Demodicosis Associated with Wearing a Face Mask: A Case Report

Demodex mites are common ectoparasites of human pilosebaceous units that do not cause any skin symptoms. However, when there is an abnormal increase in Demodex mite density, it can cause multiple skin disorders which are grouped under the term demodicosis. During the COVID-19 outbreak, public health authorities worldwide recommend people to wear face masks when in public places to reduce respiratory transmission. Wearing face mask can cause changes in microenvironment, skin barrier function, and microbiome on human skin. There are several reports of facial skin diseases such as atopic dermatitis, seborrheic dermatitis, acne vulgaris, and rosacea provoked by wearing masks for long periods of time. This is the first case report of demodicosis associated with wearing a face mask. A 46-year-old female presented with dry, itchy erythematous to purpuric patches with fine follicular scales on both cheeks and chin under the mask. Clinical symptoms started slowly with warm, slightly burning, and periodically itching sensation on both cheeks after 3 weeks of wearing surgical face mask for more than 8 h a day. Even after switching to a cloth mask and using topical steroid, the rash improved slightly and recurred after discontinuation of the treatment. The diagnosis of demodicosis was made by relevant correlation of clinical skin lesions, along with standardized skin surface biopsy results that detected abnormal proliferation of Demodex mites and clinical cure after oral ivermectin therapy.