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Case Report/Case Series |

Demodex Folliculitis Mimicking Acute Graft-vs-Host Disease

Jonathan Cotliar, MD1; Olga Frankfurt, MD2
[+] Author Affiliations
1Departments of Dermatology and Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois
2Division of Hematology-Oncology, Department of Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois
JAMA Dermatol. 2013;149(12):1407-1409. doi:10.1001/jamadermatol.2013.5891.
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Importance  Acute graft-vs-host disease (GVHD) typically requires high-dose systemic steroids as first-line treatment. Like drug eruptions, viral exanthema, and toxic erythema of chemotherapy, Demodex folliculitis is a clinical mimicker of acute GVHD and requires nonimmunosuppressive therapy. This case of Demodex folliculitis mimicking acute GVHD highlights the need for skin biopsy in patients who have undergone a stem cell transplant with eruptions on the head and neck.

Observations  A 46-year-old white woman with a history of Fms-like tyrosine kinase 3 acute myeloid leukemia presented to the dermatology clinic with a 5-day history of a nonpruritic eruption on her face and neck 28 days after undergoing a double umbilical cord blood hematopoietic stem cell transplant (HSCT). Findings from the skin biopsy demonstrated a deep dermal lymphocytic infiltrate adjacent to follicular units along with an abundance of Demodex mites noted within the hair follicles consistent with Demodex folliculitis. Oral ivermectin, 12 mg, was given, and the eruption cleared within 24 hours.

Conclusions and Relevance  To our knowledge, this is only the fifth reported case of Demodex folliculitis following HSCT, but the first ever reported to be successfully treated with oral ivermectin. Demodex folliculitis should be added to the differential diagnosis of skin eruptions that arise after HSCT.

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Figure 1.
Demodex Folliculitis Mimicking Acute Graft-vs-Host Disease

A, Patient on the day of presentation with erythema of the face and neck. B, Patient 2 weeks after initial presentation following a single dose of oral ivermectin.

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Figure 2.
Skin Biopsy of Demodex Folliculitis Mimicking Acute Graft-vs-Host Disease

Skin biopsy demonstrating perifollicular lymphocytic inflammation and Demodex mites within the hair follicle (hematoxylin-eosin, original magnification ×10).

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