# Diagnostic Challenges of Demodicosis in a 65-Year-Old Man: A Case of Chronic Pruritus

## TL;DR

A 65-year-old man with chronic skin itching and lesions improved after treatment with metronidazole and ivermectin, highlighting effective management of demodicosis.

## Contribution

Demonstrates successful treatment of demodicosis using a combination of metronidazole and ivermectin in a challenging clinical case.

## Key findings

- The patient showed significant improvement after combination therapy with metronidazole and ivermectin.
- Chronic pruritus and cutaneous lesions were effectively managed with this treatment approach.
- The case underscores the importance of proper therapeutic management for demodicosis.

## Abstract

Demodicosis is a chronic skin disease characterized by pruritic erythematous macular lesions, primarily affecting the facial area, and caused by follicular mites of the genus Demodex. An imbalance in the immune system, such as immunosuppression or prolonged use of topical corticosteroids, may promote an increase in mite population, triggering an inflammatory and clinical skin response. Demodicosis is commonly associated with chronic pruritus, inflammatory lesions, and dermatological alterations such as irritant dermatitis and erythema in friction zones. Treatment remains challenging due to the lack of consensus on the most effective therapeutic approach. In this context, drugs such as metronidazole and ivermectin, both in topical and oral formulations, have shown efficacy in symptom control and in reducing Demodex mite infestation. This case report describes a 65-year-old male with a clinical history of generalized chronic pruritus and persistent cutaneous lesions, who demonstrated significant improvement following combination therapy with metronidazole and ivermectin, underscoring the importance of proper management in the treatment of demodicosis.