Demodicidosis in scalp rosacea?

This is the authors' abstract. We don't add key points for this paper.

Rosacea is a chronic acneiform disorder often presenting with flushing, erythema, papules, pustules and telangiectasia on the face. Extrafacial rosacea is rare with few reports in the literature.1–5 In particular, rosacea affecting the bald scalp is unusual.6–8 There has been speculation that these atypical cases of rosacea are indeed rosacea‐like demodicidosis. We describe a case of facial and extrafacial rosacea with predominantly scalp involvement which has many of the features of demodicidosis. A 58‐year‐old man was referred by his general practitioner to our dermatology department with a 4‐year‐history of an intermittent facial rash. This was a symmetrical erythematous rash which had previously been treated with oral oxytetracycline and topical metronidazole cream. The rash was thought to be worsened by stress. Three months prior to his presentation his rash had worsened which he attributed to a bereavement. Ten days prior to presentation to the dermatology department, he had been started on erythromycin to treat the erythematous rash. Four days later, he developed painful crusting on his scalp. Flucloxacillin 500 mg four times daily was commenced, with slight improvement. The patient did not have any facial flushing or eye symptoms. There was no history of systemic or topical steroid application to the face or scalp. He was systemically well, with no past medical history of note and was on no regular medication.