Facial Hyperpigmentation Caused by Pigmented Demodicosis

    March 2025 in “ JDDG Journal der Deutschen Dermatologischen Gesellschaft ”
    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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