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Abstract: Cutaneous larva migrans (CLM) is an ectoparasitic infestation predominantly caused by nematodes, specifically Ancylostoma braziliense and Ancylostoma caninum , found in tropical and subtropical regions. Although follicular involvement by the parasite is a rare manifestation, with approximately 20 cases reported in the English literature, its pathogenesis remains underexplored. The present study reports 2 cases of CLM presenting with follicular involvement in patients with pruritic lesions following travel to subtropical areas. The first of them is a 32-year-old woman who developed an abdominal skin lesion subsequent to a trip to Thailand and the second is a 28-year-old woman who exhibited a knee lesion after a volunteer mission in Senegal. Histologic examination revealed characteristic features of CLM, such as nematode larvae traversing the hair follicle. The hookworm larvae were observed creating tunnels within the external root sheath. In addition, they were interfacing with the vitreous layer, sparing the perifollicular connective tissue sheath and the Henle layer, and approaching the vicinity of the hair bulb. The application of skin ultrasound to guide the biopsy facilitated the visualization and identification of the parasite within the follicle in the latter case. This study not only underscores follicular involvement in CLM but also provides insights into its anatomopathological presentation and spread through the hair follicle., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Two adolescent boys presented with acute acneiform eruptions in the setting of recent dupilumab administration. Subsequent investigation via direct scraping of pustules revealed live Demodex mite colonization of the face. These adolescent patients represent a population not commonly associated with Demodex folliculitis, and we theorize their baseline commensal Demodex mite population may have increased as a consequence of dupilumab-induced, focused immunomodulation. We recommend that pediatricians consider Demodex potentially etiologic in patients presenting with new onset acneiform or rosacea-like dermatoses in patients treated with dupilumab., Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2021 by the American Academy of Pediatrics.)

Hookworm-related cutaneous larva migrans is caused by the subcutaneous migration of hookworm larvae. The characteristic sign is a serpiginous cutaneous track. Folliculitis is an uncommon clinical manifestation. We report a case of hookworm-related folliculitis in a woman performing skin bleaching. A 33-year-old woman presented with a widespread cutaneous eruption made of erythematous and itchy follicular papulo-nodules, with erythematous serpiginous tracks, about 5-10cm long and numerous streaks of scratching, located on the limbs, buttocks and trunk. The cutaneous lesions occurred two days after contact with the floor of a warehouse contamined by faeces of cats. The lesions have been evolving for a week and have been treated with antibiotics without success. Clinical examination found cutaneous atrophy, purple stretch marks and hyperpigmentation of dorsal parts of fingers joints. The patient reported having been using bleaching cosmetics containing topical steroids and hydroquinone for twelve years. She was cured within 4 weeks with oral albendazole 400mg per day during 7 consecutive days., Competing Interests: The authors have no conflicts of interest to declare

Objective: Acne vulgaris is an inflammatory disease involving the pilosebaceous unit. Rosacea is a chronic inflammatory skin disease that affects the face in particular. This study aimed to determine if skin sebum, pH, and moisture affect the number of Demodex spp. in acne vulgaris and rosacea patients., Methods: This study focused on 30 patients each with acne vulgaris and rosacea. As a control group, 60 healthy individuals were included., Results: In acne vulgaris patients, when compared to those with Demodex mite more than 5 /cm2 in each area, less than 5/cm2 were found to be oily, acidic, dry or very dry. However, there was no significant difference in moisture value. In patients with rosacea, the skin was acidic and dry in patients those with more than 5/cm2 Demodex mites when compared to those with demodex mite less than 5 /cm2 in patients in each of the right cheek and nose areas. There was no difference in skin oil level., Conclusion: The oily, acidic, dry, and very dry skin of the acne vulgaris patients and the oily, acidic, and very dry skin of the rosacea patients are factors facilitating the development of Demodex ssp.

Competing Interests: Competing interests: None declared.

Demodecidosis is an ectoparasitosis of pilosebaceous unit caused by demodex mites. The disease may be a primary skin disease or a secondary disease to inflammatory dermatoses such as folliculitis and rosacea. Demodex spp. blepharitis is an infectious ocular disease that is common but always neglected. These mites contain lipase enzymes that help carry bacteria on the surface. The infestation of Demodex spp. has increasingly become a public health concern. A 29-year-old male patient was admitted to our dermatology clinic with a complaint of papules and pustules on his face, which started 4 years ago. A standardized skin biopsy specimen was evaluated in our microbiology laboratory, and we detected Demodex folliculorum mites on his face (3+). There was pruritus of his eyes. A total of four eyelashes were epilated and were then examined under a light microscope for the presence of Demodex infestation. In this study, we discussed the association between acne rocacea, blepharitis, and demodex mites.

Demodex is a saprophytic mite in humans commonly present in the pilosebaceous units, which has been implicated as a pathogen in several skin conditions. The clinical presentation and histopathology of Demodex folliculitis of the scalp have been described in only a few case reports. This study was performed to further elucidate the clinicopathological features of this entity. We have studied 333 consecutively submitted scalp biopsies performed for hair loss and alopecia. All specimens were completely step-sectioned. Biopsies with Demodex mites were further studied histopathologically, and the patients' clinical files were reviewed. There were 17 biopsies (5.1%) with Demodex in at least 1 pilosebaceous unit. Based on the clinical presentation, histopathology, and response to therapy, Demodex was considered to be nonpathogenic in 13 cases. The remaining 4 cases were characterized by hair loss, scalp erythema, scales, and pustules. There were 2 or more pilosebaceous units with Demodex along mononuclear and/or neutrophilic infiltrates around and in the involved follicles and occasionally granulomas. All 4 cases responded completely to metronidazole therapy. In conclusion, Demodex is infrequently found in scalp biopsies for hair loss and alopecia, and, in most cases, it does not seem to be pathogenic. Occasionally, however, it is associated with folliculitis characterized by hair loss, erythema, scales, and pustules clinically; neutrophilic and/or mononuclear-cell folliculitis with occasional granulomas histopathologically; and a prompt response to anti-Demodex therapy.

Objective: Treatment of Demodex infestations is often inadequate and associated with low effective rate. We sought to evaluate the efficacy of an ornidazole-based sequential therapy for mites folliculitis treatment., Methods: Two-hundred patients with mites folliculitis were sequentially treated with either an ornidazole- or metronidazole-based regimen. Sebum cutaneum was extruded from the sebaceous glands of each patient's nose and the presence of Demodex mites were examined by light microscopy. The clinical manifestations of relapse of mites folliculitis were recorded and the subjects were followed up at 2, 4, 8, and 12 weeks post-treatment., Results: Patients treated with the ornidazole-based regimen showed an overall effective rate of 94.0%. Additionally, at the 2, 4, 8, and 12-week follow-up, these patients had significantly lower rates of Demodex mite relapse and new lesion occurrence compared with patients treated with the metronidazole-based regimen (P < 0.05)., Conclusion: Sequential therapy using ornidazole, betamethasone, and recombinant bovine basic fibroblast growth factor (rbFGF) gel is highly effective for treating mites folliculitis., Competing Interests: The authors have no conflicts of interest to disclose.

Purpose: To report an unusual case of Demodex folliculitis presenting as periocular vesiculopustular rash., Design: Case report., Results: A 68 year-old woman presented with a unilateral periocular rash that was initially treated by her primary ophthalmologist with topical steroids and antivirals. Slit-lamp examination revealed severe bilateral blepharitis, right greater than left, with waxy sleeves around the eyelashes. The diagnosis of Demodex infestation was considered. Treatment with daily lid scrub with polyhexamethylene biguanide (PHMB), 1,2-hexanediol and 1,2-octanediol (OCuSOFT PLUS) and erythromycin ointment twice a day resulted in complete resolution of the symptoms after 4 weeks., Conclusions: Ophthalmologists should be aware of Demodex and consider it in the differential diagnosis of periocular skin lesions.

Importance: Acute graft-vs-host disease (GVHD) typically requires high-dose systemic steroids as first-line treatment. Like drug eruptions, viral exanthema, and toxic erythema of chemotherapy, Demodex folliculitis is a clinical mimicker of acute GVHD and requires nonimmunosuppressive therapy. This case of Demodex folliculitis mimicking acute GVHD highlights the need for skin biopsy in patients who have undergone a stem cell transplant with eruptions on the head and neck., Observations: A 46-year-old white woman with a history of Fms-like tyrosine kinase 3 acute myeloid leukemia presented to the dermatology clinic with a 5-day history of a nonpruritic eruption on her face and neck 28 days after undergoing a double umbilical cord blood hematopoietic stem cell transplant (HSCT). Findings from the skin biopsy demonstrated a deep dermal lymphocytic infiltrate adjacent to follicular units along with an abundance of Demodex mites noted within the hair follicles consistent with Demodex folliculitis. Oral ivermectin, 12 mg, was given, and the eruption cleared within 24 hours., Conclusions and Relevance: To our knowledge, this is only the fifth reported case of Demodex folliculitis following HSCT, but the first ever reported to be successfully treated with oral ivermectin. Demodex folliculitis should be added to the differential diagnosis of skin eruptions that arise after HSCT.

Sterile eosinophilic folliculitis, a clinical entity first described by Ofuji in 1970, is a rather rare skin disorder, in particular in the non-Asian population. We report the first case of eosinophilic folliculitis associated with toxocariasis in a Caucasian patient. Topical and systemic anti-inflammatory and antiphlogistic therapy along with systemic antihelminthic treatment resulted in complete remission of the skin lesions. In addition, there was a marked decrease of antibodies to Toxocara antigens in the patient's serum following antihelminthic therapy. Given that (I) some cases of eosinophilic folliculitis have been reported which were associated with infestation with metazoan parasites; (2) infestations with the roundworm Toxocara canis are known to induce eosinophilic reactions in some tissues; and (3) therapy-induced remission of eosinophilic folliculitis was accompanied by a decrease of Toxocara-directed antibodies in the patient's serum, we propose that there is an aetiopathogenic link between toxocariasis and eosinophilic folliculitis in this patient.

Infectious folliculitis of the head and neck has various etiologies, including bacteria, viruses, fungi, and parasites. Accurate morphologic recognition of microorganisms in biopsy and cytologic specimens is paramount in facilitating appropriate therapy. We report a case of a 37-yr-old white male with Demodex folliculitis, who presented with an extensive and painful erythematous pustular skin lesion along the right face and scalp in a dermatome pattern clinically suggestive of Varicella zoster. Examination of scraped smears obtained from one of these pustules revealed numerous parasitic organisms having morphologic features typical of Demodex. Herein, we describe the patient's clinical presentation, discuss the cytologic findings of scrape smears, and briefly review the literature., (2006 Wiley-Liss, Inc.)

Folliculitis is a common complaint and its etiology may be related to a variety of factors. We examine a case involving a 57-year-old white man presenting with scalp erythema and folliculitis secondary to Demodex mite infestation. We discuss the pathophysiology of Demodex folliculitis, as well as the epidemiology, clinical manifestation, diagnosis, and treatment of this infection.

Two patients presented with papular eruptions that could not be diagnosed clinically. Biopsies of these lesions showed eosinophilic pustular folliculitis (EPF). Both cases were subsequently found to have infestations: one as a result of cutaneous larva migrans was successfully treated with ivermectin and the other caused by scabies mites was successfully treated with topical pyrethrin. The two cases of EPF presented emphasize the need for careful clinicopathological correlation to determine the cause.

Seven patients (four men, three women, mean age 31 years), all returning from the tropics, presented with pruritic folliculitis and creeping eruption. The folliculitis consisted of 20-100 follicular papules and pustules confined to a particular area of the body, mainly the buttocks. The creeping eruption consisted of two to 10 serpiginous or linear burrows 1-5 cm long located either in the same area or in a different area from the folliculitis. Five patients were cured with one to three courses of ivermectin (one course in two cases, two courses in two cases and three courses in one case) and two patients were cured with a 3-day regimen of albendazole. Folliculitis should be added to the dermatological manifestations of cutaneous larva migrans. Treatment is more difficult than in classical forms of cutaneous larva migrans.

Examination of 388 follicles in 24 large resections of skin for the presence of histologic folliculitis and Demodex mites uncovered a nonrandom association between these two phenomena. Demodex mites were found in 42% of follicles with inflammation, but in just 10% of the follicles without inflammation. Eighty-three percent of follicles with Demodex showed inflammation. The probability that this result could occur by random chance alone was < 0.001, thus suggesting that Demodex is associated with histologic folliculitis, even minor folliculitis. The results do not, however, decide whether Demodex is causative, whether it preferentially selects follicles with histologic inflammation, or whether some of both processes operate.

A 43-year-old man with tumour stage mycosis fungoides developed multiple follicular pustules on the trunk during total-skin electron beam therapy. A potassium hydroxide preparation of the contents of the pustules revealed the presence of Demodex mites. The patient was treated with 6% sulphur lotion with rapid improvement of the cutaneous lesions. We believe that this case represents a pustular folliculitis caused by Demodex mites. Immunosuppression associated with mycosis fungoides and its treatment may have resulted in the proliferation of this obligate parasite of the pilosebaceous follicle, and the development of the folliculitis.

We sought to define the light microscopic features of eosinophilic folliculitis as it occurs in human immunodeficiency virus (HIV)-infected individuals. The histologic findings of 52 biopsies from 50 patients were graded and compared with six biopsies of suppurative folliculitis from HIV-infected individuals. In all patients, clinical examination showed an eruption of pruritic follicular papules, and the folliculocentric nature of the disorder was confirmed histologically. Perifollicular infiltrates of lymphocytes and eosinophils were identified in all study biopsies, and there was also spongiosis of follicular epithelium. The inflammatory reaction was focused at the level of the follicular isthmus and the sebaceous duct. In all biopsies, lymphocytes and/or eosinophils were present within spongiotic follicular epithelium, but intrafollicular neutrophils were rare. Sebaceous glandular inflammation, eosinophilic pustule formation, and follicular rupture were present in less than half of the biopsies. Small numbers of microbes (bacteria, yeast, Demodex) were identified in 25% of the study biopsies in routine or special stains, but the organisms were away from areas of inflammation and were interpreted as nonpathogenic flora. The biopsies of suppurative folliculitis differed in that neutrophils and macrophages predominated in the infiltrate, microorganisms were readily identified in the inflammatory reaction, and the involved follicle was often ruptured. We believe that eosinophilic folliculitis is a unique HIV-associated dermatosis distinguishable from other folliculitides and papular dermatitides by clinical examination and light microscopy. We present our diagnostic approach.

Fleas were identified after being collected from 129 dogs and 38 cats of random breed, sex and age. All these animals, infested with fleas and admitted to the Clinic of Medicine of the Veterinary Faculty in Thessaloniki for routine procedures, were from different habitats and originated from various parts of northern Greece. Ctenocephalides canis was the most common species found on the dogs (71.3%). Conversely, its prevalence in the 14 cats was substantially lower (5.3%). Ctenocephalides felis was found on 97.4% of the cats and 40.3% of the dogs surveyed. Of the other flea species, with much lower prevalence, Pulex irritans (0.8%) and Xenopsylla cheopis (0.8%) were observed only on the dogs. Seventeen dogs (13.2%) and one cat (2.6%) had mixed infestations. Flea-associated dermatoses were observed in 26 dogs (20.2%) and four cats (10.5%). Flea-allergic dermatitis, with its typical manifestations, was seen in ten of the dogs (38.5%) with skin lesions. Three out of four flea-allergic cats presented miliary dermatitis and one symmetrical hypotrichosis.

A rare case is reported of extragenital skin schistosomiasis as the presenting symptom in a 24-year-old Dutch student, who had swum some months earlier in Lake Malawi in Mozambique. Grouped papules dorsolateral on the lower thorax were shown by biopsy to be due to infection by Schistosoma haematobium. The eggs were viable and surrounded by necrosis and partly purulent, partly granulomatous dermatitis that also affected hair follicles. The second biopsy, taken 2.5 months after treatment with praziquantel, still showed viable eggs and necrosis but no more microabscesses. In the third biopsy 5 weeks after a second praziquantel treatment, no eggs were found, but a partly granulomatous abscess forming inflammation affecting a hair follicle was still present.

A case of persistent folliculitis in a 21-year-old man was demonstrated to be due to Ancylostoma caninum larvae. Treatment with oral thiabendazole was curative. Cutaneous larva migrans may be due to A caninum, but this presentation appears to be unique. The literature concerning etiology and pathogenesis of larva migrans is discussed with reference to this case.

The activities of several lysosomal hydrolases (beta-galactosidase, beta-hexosaminidase, alpha-mannosidase, beta-glycuronidase and acid phosphatase) were determined in serum and blood lymphocytes from patients affected with scleroderma. Statistical comparisons between means of patient and control groups (Student's t test) showed a significant difference in serum beta-galactosidase and acid phosphatase between patients and controls (serum beta-galactosidase: 36.5 ± 22 nmol/h/ml in the scleroderma group versus 24 ± 13 nmol/h/ml in the control group; serum acid phosphatase 853 ± 345 nmol/h/ml in the scleroderma group versus 634 ± 295 nmol/h/ml in the control group). These differences were significant (p < 0.01). Both enzyme activities were also significantly increased in the group with systemic scleroderma, but the difference was less in the group with localized scleroderma (this is discussed in terms of statistics and pathophysiology). The other enzyme activities determined were not significantly modified. The validity of these results is discussed, together with their diagnostic value and with the pathophysiological hypotheses put forward to explain the high levels found.

Demodex folliculorum infestation of human pilosebaceous follicles was revealed by scanning electron microscopy of skin replicas. This is presented as a non-invasive alternative to biopsies in studying superficial dermatological conditions.

A patient with typical larva migrans lesions associated with a highly pruritic papular folliculitis is presented. The time course of the evolution and the pathological picture - with local accumulation of lymphocytes, mast cells and eosinophils - mirror a typical thymus-dependent reaction to parasitic infestation. The papular and serpiginous lesions did not respond to the same type of therapy.

Although Demodex folliculorum is a common inhabitant of eyelid hair follicles, it has received scant attention by ophthalmologists in recent years. I examined 100 biopsies of eyelid skin for the presence of these mites. The incidence of infestation increased with age; 84% of all cases and 100% of cases over age 70 years were involved. No organisms were seen in sebaceous or meibomian glands. I found no pathologic changes except for follicular distention and hyperkeratosis and occasional mild chronic perifolliculitis. Circumstantial evidence for incriminating Demodex in human disease is good, although scientific proof is lacking.