Refractory Demodex Folliculitis in Five Children with Acute Lymphoblastic Leukemia

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.

A case series of demodicosis in children

“…In children, demodicosis was first reported with immunosuppression, especially HIV and leukemia. It has also been linked to Langerhans cell histiocytosis, as seen in two of our patients, acute lymphoblastic leukemia, and T‐cell non‐Hodgkin lymphoma . T‐cell suppression, either viral induced or due to chemotherapy, is implicated in pathogenesis.…”

Clinical, histopathological and immunohistochemical characterization of canine indolent lymphoma

“…The demodex infestation itself has subsequently been shown to cause further immunosuppression in these patients. While human patients undergoing chemotherapy have been shown to have an increased incidence of demodex infestation it appears as though we may have identified a highly susceptible population pre‐chemotherapy treatment. The immune dysregulation that occurs associated with the development of indolent lymphoma may specifically make these patients more prone to developing such an infestation.…”

Neutrophilic Sebaceous Adenitis With Intralobular Demodex Mites

“…5,18,19 Demodex folliculorum is by far the more prevalent species and is most commonly found on the face with an overall prevalence of 30% of follicles infested, whereas D. brevis is less common on the face, with an infestation rate of only 2% on the nose but with higher numbers on nonfacial sites. However, these observations, and the fact that our patient responded rapidly to metronidazole, known to be effective against Demodex, 21,22 at least raises the possibility of a causal relationship between Demodex mites and NSA. 5 The Demodex mites in our case were identified as D. brevis because they were solitary and were positioned within the sebaceous gland.…”