PMC10179315_01
(A and B) Poorly demarcated greyish-brown confluent macules and patches associated with fine rough scales on the right cheek and the left cheek respectively. Lesions on the right side are darker and more diffuse compared to the left side. (C and D) Sites of the lesions after using ivermectin 1% cream daily at 3-month follow-up, significant improvement in discoloration and texture on the right cheek and the left cheek respectively.
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The lesions on the right cheek were more pigmented compared to the left cheek (Figure 1A and B). The patient showed significant improvement in which the hyperpigmented patches became lighter in color with less associated scales (Figure 1C and D), and fewer demodex tails with partial resolution of the reticular perifollicular pigmented network on dermoscopic examination (Figure 2B) at a 3-month follow-up time frame.
(A) dermoscopic picture showing white gelatinous filaments protruding through follicular openings "demodex tails" (arrows), and reticular perifollicular pigmented network (circle). (B) dermoscopic picture showing improvement after 3 months of treatment with ivermectin 1% cream.
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Further evaluation by dermoscopy showed white gelatinous filaments protruding out of follicular openings known as "Demodex tails" associated with reticular perifollicular pigmented network (Figure 2A).   The patient showed significant improvement in which the hyperpigmented patches became lighter in color with less associated scales (Figure 1C and D), and fewer demodex tails with partial resolution of the reticular perifollicular pigmented network on dermoscopic examination (Figure 2B) at a 3-month follow-up time frame.