Facial Demodicosis-Induced Skin Hyperpigmentation in an Immunocompromised Man Treated Successfully with Ivermectin 1% Cream: A Case Report

Demodex folliculorum is a common ectoparasite of humans that inhabits follicular infundibulum and sebaceous ducts. Its role in various dermatological diseases is well studied. However, data on demodex-induced skin pigmentation are very limited. A diagnosis of this entity can be easily missed for other causes of facial hyperpigmentation such as melasma, lichen planus pigmentosus, erythema dyschromicum perstans, post-inflammatory hyperpigmentation, and drug-induced hyperpigmentation. Here, we report a case of facial demodicosis-induced skin hyperpigmentation in a 35-year-old Saudi male who is on multiple immunosuppressive agents. He was successfully treated with ivermectin 1% cream and had a dramatic improvement at his 3-month follow-up. Our aim is to shed light on this underdiagnosed cause of facial hyperpigmentation which can be easily diagnosed and followed up by bed side dermoscopic examination and managed effectively by anti-demodectic therapies.