Unless I have studied dermatology and dermatopathology, if anyone would have told me that a mite lives inside my hair follicles and crawls over my face at night to eat and mate, I wouldn't have believed!!!!!

Demodex folliculorum, this tiny mite living in symbiotic manner with us, has been implicated in the pathogenesis of rosacea and can cause resistant papulopustular eruptions in immunocompromized individuals (demodicosis).

Together with my colleague Dr. Eman El-Nabarawy, we have come across an interesting case of esinophilic pustular folliculitis (EPF) in an LE/rheumatoid arthritis patient which presented with resistant papulopustular eruption on the face. Biopsy was typical of esinophilic pustular folliculitis and many demodex mites were clearly visible inside many of the follicles. The association between demodex and EPF has been reported before in HIV cases due to severe immunosuppression*. Although the patient was immunosuppressed due to systemic steroids and immunosuppressives taken for her collagen disease, we recommended HIV testing.

I believe that our awareness about this mite should be increased. It should be kept in our minds as a cause of resistant facial papulopustules.

[center]Bodokh, I; Lacour, JP; Perrin, C; Bourdet, JF; Ortonne, JP (1994). "Papular eruption in AIDS: role of demodectic mites?"[i]Acta dermato-venereologica[/i] 74 (4): 320–2[/center]