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 Table of Contents  
CASE REPORT
Year : 2022  |  Volume : 2  |  Issue : 4  |  Page : 967-968

Demodicosis: An unusual masquerade of basal cell carcinoma


Department of Orbit and Oculoplasty, Aravind Eye Hospital, Chennai, Tamil Nadu, India

Date of Submission14-Mar-2022
Date of Acceptance15-Jul-2022
Date of Web Publication11-Oct-2022

Correspondence Address:
Dr. Gayatri Fulse
Aravind Eye Hospital, Ponamallee High Road, Noombal, Chennai - 600 077, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_645_22

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  Abstract 


A 75-year-old female presented with swelling and redness on the left lower lid away from the lid margin since 10 days. The best corrected visual acuity in both eyes is 6/6 and N6. On examination, an erythematous ulcerative lesion with rolled edges and central necrosis on the left malar area was seen clinically mimicking basal cell carcinoma. Excision biopsy was performed, and the histopathology report revealed an inflamed follicle with intra-follicular demodex folliculorum with ulceration and suppurative abscess with necrotizing destruction of hair follicles. The patient was treated with topical ciprofloxacin ointment. Follow-up after 3 weeks showed complete resolution of the lesion with no recurrence at 3 months.

Keywords: Basal cell carcinoma, demodex, necrosis


How to cite this article:
Fulse G, Jayashree B, Menon V, Shanti R. Demodicosis: An unusual masquerade of basal cell carcinoma. Indian J Ophthalmol Case Rep 2022;2:967-8

How to cite this URL:
Fulse G, Jayashree B, Menon V, Shanti R. Demodicosis: An unusual masquerade of basal cell carcinoma. Indian J Ophthalmol Case Rep [serial online] 2022 [cited 2022 Nov 27];2:967-8. Available from: https://www.ijoreports.in/text.asp?2022/2/4/967/358180



Demodicosis is a common parasitic infection of the hair follicles and the pilosebaceous unit by Demodex mites, namely, Demodex folliculorum and Demodex brevis.[1] This infection is common among immuno-compromised and elderly.[2],[3] The Demodex mite is an obligatory human ecto-parasite, and it is resides of in and around the pilo-sebaceous units. Two species, D. folliculorum and Demodex brevis, collectively referred to as Demodex are typically found on humans occurring in 10% of skin biopsies and 12% of follicles.[1],[4] About 65 species of Demodex are found. D. folliculorum is more commonly localized to the face, whereas D. brevis is more commonly found on the neck and chest. Infestation with D. folliculorum is more common than with D. brevis. D. folliculorum is usually found in the upper canal of the pilo-sebaceous unit and uses skin cells and sebum for nourishment.[1],[5] Demodex brevis is known to cause posterior blepharitis,  Meibomian gland More Details dysfunction, recurrent chalazia, and refractory keratoconjunctivitis.[6] Most people are only carriers of Demodex mites and do not develop clinical symptoms. Human demodicosis can be considered as a multi-factorial disease influenced by external and/or internal factors. The D. folliculorum mite completes its whole life cycle of 18 to 24 days in humans. When the adult mites die, they decompose inside the hair follicles and produce a yellow exudate.[7]


  Case Report Top


A 75-year-old female presented with swelling and redness on the left lower lid away from the lid margin since 10 days. Her best corrected visual acuity in both eyes is 6/6 and N6. An erythematous ulcerative lesion with rolled edges and central necrosis on the left malar area was seen clinically mimicking basal cell carcinoma. Excision biopsy was performed, and the histopathology report revealed an inflamed follicle with intra-follicular Demodex folliculorum with ulceration and suppurative abscess with necrotizing destruction of hair follicles.


  Discussion Top


Demodicosis can mimic many other inflammatory dermatoses, such as folliculitis, rosacea, and perioral dermatitis, leading to unspecific and confusing descriptions in the literature. There is a previous literature study with similar Demodex presentation which mimicked basal cell carcinoma in the nose, cheeks, and chin areas.[7] This case is being reported for the first time for its unilateral atypical presentation in the periocular area, which is an unusual site for demodicosis. In our case, local surgical eradication of Demodex explains the complete resolution of the lesion on 3-week follow-up with no recurrence at 3 months. Our patient was not evaluated for any immuno-compromised disease.

Demodex is usually diagnosed in skin scrapings from the face by KOH examination or in hair follicles in a skin biopsy examined under the microscope after methylene blue staining. The superficial part of the horny layer of the skin and the follicular content can also be sampled by skin surface biopsy. Demodicosis is diagnosed when there is a high density of demodex mites (>5/cm2). Demodex folliculorum is characterized histologically by numerous demodex mites in the infundibula of the follicles, follicular hyperkeratosis, and focal follicular lichenoid lymphocytic infiltrate.

The routine treatment for demodicosis is cleansing the face twice daily with a non-soap cleanser. Oil-based cleansers and greasy make-up and periodic exfoliation have to be avoided to remove dead skin cells. The mites may be temporarily eradicated with topical insecticides, especially crotamiton cream and permethrin cream, and also, good results are seen with topical Metronidazole gel 2%.[8] In severe cases such as those with human immuno-deficiency virus infection, oral ivermectin may be recommended.


  Conclusion Top


Therefore, clinical suspicion about the etiological role of Demodex in various dermatoses in the peri-ocular area can help to differentiate this infective pathology from more aggressive malignant conditions and to avoid unnecessary wide excisions and further re-constructions. Demodicosis should also be considered as differential in patients presenting with unilateral ulcerative peri-ocular lesion.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Rather, PA, Hassan I. Human demodex mite: The versatile mite of dermatological importance. Indian J Dermatol 2014;59:60-6.  Back to cited text no. 1
    
2.
Hom MM, Mastrota KM, Schachter SE. Demodex. Optom Vis Sci 2013;90:e198-205.  Back to cited text no. 2
    
3.
Moris García V, Valenzuela Vargas G, Marín Cornuy M, Aguila Torres P. Ocular demodicosis: A review. Arch Soc Esp Oftalmol (Engl Ed) 2019;94:316-22.  Back to cited text no. 3
    
4.
Cheng AM, Sheha H, Tseng SC. Recent advances on ocular Demodex infestation. Curr Opin Ophthalmol 2015;26:295-300.  Back to cited text no. 4
    
5.
Defty C, Breitenfeldt N, Dhital SK, Juma A. Demodex folliculorum: A parasite infection mimicking skin cancer. J Plast Reconstr Aesthet Surg 2013;66:289-90.  Back to cited text no. 5
    
6.
Elston CA, Elston DM. Demodex mites. Clin Dermatol 2014;32:739-43.  Back to cited text no. 6
    
7.
Chen W, Plewig G. Human demodicosis: Revisit and a proposed classification. Br J Dermatol 2014;170:1219-25.  Back to cited text no. 7
    
8.
Czepita D, Kuźna-Grygiel W, Czepita M, Grobelny A. Demodex folliculorum and Demodex brevis as a cause of chronic marginal blepharitis. Ann Acad Med Stetin 2007;53:63-7.  Back to cited text no. 8
    




 

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