Alles Wat Je Moet Weten over Demodex Folliculitis - Oorzaken, Symptomen en Behandeling

Introduction

Perioral dermatitis is a benign eruption that occurs most commonly in young, female adults, consisting of small inflammatory papules and pustules or pink, scaly patches around the mouth. Although the perioral region is the most common area of distribution, this disease also can affect the periocular and paranasal skin. For this reason, it is often referred to as periorificial dermatitis. Topical steroid use to the face can trigger this, and therefore, a primary recommendation for treatment would be discontinuation of steroid application by the patient. Other treatment approaches include topical metronidazole, topical calcineurin inhibitors, and oral tetracycline antibiotics. Perioral dermatitis often responds readily to therapy but can be chronic and recurrent.

The exact cause of perioral dermatitis is unknown. It has multiple environmental exposures linked to its etiology. For some patients, there is an association between topical corticosteroid use and perioral dermatitis.[1] Topical steroid use may precede the eruption, and chronic use of topical steroids increases the risk of developing severe disease.[2] Initially, the facial eruption is responsive to the use of the topical steroid. However, upon withdrawal of the topical steroid, the eruption recurs. This leads to long-term dependency on topical steroid use.[3] Eventually, perioral dermatitis may progress in severity with chronic steroid use and may evolve into a granulomatous subtype of the disease. In addition to topical steroid use, perioral dermatitis has been reported to occur with the use of nasal and inhaled corticosteroids.[4][5] The exact mechanism through which topical steroids predispose patients to perioral dermatitis is not understood. It has been postulated that topical steroids influence the microflora of the hair follicle, which may contribute to the pathogenesis of this condition.[6][7][8] Some investigators have proposed infectious sources as a cause for perioral dermatitis, including Candida albicans, fusiform bacteria, and Demodex mites.[6][7][8] Fluorinated toothpaste use has also been associated with perioral dermatitis.[9] Additionally, chewing gum and dental fillings have been associated with perioral dermatitis.[10][11] Certain cosmetic products, such as combined use of moisturizers and foundations, as well as physical sunscreens, have been etiologic in some patients.[12][13] Given the female predominance with this condition, hormonal factors have been considered in the etiology. Interestingly, oral contraceptive pills have been associated with the improvement of perioral dermatitis.[14]

Literatur

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1. Baima B, Sticherling M et al. (2002) Demodicidosis revisited. Acta Derm Venereol 82: 3-6
2. Bersano JG et al. (2016) Demodex phylloides infection in swine reared in a peri-urban family farm located on the outskirts of the Metropolitan Region of São Paulo, Brazil. Vet Parasitol 230: 67-73.
3. Cotliar J et al. (2013) Demodex folliculitis mimicking acute graft-vs-host disease. JAMA Dermatol 149:1407-1409
4. Forstinger C et al. (1999) Treatment of rosacea-like demodicidosis with oral ivermectin and topical permethrin cream. J Am Acad Dermatol 41: 775-777
5. Forton F et al. (1993) Density of Demodex folliculorum in rosacea: a case-control study using standardized skin-surface biopsy. Br J Dermatol 128: 650-659
6. Guerrero-González GA et al. (2014) Crusted demodicosis in an immunocompetent pediatric patient. Case Rep Dermatol Med doi: 10.1155/2014/458046
7. Jansen T et al. (2001) Rosacea-like demodicidosis associated with acquired immunodeficiency syndrome. Br J Dermatol 144: 139-142
8. Morras PG et al. (2003) Rosacea-like demodicidosis in an immunocompromised child. Pediatr Dermatol 20: 28-30
9. Melnik B et al. (2018) Akne und Rosazea. In: Braun-Falco`s Dermatologie, Venerologie Allergologie G. Plewig et al. (Hrsg) Springer Verlag S 1331
10. Vu JR et al. (2011) Demodex folliculitis. J Pediatr Adolesc Gynecol 24:320-321
11. Weingartner JS et al. (2012) What is your diagnosis? Demodex folliculitis. Cutis. 90:65-66
12. Yun SH et al. (2013) Demodex folliculitis presenting as periocular vesiculopustular rash. Orbit 32:370-371

Differential Diagnosis

Acne vulgaris presents as inflammatory papules, pustules, cysts, and comedones primarily on the face, but may also affect the chest and back. Patients may have flares of acne secondary to mechanical mechanisms, such as from a helmet chin strap. The distribution of involvement may mimic perioral dermatitis. Adult female acne is characterized by inflammatory papules of the chin and jawline and can have a similar distribution as perioral dermatitis.

Seborrheic dermatitis presents as ill-defined erythematous patches with greasy scale distributed on the eyebrows, glabella, paranasal skin, nasolabial folds, beard, scalp, and chest.

Demodex folliculitis presents with scattered erythematous facial papules and pustules. Demodex mites have been implicated in the pathogenesis of rosacea. Unroofing of the pustules followed by microscopy of the purulent material shows numerous Demodex.

Tinea faciei presents with erythematous scaling papules and annular plaques and can be ruled out by performing a KOH prep and microscopic examination of the scale.

Syringomas and other cutaneous adnexal neoplasms also can mimic perioral dermatitis as these lesions are flesh-colored to erythematous facial papules. A biopsy is helpful for diagnosis.

Einteilung

In der vorliegenden Übersicht sind follikulär gebundene Entzündungen aufgeführt, die teils unter Namen „Follikulitis“ oder „Folliculitis“ aber auch unter andern Begriffen, die den Bezug zu einer Folliklentzündung nicht vermuten lassen. Nicht aufgelistet sind die Erkrankungen des „Akne vulgaris Komplexes“. Follikulitiden können auch nach ihrer Etage in der sie auftreten unterteilt werden ind superfizielle und tiefe Follikulitiden.

I. Infektiöse Follikulitiden

1. Mykotisch
   • Dermatophyten-Follikulitis (s.u. Tinea corporis)
   • Pityrosporumfollikulitis
   • Pityrosporumfollikulitisdes Säuglings
   • Folliculitis barbae candidamycetica
2. Bakteriell
   • Staphylokokken/Streptokokken (s.u. Follikuläre Pyodermien)
   • Superfizielle Follikulitis (im üblichen Sprachgebrauch nicht präjudizierend als Follikulitis, umgangssprachlich als Pickel bezeichnet)
   • Profunde Follikulitis
     • Furunkel: profunde einschmelzende Follikulitis mit Perifollikulitis
     • Karbunkel: konfluierende einschmelzende profunde Follikulitiden
   • Folliculitis barbae
   • Follikulitis bei perioraler Dermatitis
   • Sonstige Bakterien
     • Acne inversa
     • Whirlpool-Dermatitis/Pseudomonas-Dermatitis (- Follikulitis)
     • Follikulitis gramnegative
     • Ulcus molle folliculare
3. Viral
   • Herpes simplex Follikulitis
4. Parasiten
   • Demodex-Follikulitis (Demodikose)

II. Follikuläre Verhornungs-/Haarwachstumsstörungen

• Follikuläre Ichthyose (Zwischen Ichthosis vulgaris und Keratosis follicularis)
• Folliculitis decalvans
• Folliculitis granulomatosa perforans
• Pseudofolliculitis barbae (Sycosis barbae)
• Folliculitis sclerotisans nuchae (Acne keloidalis)
• Folliculitis ulerythematosa reticulata
• Ulerythema ophryogenes
• Keratosis pilaris
• Lichen spinulosus (Keratosis spinulosa)
• Pityriasis rubra pilaris
• Perniosis follicularis