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March 2017

Demodectic Frost of the Ear

Author Affiliations
  • 1Department of Dermatology, Virginia Commonwealth University, Richmond, Virginia
  • 2Department of Dermatology, University of Virginia, Charlottesville, Virginia
JAMA Dermatol. 2017;153(3):356-357. doi:10.1001/jamadermatol.2016.4769

Demodicosis is a well-established pathologic entity in animals, but the role of Demodex infestation in humans is not uniformly accepted among dermatologists. There are several clinical variants of human demodicosis that bear resemblance to various inflammatory dermatoses. We propose a new clinical variant of Demodex infestation, which we call demodectic frost of the ear because of the frosted appearance of the skin on the ear caused by follicular-based scale.

A man in his 50s presenting for routine total body skin examination was found to have frosted, gritty follicular scaling of his ears superimposed on an erythematous base (Figure). He was completely asymptomatic. Findings from skin scraping followed by potassium hydroxide preparation of the scale were positive for Demodex mites. The patient was counseled on different treatment regimens but ultimately declined therapy because he was not symptomatic.

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