Demodicosis — classification, treatment and its occurrence in immunocompromised patients

Abstract

Demodicosis is a skin disease of the pilosebaceous unit associated with Demodex folliculorum and Demodex brevis that involves mainly face and scalp. The role of the Demodex mites as agents in skin diseases remains controversial. They are commensal organisms; however, they are also thought to be pathogens in e.g. rosacea. A revised classification was proposed in 2014 dividing demodicosis into primary and secondary form. Secondary demodicosis can be diagnosed when in patients with inflammatory skin disorders or systemic diseases there is an abnormal increase of Demodex mites resulting in skin lesions. Perioral dermatitis, rosacea, seborrhoeic dermatitis, treatment with topical corticosteroids or calcineurin inhibitors are examples of those conditions. Secondary demodicosis is also associated with treatment with epidermal growth factor inhibitors, transplant patients, patients with malignancy, HIV infection, chronic renal failure, diabetes and during phototherapy treatment. Demodicosis should be considered as a differential diagnosis in immunocompromised patients.