Demodex-induced Lupus miliaris disseminatus faciei

Abstract

Rationale: Lupus miliaris disseminatus faciei (LMDF) is an inflammatory granulomatous skin disease without a clear etiology that frequently involves the middle area of the face and the upper eyelids. Pathological features of the disease include caseation necrosis and epithelioid granuloma. Consensus treatment for LMDF is currently unavailable. Patient concerns: A 47-year-old Chinese female patient who presented with facial pruritic, erythematous papules 8 months before this study. She was diagnosed with skin tuberculosis at another hospital and given antituberculosis medication. However, the treatment was not efficacious. Diagnoses: In this study, the diagnosis of Demodex-induced LMDF was made by a dermatologist according to physical examination, skin biopsy pathology, and microscopic examination. Interventions: The patient was given ornidazole tablets (500 mg twice a day) and recombinant bovine basic fibroblast growth factor gel (0.2 g/cm 2 twice a day) for an 8-week period. Outcomes: Eight weeks after the treatment, the facial erythematous papules were improved, and no new skin lesions were observed. The patient showed no signs of recurrence during the 6-month follow-up. Lessons subsections: This case showed that ornidazole combined with recombinant bovine basic fibroblast growth factor gel might be useful in treatment of Demodex-induced LMDF. In addition, the results suggested that pathological caseation necrosis was caused by a series of inflammatory and immune responses to Demodex infection.

Development of an animal model for rosacea‑like skin lesions caused by Demodex

“…The tissue cells swallow the fragments of Demodex mites to form the granuloma-like structure (25). In a previous study, Demodex mites were observed at the center of the hair follicle in new facial skin lesions from patients with Demodex mites positive rosacea, with clearly visible mouthparts and body wall residues (28). However, in the present study, the body of Demodex mites was not found in the skin lesions under microscope even after 4 weeks of modeling, probably due to the fact that Demodex mites do not have an anus.…”

“…Recent studies revealed that the rbFGF gel can improve chronic inflammatory skin lesions caused by Demodex infection and reduce the granuloma ( 10 , 28 ). To verify whether the developed rabbit model can be used in basic research, the model lesions were treated with the rbFGF gel for 4 weeks.…”

A Comparative Study on Clinico-Histopathological Features of Granulomatous Rosacea and Lupus Miliaris Disseminatus Faciei

“…D. folliculorum was more common in ‘GR’ group than ‘LMDF’ group (27.8% vs. 7.7%), suggesting closer relationship with the former. Although several reports considered D. folliculorum to induce LMDF through delayed hypersensitivity reaction, this study might reflect the well-established strong relationship of D. folliculorum with rosacea through toll-like receptor 2, cathelicidin, and activation of macrophage and CD8-positive cytotoxic T cell 10 .…”

Lupus miliar diseminado facial

“…Esta teoría se basa en el hecho de que los granulomas se forman en las cercanías de folículos pilosos rotos. En el caso de la paciente, se encontró la presencia de Demodex adyacente al granuloma [2][3][4] .…”

“…Los diagnósticos diferenciales que deben considerarse son: dermatitis periorificial, rosácea granulomatosa, demodecidosis, acné, sarcoidosis, molusco contagioso, tuberculosis cutánea, dermatosis infecciosas en pacientes infectados por el VIH (micobacterias atípi-cas, histoplasmosis) y con tumores anexiales benignos como los siringomas [1][2][3]7 .…”