Scalp demodicosis: Trichoscopy unveiling the overlooked

A 30-year-old woman with a history of androgenic alopecia presented with recent intense scalp pruritus and an exacerbation of hair shedding in the frontal area. Physical examination revealed small erythematous patches on the face, predominantly on the forehead. Trichoscopic evaluation of the scalp demonstrated multiple Demodex tails protruding from follicular openings, confirming the diagnosis of scalp demodicosis. The patient was treated with topical metronidazole for six weeks, resulting in complete resolution of scalp itching, cessation of hair shedding, and clearance of the facial lesions. This case presents a rare instance of scalp demodicosis, underscoring that Demodex mite infestation, although often overlooked, can cause scalp folliculitis and be responsible for itching and, less frequently, hair shedding. Early recognition through trichoscopy is essential, as timely acaricidal therapy can lead to full recovery and prevent misdiagnosis or unnecessary invasive procedures.