Full Text:   <4373>

CLC number: R384.4; R757.3

On-line Access: 2012-02-29

Received: 2011-09-06

Revision Accepted: 2011-11-04

Crosschecked: 2012-02-17

Cited: 17

Clicked: 9598

Citations:  Bibtex RefMan EndNote GB/T7714

-   Go to

Article info.
1. Reference List
Open peer comments

Journal of Zhejiang University SCIENCE B 2012 Vol.13 No.3 P.192-202


A meta-analysis of association between acne vulgaris and Demodex infestation

Author(s):  Ya-e Zhao, Li Hu, Li-ping Wu, Jun-xian Ma

Affiliation(s):  Department of Immunology and Pathogen Biology, Xi’an Jiaotong University College of Medicine, Xi’an 710061, China

Corresponding email(s):   zhaoyae@mail.xjtu.edu.cn

Key Words:  Demodex infestation, Acne vulgaris, Case-control study, Meta-analysis

Ya-e Zhao, Li Hu, Li-ping Wu, Jun-xian Ma. A meta-analysis of association between acne vulgaris and Demodex infestation[J]. Journal of Zhejiang University Science B, 2012, 13(3): 192-202.

@article{title="A meta-analysis of association between acne vulgaris and Demodex infestation",
author="Ya-e Zhao, Li Hu, Li-ping Wu, Jun-xian Ma",
journal="Journal of Zhejiang University Science B",
publisher="Zhejiang University Press & Springer",

%0 Journal Article
%T A meta-analysis of association between acne vulgaris and Demodex infestation
%A Ya-e Zhao
%A Li Hu
%A Li-ping Wu
%A Jun-xian Ma
%J Journal of Zhejiang University SCIENCE B
%V 13
%N 3
%P 192-202
%@ 1673-1581
%D 2012
%I Zhejiang University Press & Springer
%DOI 10.1631/jzus.B1100285

T1 - A meta-analysis of association between acne vulgaris and Demodex infestation
A1 - Ya-e Zhao
A1 - Li Hu
A1 - Li-ping Wu
A1 - Jun-xian Ma
J0 - Journal of Zhejiang University Science B
VL - 13
IS - 3
SP - 192
EP - 202
%@ 1673-1581
Y1 - 2012
PB - Zhejiang University Press & Springer
ER -
DOI - 10.1631/jzus.B1100285

Until now, etiology of acne vulgaris is still uncertain. Although clinicians usually deny the association between Demodex infestation and acne vulgaris, it has been proved in some clinical practices. To confirm the association between Demodex infestation and acne vulgaris, a meta-analysis was conducted. Predefined selection criteria were applied to search all published papers that analyzed the association between Demodex infestation and acne vulgaris (January 1950 to August 2011) in ISI Web of Knowledge, MEDLINE, and China National Knowledge Infrastructure (CNKI) databases. A meta-analysis was performed to calculate odds ratios (ORs) and 95% confidence intervals (CIs) based on fixed effects models or random effects models. We enrolled the 60 Chinese and 3 English papers in this meta-analysis, which covered Turkey and 25 different provinces/municipalities in China and 42130 participants including students and residents, aged from 1 to 78 years. The pooled OR in random effects models is 2.80 (95% CI, 2.34–3.36). Stability is robust according to sensitivity analysis. The fail-safe number is 18477, suggesting that at least 18477 articles with negative conclusions would be needed to reverse the conclusion that acne vulgaris was related to Demodex infestation. So the effect of publication bias was insignificant and could be ignored. It was concluded that acne vulgaris is associated with Demodex infestation. This indicates that when regular treatments for acne vulgaris are ineffective, examination of Demodex mites and necessary acaricidal therapies should be considered.

Darkslateblue:Affiliate; Royal Blue:Author; Turquoise:Article


[1]Ayres, S.Jr., 1930. Pityriasis folliculorum (Demodex). Arch. Derm. Syphilol., 21(1):19-24.

[2]Ayres, S.Jr., Ayres, S.III, 1961. Demodectic eruptions (demodicidosis) in the human. Arch. Dermatol., 83(5):816-827.

[3]Baysal, V., Aydemir, M., Yorgancigil, B., Yildirim, M., 1997. The role of Demodexes on etiology and pathogenesis of acne vulgaris. Turkiye Parazitol. Derg., 21:265-268 (in Turkish).

[4]Bonnar, E., Eustace, P., Powell, F.C., 1993. The Demodex mites population in rosacea. J. Am. Acad. Dermatol., 28(3):443-448.

[5]Cao, G.L., Huang, Z., Liu, Y.B., 2005. Investigation in infections rate of follicle mite in some medical students in Ganzhou. J. Gannan Med. Coll., 25(5):596-597 (in Chinese).

[6]Cao, Y.S., You, Q.X., Wang, L., Lan, H.B., Xu, J., Zhang, X.H., Yang, H., Xiong, Y.J., Tian, X.F., 2009. Facial Demodex infection among college students in Tangshan. Chin. J. Parasitol. Parasit Dis., 27(3):271-273 (in Chinese).

[7]Chen, J.F., Chen, Y., Yan, D.D., Guo, X.R., Yang, H.D., Niu, B., Du, F.X., 2006. Investigation of Demodex infection in undergraduates. Acta Baotou Med. Coll., 22(2):135-136 (in Chinese).

[8]Chen, L.Q., Long, B., Wan, Q.H., Huang, X.G., Liu, H., He, L.F., Zhou, B.Y., 2008. Investigation of Demodex infection in students of a university. Lab. Med. Clin., 5(20):1246-1248 (in Chinese).

[9]Chen, X.C., Liu, J.H., Su, L.Y., Li, Y.H., 1993. Investigation on the Demodex infection among college students. J. Taishan Med. Coll., 14(4):272-275 (in Chinese).

[10]Chen, X.N., Zhao, X.J., Yan, Y., 1996. Study on face infection caused by Demodex folliculorum and epidemic factors in 444 college students. J. Chengde Med. Coll., 13(1):13-15 (in Chinese).

[11]Chen, X.Y., Shen, H.X., Li, X.M., Lin, W.Y., Li, G.P., Ruan, Y.F., Wang, X.Y., Cai, C.T., 2004. The investigation of human follicle mite infection in college students. J. Trop. Med., 4(4):401-403 (in Chinese).

[12]Chen, Y.G., Yang, Z.M., Chen, D.F., 1995. Primary investigation of facial Demodex infection. J. Hainan Univ., 13(2):145-147 (in Chinese).

[13]Clyti, E., Sayavong, K., Chanthavisouk, K., 2005. Demodecidosis in a patient infected by HIV: successful treatment with ivermectin. Ann. Dermatol. Venereol., 132(5):459-461 (in French).

[14]Damian, D., Rogers, M., 2003. Demodex infestation in a child with leukaemia: treatment with ivermectin and permethrin. Int. J. Dermatol., 42(9):724-726.

[15]Dhingra, K.K., Saroha, V., Gupta, P., Khurana, N., 2009. Demodex-associated dermatologic conditions—a coincidence or an etiological correlate. Review with a report of a rare case of sebaceous adenoma. Pathol. Res. Pract., 205(6):423-426.

[16]Di, B.H., Li, X., Li, C.Y., 2007. Investigation and analysis of Demodex infection in Tianjin undergraduate students. Chin. J. Health Lab. Technol., 17(7):1279, 1313 (in Chinese).

[17]Divani, S., Barpakis, K., Kapsalas, D., 2009. Chronic blepharitis caused by Demodex folliculorum mites. Cytopathology, 20(5):343-344.

[18]Dong, H.J., Duncan, L.D., 2006. Cytologic findings in Demodex folliculitis: a case report and review of the literature. Diagn. Cytopathol, 34(3):232-234.

[19]Du, L.Y., Zhao, L., Chen, X.N., Mi, S.B., 2006. Investigation and analysis of Demodex infection in undergraduate medical students. Chin. J. Health Stat., 23(6):532-533 (in Chinese).

[20]Erbagci, Z., Erbagci, I., Erkiliç, S., 2003. High incidence of demodicidosis in eyelid basal cell carcinomas. Int. J. Dermatol., 42(7):567-571.

[21]Fang, F., Xiao, X.L., Zeng, Y.W., Ding, S., 2003. The influence of occupation and air-condition on Demodex infection. Guangzhou Med. J., 34(5):59-60 (in Chinese).

[22]Forton, F., 2007. Standardized skin surface biopsy: method to estimate the Demodex folliculorum density, not to study the Demodex folliculorum prevalence. J. Eur. Acad. Dermatol. Venereol., 21(9):1301-1302.

[23]Forton, F., Seys, B., 1993. Density of Demodex folliculorum in rosacea: a case-control study using standardized skin-surface biopsy. Br. J. Dermatol., 128(6):650-659.

[24]Guo, E.P., Wang, S.L., Wang, Y., Wang, J.Y., 2005. Demodex infection of college students in Yunyang Medical College. Chin. J. Sch. Health., 26(6):469-470 (in Chinese).

[25]Han, J., Tao, H.Z., 1988. Epidemiological investigation on human Demodex infection. Guizhou Med. J., 12(4):234-236.

[26]Han, W.B., 1994. Investigation of Demodex infestation in military academy students and analysis of mitecide effectiveness with sulphur soap. Clin. J. Med. Offic., 22(3):9-10 (in Chinese).

[27]He, X., Chen, Y.Z., Wu, S.Y., Zhang, C.F., Wang, Q.H., Pan, L.L., 2009. Investigation of Demodex infection in students of Fujian Medical University. Strait J. Prev. Med., 15(1):39-40 (in Chinese).

[28]Hsu, C.K., Hsu, M.M., Lee, J.Y., 2009. Demodicosis: a clinicopathological study. J. Am. Acad. Dermatol., 60(3):453-462.

[29]Hu, S.F., Xia, H., Yang, Y.R., Zhao, Y.X., Liu, J.R., 1995. Investigation of Demodex infection in Bozhou secondery school students. J. Bengbu Med. Coll., 20(1):55 (in Chinese).

[30]Ji, Y.L., Zhou, X.Y., Tang, X.Y., Zhang, H.J., Zhao, D.F., Guan, M.S., 2003. Investigation of Demodex infection in medical students. Chin. J. Parasitol. Parasit Dis., 21(6):377 (in Chinese).

[31]Jiang, T.C., Li, L.Y., Peng, W., Yang, X.D., 2002. Investigation of Demodex infection in Yichang college students. J. Shanxi Med. Univ., 33(S1):5-6 (in Chinese).

[32]Kong, J.L., Shao, C.L., Ren, L.L., Nie, L.H., 2011. Mite infection survey of medical college students. J. Math. Med., 24(1):78 (in Chinese).

[33]Li, J.H., 1990. The epidemiology investigation of demodicidosis in Huairen of Guizhou. Guizhou Med. J., 14(5):314-315 (in Chinese).

[34]Li, Z., Wang, B.R., Cheng, Y.B., Ma, C., Zhang, M.R., 1991. Investigation on the infection of Demodex in Xi’an. J. Xi’an Med. Univ., 12(2):165-167 (in Chinese).

[35]Liang, D.H., Xin, B., Sun, J.B., Lu, Z.M., 2003. The investigation of Demodex mites infection among 1037 university students of Zhangjiakou medical college. J. Zhangjiakou Med. Coll., 20(2):20-22 (in Chinese).

[36]Lin, F.C., 1996. Investigation of facial Demodex infection in students of health school. J. Sch. Health, 17(1):78 (in Chinese).

[37]Liu, G.Z., Li, X.C., 2006. Investigation on the infection of Demodex among students in primary and middle school in rural area of Yanzhou city. J. Pathog. Biol., 1(1):s3 (in Chinese).

[38]Liu, Y.S., Yang, Y.P., Xie, D., Liu, S.H., Zhao, Q., Miu, H.H., Chen, S.J., Zhu, X.P., 2005. Analysis of Demodex infection of college students. Chin. J. Parasit Dis. Con., 18(5):396 (in Chinese).

[39]Moravvej, H., Dehghan-Mangabadi, M., Abbasian, M.R., Meshkat-Razavi, G., 2007. Association of rosacea with demodicosis. Arch. Iran Med., 10(2):199-203.

[40]Nong, Z.J., 1994. An analysis of the investigation on demodectic infection and epidemics in middle school students and pupils. Acta Med. Sin., 7:21-23 (in Chinese).

[41]Nong, Z.J., Nong, L.L., Mo, G., Jiang, L.P., 2011. Demodex infection of medical students and its related factors. Chin. J. Sch. Health, 32(1):84-85 (in Chinese).

[42]Okyay, P., Ertabaklar, H., Savk, E., Ertug, S., 2006. Prevalence of Demodex folliculorum in young adults: relation with sociodemographic/hygienic factors and acne vulgaris. J. Eur. Acad. Dermatol. Venereol., 20(4):474-476.

[43]Pan, C.W., 1989. A study on the epidemiology of human Demodex in Wenzhou. J. Wenzhou Med. Coll., 19(3):195-196 (in Chinese).

[44]Pan, C.W., Zhang, Z.Y., 1992. Investigation on Demodex infection in 737 facial demodicosis patients. Chin. J. Dermatovenereol., 6(3):156 (in Chinese).

[45]Peng, R.Y., Liu, Y.M., Tian, G.P., Bian, T.Y., Zhang, Y.H., 1983. Investigation on the infestation, the pathogenic effect of the mites in Tianjin. Tianjin Med. J., 11(10):592-594 (in Chinese).

[46]Post, C.F., Juhlin, E., 1963. Demodex folliculorum and blepharitis. Arch. Dermatol., 88(3):298-302.

[47]Purcell, S.M., Hayes, T.J., Dixon, S.L., 1986. Pustular folliculitis associated with Demodex folliculorum. J. Am. Acad. Dermatol., 15(5):1159-1162.

[48]Qin, J., Liu, Y.C., Guo, Y.H., Sheng, Z.Q., 1988. Investigation of Demodex infection among college students. J. Jining Med. Coll., 11(4):31-33 (in Chinese).

[49]Qin, X.H., Qin, W.Q., Liu, X.Q., Lu, Z.C., 2005. Investigation of Demodex infection in medical students and relative analysis. Guangxi J. Prev. Med., 11(6):337-339 (in Chinese).

[50]Rosenthal, R., 1979. The file-drawer problem and tolerance of null results. Psychol. Bull., 86(3):638-641.

[51]Ru, X.Y., Chen, X.B., Hu, S.F., Su, L.Y., Liu, J.H., Chen, X.C., 1993. Investigation on human Demodex in the students of primary and middle schools. J. Taishan Med. Coll., 14(2):114-116 (in Chinese).

[52]Shang, J.K., Xu, S.Z., Jiang, G.Y., Ma, Y., Qiao, Z.J., Zhang, Y., 2010. Investigation on Demodex infestation in 1103 health and patients with skin disease. J. Pract. Dermatol., 3(1):13-15 (in Chinese).

[53]Song, P., Liu, S.J., Zhao, F.Z., 2009. Investigation of human Demodex infection between 2007 and 2008. China Foreign Med. Treat., 28:118-119 (in Chinese).

[54]Sun, X.Q., Zhao, S.Y., Su, J., 1987. Examination of students of a college infected with Demodex folliculorum in Harbin. J. Harbin Med. Univ., 21(5):22-24 (in Chinese).

[55]Suo, Z.Q., Shi, Y.M., Yun, D.C., 2001. Investigation of demodicid mites infection among school students in Zhengzhou. Henan J. Prev. Med., 12(6):339-340 (in Chinese).

[56]Tao, Y.J., Peng, F.G., Hu, X.H., 2007. Investigation of Demodex infection in 1520 medical students. Pract. Prev. Med., 14(5):1463-1464 (in Chinese).

[57]Tu’er, X.A., Qiao, J.Y., Xue, H.B., 1997. Study on pathogenicity and pathogenic factor of human Demodex. Endem. Dis. Bull., 12(2):80-81 (in Chinese).

[58]Wang, A.H., Wang, T., 2008. Analysis of the relation between the facial skin diseases and the infection of demodicid mites in teenagers. Mod. Prev. Med., 35(17):3396-3399 (in Chinese).

[59]Wang, G.Y., Zhang, Y.S., 2006. Investigation of Demodex infection among medical students. Chin. J. Parasitol. Parasit. Dis., 24(2):156-157 (in Chinese).

[60]Wang, H.Y., Wang, X.X., Tu, L.X., 2010. Infection of human Demodex on facial skin of middle and primary students in rural areas of Huaibei. Mod. Prev. Med., 37(9):1728-1729 (in Chinese).

[61]Wang, Y.P., Cui, L.M., Wang, C., Li, F., Qiu, Z.X., 1982. Investigation on the Demodex infestation in Changchun. J. Norman Bethune Univ. Med. Sci., 8(3):79-80 (in Chinese).

[62]Xia, H., Hu, S.F., Chen, X.B., 1999. Relationship between vermiform mite infection and facial dermatosis. J. Pract. Parasit. Dis., 7(3):142-143 (in Chinese).

[63]Xing, D.R., Shi, J.M., Wu, Z.X., 1988. Further investigation on human Demodex infestation in Xuzhou. Acta Acad. Med. Xuzhou, 8(4):250-252 (in Chinese).

[64]Yang, H.N., Che, J., Yang, H.N., Xiao, Q.L., 2006. Study on the association between acne vulgaris and Demodex infection and Cuofuxin liniment treatment. Med. J. Chin. People’s Armed Police Forces, 17(1):55 (in Chinese).

[65]Yang, X.H., Duan, X.L., 2001. Investigation of Demodex infection in young students. J. Shanxi Med. Coll. Contin. Educ., 11(2):31-32 (in Chinese).

[66]Yang, X.H., Fan, L.N., Sun, X.L., Liu, T.Q., Yang, G.H., Qi, L., 2001. Investigation and analysis of 452 Demodex infection cases. Hebei Med. J., 23(3):215 (in Chinese).

[67]Yang, X.H., Wang, P., Deng, S.F., Wang, H., Feng, J.X., Liu, Y., Sun, X.L., 2010. Demodex infection investigation of 432 health noncommissioned officer students. Clin. J. Med. Offic., 38(3):478-479 (in Chinese).

[68]Yang, X.H., Deng, S.F., Wang, P., Feng, J.X., Fu, Z.J., Wang, H., Zhao, M.L., 2011. Demodex infection investigation of military health NCO trainees. Chin. J. Clin. Rational Drug Use, 4(7A):163-164 (in Chinese).

[69]Yang, X.M., Luo, Y., 2006. Survey of infectious status of facial vermiform mite in some primary school pupils and middle school students in Haikou City. China Trop. Med., 6(8):1532-1533 (in Chinese).

[70]Yang, Z.H., Pan, B., Lin, R.X., Gu, S.H., 1998. Epidemiological study of human Demodex in Guangdong province. Guangdong J. Health Epidemic Prev., 24(4):1-3 (in Chinese).

[71]Yao, Z.L., 2005. Investigation of Demodex infection in Qingdao students. Chin. J. Parasitol. Parasit Dis., 23(4):255 (in Chinese).

[72]Yuan, F.S., Guo, S.L., Han, Y.M., Deng, S.H., Huang, G.H., 2003. The curative effect of the cream made from the volatile oil of Chinese prickly ash on demodicidosis. Chin. J. Parasit. Dis. Con., 16(1):58-60 (in Chinese).

[73]Zhan, P.L., Shi, L.L., Sun, L., Zeng, R.R., 1997. Investigation of human Demodex infection in Hepu county. J. Guangxi Med. Univ., 14(1):146-147 (in Chinese).

[74]Zhang, H.Y., Shao, Z.P., Ding, Y.L., Xia, P., 2007. Investigation and relative factors analysis on Demodex infection in undergraduate students. J. Public Health Prev. Med., 18(1):65-66 (in Chinese).

[75]Zhang, J.S., Cui, J.G., Zhang, W.Z., Tang, H.W., 1985. Investigation of human Demodex infection. J. Hebei North Univ., 2:5-6 (in Chinese).

[76]Zhang, M.H., Xia, H., Hu, S.F., 2005. Investigation of Demodex infection in undergraduate students and observation of therapy. J. Trop. Dis. Parasitol., 3(4):213-215 (in Chinese).

[77]Zhang, X.S., Tong, X.L., Guo, Q., 1991. Investigation on Demodex infection of 1012 patients with skin disease. Chin. J. Parasit Dis. Con., 4(2):94 (in Chinese).

[78]Zhao, Y.E., Feng, L.P., Xun, M., Li, X.Q., Long, Q., 2004. Investigation on the infection of Demodex folliculorum and analysis on relative factors. Chin. J. Parasit Dis. Con., 17(1):56-57 (in Chinese).

[79]Zhao, Y.E., Guo, N., Wu, L.P., 2009. The effect of temperature on the viability of Demodex folliculorum and Demodex brevis. Parasitol. Res., 105(6):1623-1628.

[80]Zhao, Y.E., Wu, L.P., Peng, Y., Cheng, H., 2010. Retrospective analysis of the association between Demodex infestation and rosacea. Arch. Dermatol., 146(8):896-902.

[81]Zhao, Y.E., Guo, N., Xun, M., Xu, J.R., Wang, M., Wang, D.L., 2011a. Sociodemographic characteristics and risk factor analysis of Demodex infestation (Acari: Demodicidae). J. Zhejiang Univ.-Sci. B (Biomed. & Biotechnol.), 12(12):998-1007.

[82]Zhao, Y.E., Peng, Y., Wang, X.L., Wu, L.P., Wang, M., Yan, H.L., Xiao, S.X., 2011b. Facial dermatosis associated with Demodex: a case-control study. J. Zhejiang Univ.-Sci. B (Biomed. & Biotechnol.), 12(12):1008-1015.

[83]Zhao, Y.E., Guo, N., Wu, L.P., 2011c. The influence of temperature and medium on viability of Demodex folliculorum and Demodex brevis (Acari: Demodicidae). Exp. Appl. Acarol., 54(4):421-425.

[84]Zhao, Y.E., Wu, L.P., Hu, L., Xu, J.R., 2012. Association of blepharitis with Demodex: a meta-analysis. Ophthal Epidemiol., in press.

[85]Zhou, D.S., Zhu, Z.Y., Deng, Z.Q., Liu, W.T., 2002. Investigation of humans Demodex infection in Xuwen county. Chin. J. Epdemiol., 23(1):31 (in Chinese).

[86]Zhou, H.Y., Zhao, Q.L., 2001. Investigation of Demodex infection in youth. Chin. J. Pest Con., 17(12):639-640 (in Chinese).

[87]Zhou, L., Wu, Y.J., 2003. Investigation on the infection of Demodex in college students. Chin. J. Parasit Dis. Con., 16(5):262 (in Chinese).

[88]Zou, M., Zhou, D.S., Dong, J.C., Luo, Y.D., Liu, W.T., Zhou, R.H., 2004. Investigation on the Demodex infection among 2475 students of middle and primary school. Chin. J. Parasit Dis. Con., 17(4):243-244 (in Chinese).

Open peer comments: Debate/Discuss/Question/Opinion


Please provide your name, email address and a comment

Journal of Zhejiang University-SCIENCE, 38 Zheda Road, Hangzhou 310027, China
Tel: +86-571-87952783; E-mail: cjzhang@zju.edu.cn
Copyright © 2000 - 2024 Journal of Zhejiang University-SCIENCE