Density of Demodex folliculorum in patients receiving epidermal growth factor receptor inhibitors

Dermatology. 2011;222(2):144-7. doi: 10.1159/000323001. Epub 2011 Feb 22.


Background: Rosacea-like papulopustular eruptions (rash) are considered the most frequent toxicities associated with the use of inhibitors of the epidermal growth factor receptor (EGFR). Recently, evidence has been accumulating of infectious complications in patients suffering from these adverse effects.

Objective: We sought to analyze the density of Demodex folliculorum (DF) in cutaneous lesions of patients presenting with EGFR-inhibitor (EGFRI)-induced rashes.

Methods: This is a retrospective study of 19 adult patients presenting with EGFRI rashes. Patients were reviewed for the density of DF (Demodex density, Dd; mites per square centimeter) by standardized skin surface biopsy.

Results: In our patient collective the mean Dd of 4.7/cm² significantly exceeded the mean Dd reported for the healthy adult population (Dd = 0.7/cm²).

Limitations: The retrospective nature of the study.

Conclusions: EGFRI patients have an increased susceptibility to DF colonization or infection, respectively. Our results support the recent concept that EGFRI may induce an impairment of antimicrobial defense mechanisms.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Animals
  • Antineoplastic Agents / adverse effects*
  • Antineoplastic Agents / therapeutic use
  • ErbB Receptors / antagonists & inhibitors*
  • Erlotinib Hydrochloride
  • Exanthema / chemically induced*
  • Exanthema / diagnosis
  • Female
  • Gefitinib
  • Humans
  • Male
  • Middle Aged
  • Mite Infestations / chemically induced*
  • Mite Infestations / parasitology
  • Mites*
  • Protein Kinase Inhibitors / adverse effects*
  • Protein Kinase Inhibitors / therapeutic use
  • Quinazolines / adverse effects*
  • Quinazolines / therapeutic use
  • Retrospective Studies
  • Rosacea / chemically induced
  • Rosacea / parasitology
  • Skin / parasitology*


  • Antineoplastic Agents
  • Protein Kinase Inhibitors
  • Quinazolines
  • Erlotinib Hydrochloride
  • ErbB Receptors
  • Gefitinib