Boneschi, Vinicio

Nazzaro, Gianluca

Pisapia, Armando

Veraldi, Stefano

English

AIR Universita degli studi di Milano

J Cosmet Dermatol. 2023;22:335–336. wileyonlinelibrary.com/journal/jocd | 335Received: 18 October 2021  | Revised: 15 January 2022  | Accepted: 15 February 2022DOI: 10.1111/jocd.14863  L E T T E R S  T O  T H E  E D I T O RUnilateral rosacea, unilateral demodicidosis, unitaleral Demodex sp. folliculitis: Three names for the same diseaseTo the Editor,Literature data about a clinical entity which was named unilateral rosacea (UR), unilateral demodicidosis (UD), or unilateral Demodex sp. folliculitis are poor.1– 11 We report a case of UR (this is the name we prefer). The patient was a 39- year- old Caucasian woman who was admitted to our Dermatology Unit with a clinical diagnosis of acne. The patient stated that she was in good general health and that she was not in therapy with systemic drugs. She also declared that the dermatitis was unsuccessfully treated at other centers with topical clindamycin and tretinoin.Dermatologic examination revealed numerous, isolated, or grouped, erythematous papules and pustules, located exclusively on her right forehead, temple, cheekbone, and cheek. No comedones were visible (Figure 1).General physical examination did not reveal anything pathological.Laboratory tests were within normal ranges. Mycologic and bac-teriologic examinations were negative. Microscopic examinations of scrapings from skin lesions revealed some Demodex sp. (3 mites/cm2).A diagnosis of UR was made.The patient was treated with 0.75% metronidazole cream (2 applications/day) and doxycycline (40 mg/day) for three months. Almost complete remission was observed 3 weeks after the begin-ning of the therapy.Complete remission was observed at the end of the treatment (Figure 2). Follow- up was negative.UR was first described in 1989 by Shelley et al.1 The first European case was published in 1997 by Jansen and Plewig.2 To our knowledge, a couple of cases were published.3– 11 UR occurs both in adult men1,3,5,9– 11 and women.2,4,6,7 No cases in children were re-ported. In one patient, UR occurred at the same location of previous ophthalmic herpes zoster.5 In two patients, UR was associated with Bell's paralysis.7,8 Although the cheek is the most frequent location, also the forehead,3,5 periorbital area,3,5,9 nose,5 upper lip9, and chin9 may be involved, always unilaterally. We do not want to question what some authors published about UR; however, in at least two articles, only one side of the face was photographed, thus leaving some doubts about the unilaterality of the dermatitis.1,3 In addition, in one case, UR was defined as “fulminans,” but the clinical picture does not meet diagnostic criteria of rosacea fulminans.10UR has been treated with topical crotamiton,1,3,6 metronida-zole2,3,9,11 and permethrin,5 and oral metronidazole,1,6 minocycline,2 tetracycline,9 isotretinoin10 and ivermectin.11As previously mentioned, this dermatitis was named UR,2,7– 10 UD,3,4,6,11 unilateral demodectic rosacea1, and demodicosis.5 We think that the term UR is more appropriate the lesions of UR, that is, papules and pustules on an erythematous base, are typical of rosacea. It is possible that this dermatitis is characterized by a high burden of Demodex sp. In the case reported by Shelley et al.,1 the authors stated that oral metronidazole improved the dermatitis, but it did not significantly reduce the Demodex sp. F I G U R E  1  Numerous, isolated or grouped, erythematous papules and pustules, located exclusively on the right forehead and cheekThis is an open access article under the terms of the Creative Commons Attribution- NonCommercial- NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non- commercial and no modifications or adaptations are made.© 2022 The Authors. Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.336  |    LETTERS TO THE EDITOR population: This would suggest that the role of the mite may be secondary.INFORMED CONSENTInformed consent for the publication of medical images was ob-tained by the patient.KE Y WORDSunilateral Demodex sp. folliculitis, unilateral demodicidosis, unilateral rosaceaCONFLIC T OF INTERE S TNone.Stefano Veraldi MD, PhDArmando Pisapia MDGianluca Nazzaro MDVinicio Boneschi MDDepartment of Pathophysiology and Transplantation, Università degli Studi, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, ItalyCorrespondenceArmando Pisapia, Dermatology Unit, University of Milan, Milan, Italy.Email: armando.pisapia@unimi.itORCIDStefano Veraldi  https://orcid.org/0000-0002-0985-3590 Armando Pisapia  https://orcid.org/0000-0002-7326-3253 Gianluca Nazzaro  https://orcid.org/0000-0001-8534-6497 R E FE R E N C E S 1. Shelley WB, Shelley ED, Burmeister V. Unilateral demodectic rosa-cea. J Am Acad Dermatol. 1989;20:915- 917. 2. Jansen T, Plewig G. Einseitige Rosazea. Akt Dermatol. 1997;23:114- 116. 3. Pallotta S, Cianchini G, Martelloni E, et al. Unilateral demodicidosis. Eur J Dermatol. 1998;8:191- 192. 4. Jang YH, Kim YJ, Kang HY. A case of unilateral demodicidosis. Korean J Dermatol. 2006;44:890- 891. 5. Karincaoglu Y, Tepe B, Kalayci B, Seyhan M. Pseudozoster clinical presentation of Demodex infestation after prolonged topical steroid use. Clin Exp Dermatol. 2008;33:740- 742. 6. Park SB, Jeong NJ, Lee Y, Seo YJ, Lee JH, Im M. Unilateral demod-icidosis in a patient with seborrheic dermatitis. Kor J Med Mycol. 2011;16:67- 70. 7. Cabete J, Serrão V, Lestre S. Unilateral rosacea in a patient with Bell's palsy. J Dermatol. 2013;40:403- 404. 8. Piccolo V, Ruocco V, Russo T, Ruotolo F, Piccolo S, Baroni A. Unilateral rosacea in patients with facial nerve palsy: a mere exam-ple of immunocompromised district. J Dermatol. 2013;40:850. 9. Kuo TT, Chen CH. Unilateral granulomatous rosacea – the im-munocompromised district as a possible cause. Dermatol Sin. 2017;35:219- 220. 10. Turkmen D. A rosacea case involving one side of the face accom-panied by Demodex infestation: unilateral rosacea fulminans. Ann Dermatol. 2019;31:115- 116. 11. Vashisht D, Singh J, Baveja S, Tiwari R, Bhatnagar A. Unilateral demodicidosis of face mimicking Hansen’s disease. Dermatol Rep. 2016;8:6891.How to cite this article: Veraldi S, Pisapia A, Nazzaro G, Boneschi V. Unilateral rosacea, unilateral demodicidosis, unitaleral Demodex sp. folliculitis: Three names for the same disease. J Cosmet Dermatol. 2023;22:335– 336. doi:10.1111/jocd.14863F I G U R E  2  Complete remission three months after the beginning of the therapy with metronidazole and doxycycline 14732165, 2023, 1, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/jocd.14863 by Universita'Degli Studi Di Mila, Wiley Online Library on [21/07/2025]. 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Unilateral rosacea, unilateral demodicidosis, unitaleral Demodex sp. folliculitis: Three names for the same disease

Stefano Veraldi

Armando Pisapia

Gianluca Nazzaro

Vinicio Boneschi

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 sp. folliculitis: Three names for the same disease 

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Unilateral rosacea, unilateral demodicidosis, unitaleral Demodex sp. folliculitis: Three names for the same disease

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