Dermoscopy of papulopustular rosacea and comparison of dermoscopic features in patients with or without concomitant Demodex folliculorum.

Dermoscopic findings of papulopustular rosacea include follicular plugs, white scales and follicle dilatation. Demodex tails and Demodex follicular openings are dermoscopic indicators mainly found in primary demodicosis and, less frequently, in rosacea.The aim of this study was to describe the dermoscopic features of papulopustular rosacea and investigate the differential dermoscopic features between patients with and without concomitant Demodex infestation.We conducted a prospective study of subjects affected by almost clear, mild and moderate papulopustular rosacea. For each patient, dermoscopic images were taken and a standardized skin surface biopsy was performed.Out of a group of 60 patients, the most frequent dermoscopic findings were: yellow dots, vascular polygons and follicular scales. Patients with moderate rosacea showed more Demodex follicular openings compared to patients with mild rosacea (p=0.016). Patients affected by mild rosacea showed more frequent follicular scales than patients with almost clear rosacea (p=0.007). Moreover, patients with moderate rosacea showed more Demodex follicular openings (p=0.018), follicular scales (p<0.0001), honeycomb pigment pattern (p=0.001) and follicular pustules ( p<0.0001) than patients with almost clear rosacea. No significant dermoscopic differences were observed between patients with and without concomitant Demodex infestation.Papulopustular rosacea has specific dermoscopic findings. In our opinion, dermoscopy is not the best method for the diagnosis of Demodex mites proliferation in rosacea.


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Authors: I Trave, C Micalizzi, G Gasparini, E Cozzani, A Parodi