What Is Your Diagnosis? Demodex Folliculitis

A 79-year-old man presented with rosacea of 3 years’ duration that was refractory to multiple medications. His medical history was notable for type 2 diabetes mellitus. His dermatologic history was otherwise unremarkable. Prior therapies for his rosacea included minocycline hydrochloride, doxycycline monohydrate, and tetracycline hydrochloride, which did not result in improvement. His most recent therapy was hydrocortisone butyrate cream 0.1% applied daily for a year and a half that resulted in only partial response. On physical examination he had multiple inflammatory papules and pustules noted on the neck and bilateral cheeks with extension to his upper chest, especially on his right side.