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Case Report/Case Series | The cutting Edge

Severe Demodexfolliculorum–Associated Oculocutaneous Rosacea in a Girl Successfully Treated With Ivermectin

Megan Brown, MD1; Angela Hernández-Martín, MD2; Ana Clement, MD3; Isabel Colmenero, MD4; Antonio Torrelo, MD2
[+] Author Affiliations
1Department of Dermatology, School of Medicine, University of New Mexico, Albuquerque
2Department of Dermatology, Hospital Infantil del Niño Jesús, Madrid, Spain
3Department of Ophthalmology, Hospital Infantil del Niño Jesús, Madrid, Spain
4Department of Pathology, Hospital Infantil del Niño Jesús, Madrid, Spain
JAMA Dermatol. 2014;150(1):61-63. doi:10.1001/jamadermatol.2013.7688.
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Importance  There is a limited therapeutic armamentarium for recalcitrant cases of childhood rosacea. 

Observations  We report the case of a 12-year-old girl who presented with severe ocular and cutaneous rosacea unresponsive to oral doxycycline, oral isotretinoin, and topical tacrolimus. A biopsy specimen showed numerous mites within the folliculosebaceous unit. Treatment with a single dose of oral ivermectin achieved resolution of her symptoms. 

Conclusions and Relevance  The causative role of Demodex folliculorum should be considered in immunocompetent children with rosacea or rosacea-like refractory eruptions. In such cases, treatment with ivermectin can be beneficial. 

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Figure.
Severe Oculocutaneous Rosacea in an Adolescent Girl

A, Before treatment with ivermectin. Oral isotretinoin had been discontinued 1 month ago and the patient was using only topical tacrolimus twice daily. B, Resolution of the lesions after a single dose of oral ivermectin. The photograph was taken at the 6-month follow-up visit.

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