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Evidence-Based Dermatology: Review |

Retrospective Analysis of the Association Between Demodex Infestation and Rosacea

CHOSIDOW OLIVIER, MD, PhD; P. DELLAVALLE ROBERT, MD, PhD, MSPH; DO DAIHUNG, MD; GONZÁLEZ URBÀ, MD, PhD; M. POPESCU CATALIN, MD, PhD; WILLIAMS HYWEL, MSc, PhD, FRCP; Ya E. Zhao, MPH; Li Ping Wu, MB; Yan Peng, MMed; Hui Cheng, MMed
Arch Dermatol. 2010;146(8):896-902. doi:10.1001/archdermatol.2010.196.
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Objectives  To explore the association between Demodexinfestation and rosacea and the pathogenesis of demodicosis rosacea by means of a meta-analysis.

Data Sources  Electronic searches of the ISI Web of Knowledge (Science Citation Index, ISTP [Index to Scientific & Technical Proceedings], Journal Citation Reports, BP [BIOSIS Preview], INSPEC [Ination Service in Physics, Electronics Technology, and Computer and Control], and DII [Derwent Innovation Index]), MEDLINE, and CNKI (China National Knowledge Infrastructure) databases (January 1, 1950, to December 31, 2009). We also performed hand searches of reference lists and conference proceedings.

Study Selection  Predefined selection criteria were applied to all published case-control studies that analyzed the association between Demodexinfestation and rosacea.

Data Extraction  Two of us independently extracted data from the included studies. For disputed articles, a third party mediated whether to include the study.

Data Synthesis  Forty-eight English- and Chinese-language articles, which covered 10 different countries and 28 527 participants, were eligible. The pooled odds ratio in random-effects models is 7.57 (95% confidence interval, 5.39-10.62). Stability is good according to sensitivity analysis. The fail-safe number is 18 456 in the quantitative analysis of publication bias.

Conclusions  A significant association exists between Demodexinfestation and the development of rosacea. Demodexinfestation is a vital risk factor for rosacea according to the time-to-event relationship, and the degree of infestation played a more important role than did the mite infestation rate in the development of rosacea.

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Figure 1.

Forest plot of the 48 included studies about the association between Demodexinfestation and rosacea. We found more heterogeneity in the 48 included studies (Q = χ247 = 324.96, P < .001; I2 = 85.5%>56.0%). CI indicates confidence interval; OR, odds ratio.

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Figure 2.

Forest plot of 39 Chinese-language studies about the association between Demodexinfestation and rosacea. CI indicates confidence interval; OR, odds ratio.

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Figure 3.

Forest plot of 9 English-language studies about the association between Demodexinfestation and rosacea. CI indicates confidence interval; OR, odds ratio.

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Figure 4.

Forest plot of 20 studies with a large sample size about the association between Demodexinfestation and rosacea. CI indicates confidence interval; OR, odds ratio.

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