Differences between the two groups in mite density were not statistically significant (P=0.13). There was also no significant difference in mite length between the two groups (P=0.06). There was, however, a significant difference in mite width (P=0.018). CONCLUSION Despite the presence of sebaceous gland atrophy in haemodialysis patients, the higher density of DF in these patients than controls supports the supposition that this mite can increase immunosuppression.
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Clyti E, Klisnik J, Sainte-Marie D, Pradinaud R, Couppié P. Placards papulo-croûteux prurigineux des régions malaires. Ann Dermatol Venereol 2007; 134:79-80. [PMID: 17384555 DOI: 10.1016/s0151-9638(07)89001-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- E Clyti
- Service de Dermatologie, Centre Hospitalier Andrée Rosemon de Cayenne, BP 6006, 97306 Cayenne Cedex.
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Abstract
Pruritic papular eruption (PPE) is characterized chronic pruritus and symmetric papular eruptions on the trunk and extremities with the absence of other definable causes of itching in an HIV-infected patient. PPE seems to be much more prevalent in less developed regions of the world. The etiology of this distressing condition is unclear, although an inappropriate response to an exogenous agent, such as arthropod bites, may underlie the pathogenesis. Identifying PPE's association with the immune dysregulation of HIV and distinguishing this condition from other pruritic disorders found in HIV-infected patients is important for optimal management.
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Affiliation(s)
- Samantha Eisman
- Division of Dermatology, Groote Schuur Hospital, Anzio Road, Observatory 7925, South Africa.
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Clyti E, Nacher M, Sainte-Marie D, Pradinaud R, Couppie P. Ivermectin treatment of three cases of demodecidosis during human immunodeficiency virus infection. Int J Dermatol 2006; 45:1066-8. [PMID: 16961510 DOI: 10.1111/j.1365-4632.2006.02924.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Demodecidosis is an ectoparasitosis that is infrequently observed in subjects with human immunodeficiency virus (HIV) infection. It has a rosacea-like presentation. We present three cases in patients with acquired immunodeficiency syndrome (AIDS). Two of these patients had a profuse eruption, and all three cases were cured by ivermectin. The single-dose treatment could be repeated in cases of subsequent recurrence. Ivermectin thus seems to be a good alternative in the treatment of demodecidosis in patients with HIV infection.
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Affiliation(s)
- Emmanuel Clyti
- Institut Guyanais de Dermatologie Tropicale, Service de Dermatologie, Center Hospitalier de Cayenne, Cayenne, France.
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NAKAGAWA T, SASAKI M, FUJITA K, NISHIMOTO M, TAKAIWA T. Demodex folliculitis on the trunk of a patient with mycosis fungoides. Clin Exp Dermatol 2006. [DOI: 10.1111/j.1365-2230.1996.tb00041.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Jing X, Shuling G, Ying L. Environmental scanning electron microscopy observation of the ultrastructure of Demodex. Microsc Res Tech 2005; 68:284-9. [PMID: 16315233 DOI: 10.1002/jemt.20253] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In this study, numbers of Demodex of hair follicles and sebaceous glands were prepared and the ultrastructure (especially the mouthparts) of Demodex was observed firstly with environmental scanning electron microscopy (ESEM). The most suitable treatment methods and optimal environmental condition for observing the genus samples were found. The samples were washed with detergent and rinsed with distilled water, and then were taken to the specimen stage, on which there was carbon adhesive tape, using special tools. When the temperature was at 5 degrees C and chamber pressure at 5 mbar respectively, the surface of the samples could be fully imaged without covering water or dehydration. The sample surfaces were plump and clear without postmortem changes and charging artifacts. Detailed information about each part of Demodex was observed by ESEM, and clear three-dimensional images were recorded. The mouthparts of D. folliculorum were composed of a complex set of structures, which included a round oral opening, a sharp oral needle, and a special hypostome that looked like a longitudinal spindle in the central position. On the end segment of palpus, there were seven strong palpal claws located on each side of the mouthparts. D. folliculorum had special piercing mouthparts, while the mouthparts of D. brevis were a simpler structure. We could not observe the oral needle of D. brevis, and there were only five pairs of palpal claws on the end segment of palpus. The offensive organs of Demodex resulted in its pathogenic effects. After studying hundreds of Demodex, we identified both female and male species of D. folliculorum, but only females of D. brevis in our sample.
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Affiliation(s)
- Xu Jing
- Instrumental Analysis Center, Shandong Institute of Light Industry, Jinan 250100, People's Republic of China.
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Herron MD, O'reilly MA, Vanderhooft SL. Refractory Demodex folliculitis in five children with acute lymphoblastic leukemia. Pediatr Dermatol 2005; 22:407-11. [PMID: 16190988 DOI: 10.1111/j.1525-1470.2005.00103.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
We report five children with acute lymphocytic leukemia on maintenance chemotherapy who had Demodex folliculitis. None experienced complete clearing when treated with permethrin 5% cream. Topical metronidazole helped to lessen the eruption in four, but did not provide full clearing. The one child who was treated with sodium sulfacetamide 10%, sulfur 5% formulation had resolution of the eruption. We suggest that treatment of Demodex folliculitis in children with acute lymphocytic leukemia is more difficult than is suggested in the literature. Newer sodium sulfacetamide/sulfur formulations should be considered when treating this condition, particularly in children with acute lymphocytic leukemia.
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Affiliation(s)
- Mark D Herron
- Department of Dermatology, University of Utah School of Medicine, Salt Lake City, Utah 84132, USA
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23
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Clyti E, Sayavong K, Chanthavisouk K. Démodécie chez un malade infecté par le VIH : guérison par ivermectine. Ann Dermatol Venereol 2005; 132:459-61. [PMID: 15988358 DOI: 10.1016/s0151-9638(05)79308-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Demodex is a saprophyte parasite in mammals. In Man, it is associated with differing clinical profiles (rosacea-like dermatitis, folliculitis and blepharitis). We report a case of demodecidosis in an HIV-infected patient that was successfully treated with ivermectin. CASE REPORT A man from Laos, infected by HIV and treated for glandular tuberculosis, presented with a prurigenous eruption on the face and the pre-sternal and interscapular areas. Direct examination of scraped product and histopathological examinations confirmed the diagnosis of demodecidosis. Clinical cure was obtained after 2 single cures of ivermectin a one month's distance. DISCUSSION The features of demodecidosis are often similar to those of rosacea. In immunodeficient patients, the semiology remains the same but the eruption is more abundant. During HIV-infection, demodecidosis occurs at the AIDS stage or with a CD4 count lower than 200/mm3. Many anti-dust mite molecules are used to treat the disease but frequently lead to irritation. Administration of a single cure of ivermectin, repeated if necessary, appears to be an interesting alternative to contact anti-dust mite agents.
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Affiliation(s)
- E Clyti
- Service de Dermatologie, Institut Guyanais de Dermatologie Tropicale, Hôpital de Cayenne, Guyane Française
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24
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Forton F, Germaux MA, Brasseur T, De Liever A, Laporte M, Mathys C, Sass U, Stene JJ, Thibaut S, Tytgat M, Seys B. Demodicosis and rosacea: Epidemiology and significance in daily dermatologic practice. J Am Acad Dermatol 2005; 52:74-87. [DOI: 10.1016/j.jaad.2004.05.034] [Citation(s) in RCA: 111] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Delfos NM, Collen AFS, Kroon FP. Demodex folliculitis: a skin manifestation of immune reconstitution disease. AIDS 2004; 18:701-2. [PMID: 15090780 DOI: 10.1097/00002030-200403050-00019] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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26
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Abstract
Folliculitis is an inflammatory reaction in the superficial aspect of the hair follicle and can involve the follicular opening or the perifollicular hair follicles. The pilosebaceous unit of the follicle is divided into three compartments: the infundibulum (superficial part, outlined by the sebaceous duct), the isthmus (between the sebaceous duct and arrector pili protuberance), and the inferior segment (stem and hair bulb). This anatomical scheme forms the basis for any evaluation of the clinical manifestations of folliculitis. Most of the follicular conditions can be classified according to their anatomical location and histopathologic patterns. Clinically, the inflammation manifests as 1mm-wide vesicles, pustules, or papulopustules in acute cases; however, hyperkeratosis and keratotic plug formations are indicative of a chronic process. The presence of superficial pustules does not always imply an infectious origin, as there are many noninfectious types of folliculitis. In this review, we describe the different types of folliculitis based on their etiology, clinical manifestation, and treatment. We also discuss some newly described disorders and the latest information on their treatment.
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Abstract
A 53-year-old man had a 6-week history of confluent erythematous papules, pustules, and abscesses of the face initially limited to the right nasolabial fold. Histologic investigation revealed a perifollicular infiltrate with lymphocytes, histiocytes, and many Demodex folliculorum mites. A large number of mites were seen in skin scrapings. The skin manifestations progressed and persisted for the following 5 years and were unresponsive to numerous antiparasitic treatments, including repeated oral administration of ivermectin and external application of lindane, permethrin, and benzoyl benzoate. Therapy with oral administration of 250 mg metronidazole 3 times a day for 2 weeks resulted in rapid and lasting recovery. Demodex folliculitis remains a diagnostic and therapeutic challenge. Antiparasitic therapies used against lice or scabies may fail in control of D folliculorum mites. In the presence of clinical and microscopic findings typical of Demodex folliculitis or abscesses, treatment failure with acaricidal agents does not exclude the diagnosis. Oral metronidazole seems to work in the management of this chronic mite infestation.
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Affiliation(s)
- Martin Schaller
- Department of Dermatology and Allergology, University of Munich, Germany.
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28
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Morrás PG, Santos SP, Imedio IL, Echeverría ML, Hermosa JMH. Rosacea-like demodicidosis in an immunocompromised child. Pediatr Dermatol 2003; 20:28-30. [PMID: 12558842 DOI: 10.1046/j.1525-1470.2003.03006.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Demodex folliculorum is a saprophytic mite of the human pilosebaceous unit. It is rarely found in children. It has been implicated in the development of follicular pityriasis, rosacea-like demodicidosis, pustular folliculitis, blepharitis, and granulomatous rosacea. We describe a 4-year-old boy who developed asymptomatic facial lesions that histologically corresponded to demodicidosis. He was in clinical remission of acute lymphoblastic leukemia and currently receiving maintenance chemotherapy. Exanthems related to D. folliculorum are rare in children. Most cases occur in immunocompromised patients and the clinical and histologic findings are diverse. A differential diagnosis should be established with rosacea and perioral dermatitis. The role of Demodex in the pathogenesis of these disorders is controversial. Immunosuppression might increase the number of mites, favoring an inflammatory reaction, or there could exist an impaired cutaneous immunologic response to the parasites.
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29
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Akdeniz S, Bahceci M, Tuzcu AK, Harman M, Alp S, Bahceci S. Is demodex folliculorum larger in diabetic patients? J Eur Acad Dermatol Venereol 2002; 16:539-41. [PMID: 12428862 DOI: 10.1046/j.1468-3083.2002.00545_7.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Basta-Juzbasić A, Subić JS, Ljubojević S. Demodex folliculorum in development of dermatitis rosaceiformis steroidica and rosacea-related diseases. Clin Dermatol 2002; 20:135-40. [PMID: 11973047 DOI: 10.1016/s0738-081x(01)00244-9] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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31
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Jansen T, Kastner U, Kreuter A, Altmeyer P. Rosacea-like demodicidosis associated with acquired immunodeficiency syndrome. Br J Dermatol 2001; 144:139-42. [PMID: 11167695 DOI: 10.1046/j.1365-2133.2001.03794.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We present a 35-year-old patient with acquired immunodeficiency syndrome who had demodicidosis on his face, characterized by multiple papules and papulopustules, associated pruritus, numerous mites on skin-surface biopsy and in biopsy specimens, and rapid response to topical treatment with permethrin. It seems likely that Demodex infestation does not manifest unless local or systemic immune function is altered, leading to the proliferation of the organism and subsequent disease.
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Affiliation(s)
- T Jansen
- Department of Dermatology and Allergology, Ruhr-University Bochum, Gudrunstrasse 56, 44791 Bochum, Germany
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32
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Abstract
BACKGROUND Demodex folliculorum (DF), which is a resident in human pilosebaceous follicles, has been implicated in rosacea, blepharitis, pityriasis folliculorum, pustular folliculitis, and skin lesions of immunosuppressed patients on chemotherapy or with acquired immunodeficiency syndrome (AIDS). OBJECTIVE We aimed to determine the influence of pregnancy on the carriage of DF. METHODS Mite density in 40 pregnant women was compared with that of age- and sex-matched controls. Two standardized skin surface biopsies were taken from each subject. Results In pregnant women, DF was found at 0.55/cm2, compared with a mean value of 1.2/ cm2 in nonpregnant controls. The difference between the two groups was not statistically significant (Mann-Whitney test, P = 0.22). CONCLUSIONS Our findings indicate that pregnancy may not have a direct effect on mite density.
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Affiliation(s)
- I E Aydingöz
- Department of Dermatology, Haydarpaşa Numune Hospital, Istanbul, Turkey
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34
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Breuer-McHam JN, Marshall GD, Lewis DE, Duvic M. Distinct serum cytokines in AIDS-related skin diseases. Viral Immunol 1999; 11:215-20. [PMID: 10189188 DOI: 10.1089/vim.1998.11.215] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
To determine whether common skin diseases associated with human immunodeficiency virus (HIV) were distinguishable based on the pattern of serum cytokine expression, we studied patients with psoriasis, pruritus, and Kaposi's sarcoma (KS) for levels of tumor necrosis factor (TNF)-alpha, interferon-gamma (IFN-y), interleukin (IL)-10, and IL-4. Thirty-two HIV-positive (HIV+) patients including 8 with KS, 11 with psoriasis, and 13 with pruritus along with 16 HIV-negative subjects with psoriasis were studied. IFN-gamma levels were highest in sera of HIV+ patients with psoriasis (p = 0.040). By contrast, TNF-alpha and IL-10 levels were highest in sera of HIV+ patients with pruritus (p = 0.012). Detectable levels of all cytokines in these patients were remarkably higher than for healthy adults. These results suggest that common skin diseases associated with HIV infection and AIDS can be distinguished by the production of unique cytokines.
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Affiliation(s)
- J N Breuer-McHam
- Department of Dermatology, The University of Texas Medical School, Houston, USA
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Sarro RA, Hong JJ, Elgart ML. An unusual demodicidosis manifestation in a patient with AIDS. J Am Acad Dermatol 1998; 38:120-1. [PMID: 9448221 DOI: 10.1016/s0190-9622(98)70554-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- R A Sarro
- Department of Dermatology, George Washington School of Medicine, Washington, DC 20037, USA
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36
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Majors MJ, Berger TG, Blauvelt A, Smith KJ, Turner ML, Cruz PD. HIV-related eosinophilic folliculitis: a panel discussion. SEMINARS IN CUTANEOUS MEDICINE AND SURGERY 1997; 16:219-23. [PMID: 9300633 DOI: 10.1016/s1085-5629(97)80045-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Eosinophilic folliculitis is a common cause of morbidity in patients infected with the human immunodeficiency virus (HIV) and a marker of the acquired immunodeficiency syndrome (AIDS). No causative organism has yet been identified, although an aberrant Th2-type immune response to a follicular antigen appears relevant to pathogenesis. A variety of treatments have been reported to minimize the inflammatory component, relieve the concomitant pruritus, and/or favorably alter the cutaneous microenvironment.
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Affiliation(s)
- M J Majors
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas 75235-9292, USA
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37
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38
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Majors MJ, Cockerell CJ, Cruz PD. PRURITUS IN HIV-INFECTED PATIENTS:. Radiol Clin North Am 1997. [DOI: 10.1016/s0033-8389(22)00276-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Abstract
A 15-month-old girl developed acute lymphoblastic leukemia. Chemotherapy had induced a complete remission and she was continued on maintenance therapy. At 3 years of age, she developed an eruption consisting of excoriated papules and pustules on the face. Demodex folliculorum seemed to be the cause. Topical treatment with metronidazole applied twice a day over a period of 2 weeks resulted in partial improvement. The dermatosis finally cleared gradually with oral erythromycin therapy and one overnight application of 1% lindane cream per week for 2 successive weeks.
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Affiliation(s)
- J Castanet
- Department of Dermatology, University of Nice, France
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40
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Stell I, Leen E. HIV-associated eosinophilic pustular folliculitis: The first case reported in a woman. J Am Acad Dermatol 1996; 35:106-8. [PMID: 8682943 DOI: 10.1016/s0190-9622(96)90517-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- I Stell
- Accident and Emergency Department UMDS, Guy's Hospital, U.K
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41
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Abstract
We report a 75-year-old man with a fulminant rosacea-like eruption, suggestive of demodicidosis. Multiple Demodex folliculorum mites were found in facial scales and pustules and, on histological examination, in the infundibulum of pilosebaceous follicles and in the dermis. Intradermal mites were surrounded either by polymorphonuclear granulocytes and histiocytes, or by a granulomatous infiltrate containing foreign-body giant cells, which had phagocytosed the parasites. Complete recovery, with disappearance of facial mites, was achieved by treatment with a combination of oral and topical metronidazole, although this drug is not known to be miticidal.
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Affiliation(s)
- R Hoekzema
- Department of Dermatology, Academisch Medisch Centrum, University of Amsterdam, The Netherlands
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42
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Abstract
Acquired immunodeficiency syndrome was first recognized as a new disease in 1981 because of the unusual association of Kaposi's sarcoma and Pneumocystis carinii pneumonia in young men. The skin remains one of the most important clinical markers for acquired immunodeficiency syndrome, now recognized as the end stage of infection with the human immunodeficiency virus (HIV). Indeed, an urticarial viral exanthem appearing during seroconversion may allow early identification of newly infected individuals who might benefit from administration of antiviral therapy during plasma viremia. The "asymptomatic HIV infection" is often accompanied by multiple skin complaints, which commonly include xerosis, pruritus, psoriasis/seborrheic dermatitis, and pruritic papular eruptions, the cause of which remains controversial. Psoriasis and Kaposi's sarcoma lesions share features including angiogenesis, dermal dendrocytes infected with HIV, and epidermal hyperproliferation, and are manifested by mice transgenic for HIV provirus or Tat-ltr. Changes in the immune system including T-cell function, antigen response, and shifting cytokine expression as well as a propensity for autoimmune reactions must underlie the skin immunodysfunction occurring in the setting of HIV infection. One of the most unsettling controversies suggested by in vitro data is that ultraviolet light, an effective therapy for HIV-related skin disorders, may actually activate the virus.
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Affiliation(s)
- M Duvic
- Department of Dermatology, University of Texas Medical School, Houston, 77030, USA
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Affiliation(s)
- M M Bason
- Department of Dermatology, Louisiana State University Medical Center, New Orleans 70112
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45
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Abstract
A 2-year-old girl developed acute lymphoblastic leukemia at the age of 9 months. She was treated successfully with chemotherapy but developed a pruritic, papulopustular facial eruption that was caused by Demodex folliculorum. The eruption cleared after treatment with one overnight application of 5% permethrin cream. Demodicidosis should be included in the differential diagnosis of facial eruptions in children who undergo chemotherapy and in those with congenital or acquired immunodeficiency.
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Affiliation(s)
- E E Sahn
- Department of Dermatology, Medical University of South Carolina, Charleston 29425-2215
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48
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Bañuls J, Ramon D, Aniz E, Jorda E, Torres V. Papular pruritic eruption with human immunodeficiency virus infection. Int J Dermatol 1991; 30:801-3. [PMID: 1757183 DOI: 10.1111/j.1365-4362.1991.tb04791.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- J Bañuls
- Service of Dermatology, Valencia Clinic Hospital, Spain
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49
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Reply. J Am Acad Dermatol 1991. [DOI: 10.1016/s0190-9622(08)80997-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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50
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