Demodex Folliculitis of the Scalp: Clinicopathological Study of an Uncommon Entity

September 2016 in “ The American Journal of Dermatopathology ”

Wissam Helou, Emily Avitan‐Hersh, Reuven Bergman

Demodex folliculitis hair loss alopecia scalp erythema scales pustules neutrophilic folliculitis mononuclear-cell folliculitis granulomas metronidazole Demodex mites rosacea-like demodicosis anti-Demodex therapy scalp redness scalp scales scalp pustules anti-Demodex treatment

TLDR Demodex mites rarely cause scalp infections leading to hair loss, but when they do, treatment is effective.

In a study of 333 scalp biopsies from patients with hair loss and alopecia, Demodex mites were detected in 17 cases (5.1%), but only 4 cases (1.2%) showed clinical and histopathological evidence of Demodex folliculitis, characterized by hair loss, scalp erythema, scales, and pustules. These 4 cases also presented with neutrophilic and/or mononuclear-cell folliculitis with occasional granulomas in histopathological examination. The affected patients responded completely to treatment with metronidazole. The study concluded that Demodex mites are infrequently pathogenic in scalp biopsies for hair loss and alopecia, but when they are, the condition resembles rosacea-like demodicosis and can be effectively treated with anti-Demodex therapy.

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