# The Hidden Culprit Unraveled by Dermoscopy: A Rare Case of Pediatric Facial Demodicosis

## TL;DR

A rare case of facial and eye demodicosis in a child was correctly diagnosed using dermoscopy after years of misdiagnosis.

## Contribution

Demonstrates the utility of dermoscopy in diagnosing pediatric demodicosis, a rare and often overlooked condition.

## Key findings

- Dermoscopic examination revealed high-density Demodex infestation in a child with chronic facial and ocular symptoms.
- Combined metronidazole therapy led to complete remission of the condition.
- The case emphasizes the importance of considering demodicosis in children with persistent facial and eye issues.

## Abstract

We report a rare case of pediatric facial and ocular demodicosis in an immunocompetent seven-year-old with chronic centrofacial papulopustular lesions and recurrent blepharitis misdiagnosed over several years. Dermoscopic examination revealed a high-density Demodex infestation on facial skin and eyelashes, leading to a definitive diagnosis. A combined treatment approach using topical and systemic metronidazole, along with targeted ocular therapy, achieved complete remission. This case highlights the diagnostic power of dermoscopy and underscores the importance of considering demodicosis in children with refractory facial and ocular involvement.