Role of Demodex mite infestation in rosacea: A systematic review and meta-analysis

J Am Acad Dermatol. 2017 Sep;77(3):441-447.e6. doi: 10.1016/j.jaad.2017.03.040. Epub 2017 Jul 12.


Background: The reported prevalence and degrees of Demodex mite infestation in rosacea vary widely.

Objective: We sought to conduct an evidence-based meta-analysis of the prevalence and degrees of Demodex mite infestation in patients with rosacea.

Methods: Systematic literature review and meta-analysis were conducted. Odds ratios for prevalence of infestation and standardized mean difference (SMD) for Demodex density in patients with rosacea were pooled. Subgroup analysis for type of rosacea, control group, and sampling and examination methods were also performed.

Results: Twenty-three case-control studies included 1513 patients with rosacea. Compared with the control patients, patients with rosacea were more likely to be infested by Demodex mites [odds ratio, 9.039; 95% confidence interval (CI), 4.827-16.925] and had significantly higher Demodex density (SMD, 1.617; 95% CI, 1.090-2.145). Both erythematotelangiectatic rosacea (SMD, 2.686; 95% CI, 1.256-4.116) and papulopustular rosacea (SMD, 2.804; 95% CI, 1.464-4.145) had significantly higher Demodex density than did healthy control patients.

Limitations: Interstudy variability was high, and a causal relationship could not be established by case-control studies.

Conclusions: Patients with rosacea had significantly higher prevalence and degrees of Demodex mite infestation than did control patients. Demodex mites may play a role in both erythematotelangiectatic rosacea and papulopustular rosacea.

Keywords: Demodex mites; erythematotelangiectatic rosacea; meta-analysis; papulopustular rosacea; rosacea; standardized superficial skin biopsy.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Case-Control Studies
  • Humans
  • Mite Infestations / complications*
  • Mite Infestations / epidemiology
  • Prevalence
  • Rosacea / parasitology*