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\begin{document}

\title{Atypical localization of demodicosis after COVID-19 infection.}



\author[1]{Ines Lahouel}%
\author[1]{Randa Said El Mabrouk}%
\author[1]{Rim Hadhri}%
\author[1]{Monia Youssef}%
\author[1]{Hichem Belhadjali}%
\author[1]{Jameleddine Zili}%
\affil[1]{Fattouma Bourguiba University Hospital of Monastir}%


\vspace{-1em}



  
  \date{May 10, 2024}


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\selectlanguage{english}
\begin{abstract}
Since its outbreak in December 2019, a consistent number of case reports
have been published describing a complex spectrum of skin manifestations
associated with COVID-19. We report a first observation of demodicidosis
of the scalp after a severe acute respiratory syndrome coronavirus 2
(SARS-COV-2) infection.%
\end{abstract}%



\sloppy


\textbf{Title:} Atypical localization of demodicosis after COVID-19
infection.

\textbf{Running title} : Scalp demodicosis after COVID-19

\textbf{The category for which the article is being submitted} :
Clinical image

\textbf{Authors:}

Ines Lahouel MD (1) (2): Medical doctor of dermatology

Randa Said El Mabrouk MD (1) (2): Medical doctor of dermatology

Rim Hadhri MD (3): Medical doctor of anatomopathology

Monia Youssef MD PhD (1) (2): Clinical~professor of~dermatology,

Hichem Belhadjali MDPhD (1) (2): Clinical~professor of~dermatology,

Jameleddin Zili MD Ph D (1) (2): Clinical~professor of~dermatology,

\textbf{Affiliations:}

(1) Dermatology department, Fattouma Bourguiba Hospital, University of
Medicine, Monastir, Tunisia.

(2) Dermo-respiratory research laboratory, the University of Medicine of
Monastir, Tunisia.

(3) Anatomo-pathology department, University of Medicine, Monastir,
Tunisia.

\textbf{Contributors' Statement Page:}

Ines Lahouel: Writing the manuscript.

Randa Said El Mabrouk: Writing the manuscript and submitting the revised
article.

Rim Hadhri: Wiriting~the histological part of the manuscript.

Monia Youssef: Supervised and approved the revised manuscript.

Hichem Belhadjali: Supervised and approved the revised manuscript

Jameleddin Zili: Supervised and approved the revised manuscript

\textbf{Consent~statement:} ~approved~by all~authors

Written~informed~consent~was~also~obtained~from~the patient
to~publish~this~report in accordance~with~the~journal'~patient
consent~policy''

\textbf{Ethical~statement} ~:~approved

\textbf{Statement~of~acknowledgement~:} none

We~choose~this~~statement~of
Data~availability~:~Data~openly~available~in a public repository
that~issues~datasets~with~DOIs

\textbf{Corresponding author:}

Randa Said El Mabrouk, MD,

Department of Dermatology, Fattouma Bourguiba Hospital, 5000 Monastir,
Tunisia

Email: saidranda@yahoo.fr Phone: +216 54 49 22 41

\textbf{Key words:} demodicosis, scalp, COVID 19, immunodepression,
dermatology, parasitology.

\textbf{Word counts~for the text:} 193

\textbf{Source of support:} none

\textbf{Acknowledgments:} none

\textbf{Conflict of interest:} none

\textbf{Case presentation~:}

A 45-year-old male patient presented with a lesion of the scalp
appearing 10 days after a SARS-COV-2 infection. The skin examination
found many firm and erythematous papules on a background of a diffuse
erythema associated with hair thinning.~Skin biopsy revealed excessive
Demodex mites in the follicular infundibulum with perivascular and
perifollicular lymphocytic infiltration.~Based on the clinical and
histopathological data, the diagnosis of scalp demodecidosis was
retained. The patient was treated with topical metronidazole, achieving
a complete regression of the lesions.

\textbf{Discussion:}

COVID-19 caused a variety of dermatological manifestations.
Demodicidosis is an ectoparasitosis caused by the proliferation of a
mite: \emph{Demodex sp} , that permanently resides in or near the
pilosebaceous unit and seborrheic glands. It has been implicated as a
pathogen in innumerable skin conditions and typically in blepharitis and
facial dermatitis such as rosacea-like or papulo-pustular
eruptions\textsuperscript{1}. The symptoms of scalp demodicidosis are
not common, and can be found mainly in people with weakened immune
systems \textsuperscript{2}. Immunodeficiency appears to create a
favourable environment for the development of the parasite.

In our case, disturbances of the host's immune response caused by
SARS-COV-2 explains this atypical localization of demodicidosis.

\textbf{Key clinical message~:}

Our observation emphasizes the importance of recognizing the cutaneous
manifestations of COVID-19 given their variability and the necessity of
a careful and critical skin evaluation in this pandemic period.

\textbf{References:}

1. Fernandez-Flores A, Alija A. Scalp folliculitis with Demodex:
innocent observer or pathogen? Braz J Infect Dis. 2009 ;13(2):81-2.

2. Seyhan ME, Karincao\selectlanguage{polish}ğ\selectlanguage{english}lu Y, Bayram N, Aycan O, Kuku I. Density of
Demodex folliculorum in hematological malignancies. J Int Med Res.
2004;32(4):411-5.

\textbf{Figures legends:}

\textbf{Figure:} ~~\textbf{1:} ~Diffuse erythema with erythematous
papules associated with hair thinning in the occipital scalp.

\textbf{Figure 2a:} ~Lymphocytic infiltrate around follicles
(Hematoxylin Eosin X 100)\textbf{.}

\textbf{Figure 2b:} ~ Multiple Demodex mites within pilosebaceous
follicle (Hematoxylin Eosin X 400).\selectlanguage{english}
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\includegraphics[width=0.70\columnwidth]{figures/Figure-1/Figure-1}

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\end{figure}\selectlanguage{english}
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\includegraphics[width=0.70\columnwidth]{figures/Figure-2/Figure-2}

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\end{figure}

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