# Demographic Patterns and Clinical Presentations of Demodicosis in a Longitudinal Study From Khuzestan Province, Southwest Iran

## TL;DR

This study examines demodicosis in southwest Iran over 22 years, revealing patterns in age, gender, and co-infections.

## Contribution

The first large-scale, longitudinal study of demodicosis in Iran's general population, highlighting novel co-infections and atypical presentations.

## Key findings

- Female predominance (77.7%) and peak age group (21–35 years) identified in demodicosis cases.
- 6.8% of cases showed co-infections, primarily dermatophyte infections like Tinea facei.
- Atypical presentations included trunk, sinus, ear, and thigh involvement.

## Abstract

Demodicosis is a significant dermatological condition caused by Demodex mites, with a wide range of clinical manifestations. Despite its prevalence, population‐based studies on the epidemiology, co‐infections, and atypical presentations of demodicosis remain limited globally. This study aimed to investigate the demographic patterns, clinical characteristics, and associated co‐infections of demodicosis over a 22‐year period in southwest Iran.

A total of 382 patients with confirmed demodicosis were retrospectively analyzed. Data were collected from records of Iran Zamin Medical Diagnostic Laboratory (2002–2024). Demographic characteristics, clinical presentations, co‐infections, and atypical manifestations were documented. Skin scrapings were examined microscopically to confirm Demodex infestation, and statistical analyses were conducted to identify significant patterns.

The mean patient age was 36.6 ± 12.8 years, with a marked female predominance (77.7%). The age distribution showed that the 21–35 age group accounted for the largest proportion of cases (45.3%), while pediatric (≤ 20 years) and geriatric (> 65 years) groups showed no significant gender disparity. Co‐infections were identified in 6.8% of cases, predominantly involving dermatophyte infections, such as Tinea facei (46.1% of co‐infections). This study also highlights novel co‐infections and atypical presentations, including involvement of the trunk, sinus, ear, and thigh.

This is the first large‐scale study of demodicosis in the general population of Iran, covering a 22‐year period. It is also among the first worldwide to explore co‐infections systematically. The findings emphasize significant demographic and clinical patterns, particularly age‐ and gender‐specific susceptibility and the complex interplay of co‐infections. These insights expand the understanding of demodicosis and highlight the importance of considering its atypical manifestations and associated infections in clinical practice.