Case Number : CT0046 Adam_Bates

Ruptured demodex folliculitis with granulomatous reaction.
 

I think this is rosacea. An infundibulofollicular unit was destroyed by the inflammatory process, thereby its ontents, including Demodex mites, have ensued a peri-infundibular foreign body granuloma against fragments of infundibular epithelium, keratin, sebaceous gland secretion, and Demodex mites. I believe Demodex are no more than non-pathogenic commensals that can be found incidentally in any infundibulum lesions, and they are not the cause of those lesions, even less of the so-called demodicosis.

Granulomatous rosaea.
 

I confess I was hoping for a bit more discussion of granulomatous rosacea v's demodecosis in this case. Does everyone agree demodex is incidental? I am inclined to think it may be worth treating some patients. I remember one case where I really did feel histologically the demodex was relevent and the patient was treated with ivermectin. It was a localised patch on the face I think and it became very red and angry after ivermectin. This case was clinically ?dermatitis ?rosacea.