Facial Hyperpigmentation Caused by Pigmented Demodicosis

    Ephsona Shencoru, Annika Vogt, Kamran Ghoreschi
    TLDR Facial hyperpigmentation improved with oral isotretinoin and ivermectin cream after Demodex mites were identified as the cause.
    This document presents a case of facial hyperpigmentation in a 16-year-old male, attributed to pigmented demodicosis, a condition caused by the overgrowth of Demodex mites. Despite previous treatments with topical retinoid and hydroquinone, the patient showed no improvement until the introduction of oral isotretinoin and ivermectin 1% cream, which led to significant improvement after 3 months. Histopathological examination revealed Demodex mites in dilated hair follicles, supporting the diagnosis. The study emphasizes the importance of considering demodicosis as a differential diagnosis for chronic or treatment-resistant facial hyperpigmentation, especially in patients with skin of color, as early recognition and treatment can lead to significant clinical improvement.
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