Refractory Blepharitis and Facial Dermatitis Due to Demodex Overgrowth in an Immunosuppressed Patient with Lupus Nephritis: A Case Report

Abstract

Background: Demodex mites are common commensals of human skin and eyelids but may become pathogenic in immunocompromised individuals. Increased mite density has been associated with ocular surface disease, blepharitis, and dermatological manifestations, particularly in patients receiving long-term immunosuppressive therapy. Case Presentation: We report a woman in her late 60s with lupus nephritis on immunosuppressive therapy who presented with persistent facial dryness, erythema, scaly patches, and chronic eyelid itching unresponsive to topical antibiotic ointment, which was used only as adjunctive therapy to reduce secondary bacterial colonization. Dermatological assessment with Standardized Skin Surface Biopsy revealed a high density of Demodex mites (>5 mites/cm²). Ophthalmological examination demonstrated cylindrical dandruff, and eyelash epilation according to the Gao method, confirmed Demodex infestation. A combined treatment regimen of topical ivermectin 1% cream, tea tree oil–based eyelid wipes, and adjunctive antibiotic ointment led to significant clinical improvement within six weeks. By three months, both dermatological and ocular symptoms had resolved completely, and follow-up testing confirmed normalized mite density. No recurrence occurred during 12 months of follow-up. Conclusion: This case highlights a possible association between immunosuppression and Demodex overgrowth, underscoring the importance of considering demodicosis in patients with refractory blepharitis and dermatitis. Early recognition, interdisciplinary collaboration, and targeted acaricidal therapy can achieve full remission and prevent chronic ocular surface inflammation in immunocompromised individuals.