Papulopustular periorbital demodicosis: A diagnosis often overlooked

Demodicosis is the term given for cutaneous diseases caused by the human ectoparasitic mites Demodex folliculorum and Demodex brevis which are common commensals of the pilosebaceous units in human beings. We report a 72-year-old female who presented with erythematous papulopustular lesions over both upper and lower eyelids and a few similar lesions on the cheeks of 2 weeks duration with one similar episode in the past. A cyanoacrylate standardized skin surface biopsy showed increased mite density and the patient was successfully treated with acaricides. Demodicosis is often misdiagnosed as contact dermatitis, papulopustular rosacea, or seborrheic dermatitis. A high index of suspicion of demodicosis is needed to arrive at an accurate diagnosis.