Efficacy of topical Ivermectin in controlling human Demodex infestation: Evidence from systematic review and meta-analysis

IF 2.4 Q3 INFECTIOUS DISEASES

Parasite Epidemiology and Control Pub Date : 2025-09-23 DOI:10.1016/j.parepi.2025.e00461

Anon Paichitrojjana , Kitsarawut Khuancharee , Anand Paichitrojjana

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引用次数: 0

Abstract

Background

Demodex mites are usually harmless but can contribute to inflammatory skin conditions like rosacea, blepharitis, and demodicosis. While new therapies like lotilaner, niclosamide, and berberine show promise against D. folliculorum, ivermectin remains widely used for its strong antiparasitic and anti-inflammatory effects. However, the direct effectiveness of ivermectin in reducing Demodex mite density in associated skin diseases is not fully quantified.

Materials and methods

A systematic review and meta-analysis were conducted following PRISMA guidelines. PubMed, Scopus, the Cochrane Library, and Google Scholar were searched for studies published between December 2014 and December 2024. Eligible studies have assessed the effect of topical ivermectin on Demodex mite number or density using standardized diagnostic methods. Risk of bias was evaluated using the Risk of Bias Assessment Tool for Non-randomized Studies (RoBANS) and the Cochrane Risk of Bias Tool. Data were pooled using a random-effects model where appropriate.

Results

A total of 2344 studies were identified, with five studies (n = 180 participants) meeting the inclusion criteria. All studies reported significant reductions in Demodex mite count or density after daily application of topical ivermectin 1 %. Meta-analyses demonstrated a mean reduction of 70.01 mites/cm² and an 80 % decrease in Demodex-positive (≥5 D/cm²) rates. A 16-week treatment duration was associated with a notable reduction, with effects sustained for up to 12 weeks post-treatment. Only mild, localized adverse events were reported, with no systemic side effects observed.

Conclusion

Topical ivermectin is effective and well-tolerated for reducing the number and density of Demodex mites. A 16-week treatment course significantly decreases mite burden and improves clinical outcomes with minimal adverse events. However, the potential for mite repopulation after treatment underscores the importance of ongoing monitoring. Study heterogeneity and the limited number of included trials warrant cautious interpretation of the findings.

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局部伊维菌素控制人类蠕形螨感染的效果：来自系统评价和荟萃分析的证据

蠕形螨通常是无害的，但可引起皮肤炎症，如酒渣鼻、眼炎和蠕形螨病。虽然像洛替拉、氯硝胺和小檗碱这样的新疗法显示出治疗滤泡杆菌的希望，但伊维菌素仍因其强大的抗寄生虫和抗炎作用而被广泛使用。然而，伊维菌素在降低相关皮肤病蠕形螨密度方面的直接效果尚未完全量化。材料和方法按照PRISMA指南进行系统评价和荟萃分析。PubMed、Scopus、Cochrane Library和谷歌Scholar检索了2014年12月至2024年12月间发表的研究。采用标准化诊断方法评估了局部使用伊维菌素对蠕形螨数量或密度的影响。使用非随机研究偏倚风险评估工具（RoBANS）和Cochrane偏倚风险评估工具评估偏倚风险。在适当的情况下，使用随机效应模型汇总数据。结果共纳入2344项研究，其中5项研究（n = 180名受试者）符合纳入标准。所有的研究都报告说，每天使用局部伊维菌素后，蠕形螨的数量或密度显著降低1%。荟萃分析显示，平均减少70.01螨/cm2，蠕形螨阳性（≥5 D/cm2）率降低80%。16周的治疗时间与显著减少相关，效果持续到治疗后12周。仅报道了轻微的局部不良事件，未观察到全身副作用。结论局部使用伊维菌素可有效降低蠕形螨的数量和密度，且耐受性良好。一个16周的疗程显著减少螨负担和改善临床结果与最小的不良事件。然而，治疗后螨虫繁殖的可能性强调了持续监测的重要性。研究的异质性和纳入试验的有限数量要求对研究结果进行谨慎的解释。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Parasite Epidemiology and Control Medicine-Infectious Diseases

CiteScore

5.70

自引率

3.10%

发文量

审稿时长

17 weeks

期刊介绍： Parasite Epidemiology and Control is an Open Access journal. There is an increasing amount of research in the parasitology area that analyses the patterns, causes, and effects of health and disease conditions in defined populations. This epidemiology of parasite infectious diseases is predominantly studied in human populations but also spans other major hosts of parasitic infections and as such this journal will have a broad remit. We will focus on the major areas of epidemiological study including disease etiology, disease surveillance, drug resistance and geographical spread and screening, biomonitoring, and comparisons of treatment effects in clinical trials for both human and other animals. We will also look at the epidemiology and control of vector insects. The journal will also cover the use of geographic information systems (Epi-GIS) for epidemiological surveillance which is a rapidly growing area of research in infectious diseases. Molecular epidemiological approaches are also particularly encouraged.