Concurrent presence of Malassezia-suggestive yeasts and Demodex mites in perilesional follicles of facial porokeratosis: An incidental histopathologic observation

Facial skin represents a lipid-rich niche that is a suitable environment for commensals. Porokeratosis limited to the face is uncommon. We report an elderly man with a small annular plaque on the cheek that was confirmed by histopathology to be porokeratosis with multiple cornoid lamellae. Periodic acid–Schiff staining of the perilesional adnexa revealed clusters of yeast-like organisms consistent with Malassezia and elongated structures suggestive of Demodex within follicular lumina, accompanied by minimal perifollicular inflammation. Concomitant detection within a single follicular unit is unusual but should be interpreted in the context of the cohabitation of these commensals on sebaceous facial skin. Our findings highlight the site- and lesion-dependent ecology of these organisms and underscore the risk of overinterpreting dysbiosis as causative in cutaneous disease cases. This case expands the recognized spectrum of incidental adnexal colonization associated with porokeratosis and underscores the need for standardized sampling and reproducible human evidencwhen attributing pathogenicity.