Ocular surface changes in moderate-to-severe acne vulgaris

AIM:To investigate ocular surface disorders and tear function changes in patients with acne vulgaris and explore the potential relationship between acne vulgaris and dry eye.METHODS:This cross-sectional study included right eyes of 53 patients with acne vulgaris and 54 healthy controls.The participants completed the Ocular Surface Disease Index(OSDI)questionnaire.The following ocular surface-related parameters were measured:tear meniscus height(TMH),noninvasive tear breakup time(NIBUT),Schirmer I test(SIT),lipid layer thickness(LLT)score of the tear film,meibum score,meibomian gland orifice obstruction score,the ratio of meibomian gland loss,conjunctival hyperemia score,and corneal fluorescein staining(CFS)score.RESULTS:The stability of the tear film decreased in acne vulgaris patients.In the acne group,the TMH and NIBUT were lower,whereas the OSDI,meibum score,meibomian gland orifice obstruction score,ratio of meibomian gland loss,and conjunctival hyperemia score were higher compared with controls(P<0.05).There were no significant differences in the CFS score,SIT,or LLT score between the groups(P>0.05).In two dry eye groups,the TMH,NIBUT,and LLT score were lower in the acne with dry eye(acne-DE)group,and the meibum score,meibomian gland orifice obstruction score,ratio of meibomian gland loss and conjunctival hyperemia score in the acne-DE group were higher(P<0.05).There were no significant differences between OSDI,SIT,and CFS score(P>0.05).CONCLUSION:Patients with moderate-to-severe acne vulgaris are more likely to experience dry eye than those without acne vulgaris.Reduced tear film stability and meibomian gland structure dysfunction are more pronounced in patients with moderate-to-severe acne and dry eye.

Serum level changes of inflammatory cytokines in patients with moderate to severe acne vulgaris treated with dual-wavelength laser

Background:Acne vulgaris(AV)is a common inflammatory skin disease.Although various mechanisms have been indicated in the etiopathogenesis of AV,the exact pathophysiology remains unknown.Various lasers have been used to treat AV;however,the serum level changes of inflammatory cytokines after laser therapy have not been elucidated.We aimed to investigate the relationship between inflammatory changes and remission on the opposite side in patients with moderate to severe AV after treating half of the face with 595-and 1064-nm dualwavelength laser.Methods:In total,18 patients(9 male and 9 female)between 16 and 35 years of age with moderate to severe AV were evaluated in the study.Disease severity was classified according to the Pillsbury grading system of acne.Patients were randomized to receive a series of two treatment sessions at intervals of 2 weeks and followed up at 2 weeks after the final treatment.A 3 mL blood sample was drawn from every subject each time,and serum levels of inflammatory cytokines such as interleukin(IL)-6,IL-8,and IL-22 were determined using enzyme-linked immunosorbent assay at baseline and 2 weeks after each treatment.Improvement was determined by a blinded assessment of photographs taken before and after the final evaluation.Results:Inflammation was significantly reduced on both the treated and untreated sides,and symptoms of AV lesions were alleviated.All patients showed a significant increase in serum IL-22 levels after the first laser therapy,with no significant difference in serum IL-6 and IL-8 levels.After the second laser therapy,serum IL-6,IL-8,and IL-22 levels were significantly decreased.No significant side effects such as bruising,edema,hyperpigmentation,hypopigmentation,or scarring were reported.Conclusion:Half-face treatment with 595-and 1064-nm dual-wavelength laser for moderate and severe AV showed a significant effect of full-face remission,which was associated with a gradual decrease in IL-6,IL-8,and IL-22 levels after half-face topical treatment.This suggests that reducing inflammatory cytokine levels in the serum can relieve inflammation in non-therapeutic sites.This laser treatment is effective,economical,and painless.

Effective Skin Care Guidance for Patients with Acne Vulgaris after Standard Treatment

With the introduction of new drugs, the treatment of acne vulgaris has improved dramatically;however, there remains a considerable gap between treatment outcomes and patients’ treatment goals. This study aimed to determine whether dermatologists’ guidance on appropriate skincare for skin symptoms such as post-inflammatory erythema and post-inflammatory hyperpigmentation (PIH), which are not covered by acne treatment, leads to an improvement in patients’ skin condition and patient satisfaction. Japanese women who had completed standard treatment for acne vulgaris and those with mild symptoms not requiring treatment were included in the study. The participants received instructions about skin care at the beginning of the study, which they continued to apply for 6 weeks. At the start and end of the study, participants were examined by a dermatologist;afterward, skin measurements, including skin color, skin surface lipid content, and image analysis by VISIA® Evolution, analysis of stratum corneum obtained from the skin surface, and Skindex-16 questionnaire for assessing quality of life (QOL), were performed. The following showed significant improvements: PIH score, number of inflammatory acne lesions, and number of non-inflammatory acne lesions observed via skin examination;skin surface lipid content and values of L* and a* obtained via instrumental measurement;n number of pore, texture, red spot, and pigmented spot obtained via by image analysis;and degree of multilayer exfoliation and interleukin-1α determined by analysis of epidermal stratum corneum. QOL measurement using Skindex-16 also improved significantly. Appropriate skin care guidance following standard acne vulgaris treatment is helpful in achieving patients’ treatment goals. .

Autocrine IL-8 Contributes to Propionibacterium Acnes-induced Proliferation and Differentiation of HaCaT Cells via AKT/FOXO1/Autophagy

Objective Proprionibacterium acnes(P.acnes)-induced inflammatory responses,proliferation and differentiation of keratinocytes contribute to the progression of acne vulgaris(AV).P.acnes was found to enhance the production of interleukin-8(IL-8)by keratinocytes.This study aimed to investigate the role of IL-8 in P.acnes-induced proliferation and differentiation of keratinocytes and the underlying mechanism.Methods The P.acnes-stimulated HaCaT cell(a human keratinocyte cell line)model was established.Western blotting and immunofluorescence were performed to detect the expression of the IL-8 receptors C-X-C motif chemokine receptor 1(CXCR1)and C-X-C motif chemokine receptor 2(CXCR2)on HaCaT cells.Cell counting kit-8(CCK-8)assay,5-ethynyl-20-deoxyuridine(EdU)assay and Western blotting were performed to examine the effects of IL-8/CXCR2 axis on the proliferation and differentiation of HaCaT cells treated with P.acnes,the IL-8 neutralizing antibody,the CXCR2 antagonist(SB225002),or the CXCR1/CXCR2 antagonist(G31P).Western blotting,nuclear and cytoplasmic separation,CCK-8 assay,and EdU assay were employed to determine the downstream pathway of CXCR2 after P.acnes-stimulated HaCaT cells were treated with the CXCR2 antagonist,the protein kinase B(AKT)antagonist(AZD5363),or the constitutively active forkhead box O1(FOXO1)mutant.Finally,autophagy markers were measured in HaCaT cells following the transfection of the FOXO1 mutant or treatment with the autophagy inhibitor 3-methyladenine(3-MA).Results The expression levels of CXCR1 and CXCR2 were significantly increased on the membrane of HaCaT cells following P.acnes stimulation.The IL-8/CXCR2 axis predominantly promoted the proliferation and differentiation of P.acnes-induced HaCaT cells by activating AKT/FOXO1/autophagy signaling.In brief,IL-8 bound to its receptor CXCR2 on the membrane of keratinocytes to activate the AKT/FOXO1 axis.Subsequently,phosphorylated FOXO1 facilitated autophagy to promote the proliferation and differentiation of P.acnes-induced keratinocytes.Conclusion This study demonstrated the novel autocrine effect of IL-8 on the proliferation and differentiation of P.acnes-induced keratinocytes,suggesting a potential therapeutic target for AV.

Effects of cosmetics containing purified honeybee(Apis mellifera L.) venom on acne vulgaris

Acne vulgaris is a chronic dermatologic problem with multiple factors involved in its pathogenesis. Alternative solutions to acne treatment were instigated by antibiotic resistance despite of its extensive use. Purified bee venom （PBV） has been proposed as a promising candidate for that purpose. The present study was designed to confirm the antibacterial effect of PBV and access the efficacy of cosmetics containing PBV in subjects with acne vulgaris. METHODS： The skin bacterium Propionibacterium acnes was incubated with PBV at various concentrations and bacterial growth was evaluated using the colony forming unit （CFU） assay. The mechanism of PBV employed in killing P. acnes was examined by scanning electron microscopy （SEM） and transmission electron microscopy （TEM）. In addition, a total of 12 subjects were randomized in a double-blind, controlled trial to receive either cosmetics containing PBV or cosmetics without PBV for two weeks. Evaluations included lesion counts and skin microorganism. RESULTS： PBV exhibited antimicrobial activity in a concentration-dependent manner, reducing the number of P. acnes CFU by approximately 6 logs at a concentration of 0.5 mg. When PBV concentration was higher than 1.0 mg, no P. acnes colonies were spotted on an agar. TEM and SEM of untreated P. acnes illustrated the normal pleomorphic structure, whereas the PBV- treated bacterium lost the integrity of surface architecture. Significant difference （P=0.027） in the grading levels based on numbers of lesion counts for inflammatory and noninflammatory was observed in favour of the PBV group compared with the control group. In terms of average decrement of skin microorganism, subjects receiving cosmetics containing PBV experienced a significant 57.5% decrease of adenosine triphosphate levels, whereas participants receiving cosmetics without PBV experienced a nonsignificant decrease of 4.7%. CONCLUSION： These results show that the in vitro actions of antimicrobial activity of PBV were translated in vivo. Cosmetics containing PBV provided a certain degree of efficacy in terms of lesion counts and skin microorganism concentration compared with cosmetics without PBV in subjects with acne vulgaris. PBV may be a good candidate compound for developing therapeutic drua for the treatment of acne vulaaris.

Long Term Follow-Up Results of a Fractional Radio Frequency Ablative Treatment of Acne Vulgaris and Related Acne Scars

Introduction: Acne vulgaris and acne scarring are prevalent conditions that can have a negative effect on a patient’s quality of life. Fractional radiofrequency technologies have been shown to be clinically safe and effective in managing acne scars through dermal remodeling without causing direct damage to the epidermis. In a recently published study, we presented our clinical and histological results in the treatment of patients with active acne and acne related scarring using a Fractional RF (FRF) device. In the current article we demonstrate long term follow-up results, up to two years post last fractional treatment. Methods: Four out of the eight patients who completed a four treatment regimen were invited for long term follow-up visit to document treatment results. In some cases, touch-up treatments were conducted to optimize clinical results. Results: Patients demonstrated significant improvement of acne lesions, acne scarring, pores and skin texture. Long term photos demonstrated that clinical improvement progressed with time. Conclusion: The current study further supports the previous findings that FRF is a safe and effective treatment modality for active acne and acne related scars. Treatment protocol can be customized according to patient needs and clinical results last for long term.

Optimal laboratory testing protocol for patients with acne taking oral isotretinoin

BACKGROUND Isotretinoin is a widely prescribed drug for various dermatological conditions,especially acne.Blood tests are routinely performed to monitor its side effects.However,the optimal testing schedule remains controversial.AIM To evaluate the laboratory monitoring tests and schedules of patients with acne taking isotretinoin to determine the most efficient testing regimen.METHODS We retrospectively reviewed electronic medical records from the Dermatology Department of Dongguk University Ilsan Hospital from 2005 to 2020 for patients prescribed isotretinoin for acne who underwent monthly blood tests.RESULTS Aspartate aminotransferase(AST),alanine aminotransferase(ALT),and trigly-ceride(TG)levels significantly changed between 5 and 6 mo when the total prescription period and dose variables were considered altogether.The high-density lipoprotein level also significantly changed between 5 and 6 mo.However,low-density lipoprotein(LDL)and total cholesterol levels significantly changed between 1 and 2 mo.CONCLUSION We recommend testing AST,ALT,and TG levels once every 5 to 6 mo.We also suggest testing LDL and total cholesterol levels during the first and second months.

Clinical Observation in 86 Cases of Acne Vulgaris Treated with Compound Oldenlandis Mixture

86 cases of acne vulgaris were treated with Fu Fang She She Cao He Ji (复方蛇舌草合剂Compound Oldenlandis Mixture), with the other 34 cases treated with Dang Gui Ku Shen Wan (当归苦参丸Pills Prepared from Chinese Angelica and Flavescent Sophora Root) as the controls, to observe the therapeutic effect of the former. The results showed that the cure plus markedly effective rate was 73.26% in the treatment group, and 47.06% in the control group, with a significant difference in the cure plus markedly effective rate between the two groups (P<0.01), and also in the total effective rate between the two groups significant (P<0.05). It may be concluded that the Compound Oldenlandis Mixture is a better agent for the illness.

TNFR 2 M196R Polymorphism and Acne Vulgaris in Han Chinese:A Case-control Study

In this case-control study,the relationship between M196R(676 T→G) variant in exon 6 of tumor necrosis factor receptor type 2(TNFR2) gene and genetic susceptibility of acne vulgaris in Han Chinese was investigated.A total of 93 acne vulgaris patients and 90 healthy subjects from Han Chinese ethnic group were enrolled in this study.Polymerase chain reaction-restriction fragment length polymorphism(PCR-RFLP) technique was adopted to analyze the single nucleotide polymorphisms(SNPs) of TNFR2 M196R gene,and to examine the association between acne vulgaris and the polymorphisms in TNFR2 M196R gene.The relationship between different genotypes and the susceptibility of acne vulgaris was analyzed.The results showed that there was significant difference in the frequency of the genotype M/R+R/R in the TNFR2 M196R genetic polymorphisms between acne vulgaris patients and healthy controls(χ2=4.343;P=0.037;OR=1.899;95% CI:1.036-3.445);and there was significant difference in the allele(R) frequency between acne vulgaris patients and healthy controls(χ2=5.588;P=0.018;OR=1.838;95% CI:1.105-3.057).It was concluded that the high frequency of 196R allele in the functional M196R polymorphism of TNFR2 is a risk factor for acne vulgaris in Han Chinese.

PHOTOTHERAPY FOR MILD TO MODERATE ACNE VULGARIS WITH PORTABLE BLUE AND RED LED

In this paper,we studied portable blue and red light-emitting-diode(LED)light sources in phototherapy for mild to moderate acne vulgaris to evaluate the efficacy and tolerance of patients.Patients,randomly divided into blue and red groups,received either blue or red LED phototherapy twice a week for four weeks.After complete treatment,the number of lesions reduced by 71.4% in the blue group,in contrast to 19.5% in the red group.No obvious side effects were observed during and one month after the treatment,except for some mild dryness mentioned by several patients.

COMPARATIVE TREATMENT OF ACNE VULGARIS USING PALOMAR LUX APPLIQU´E TECHNIQUE AND DIRECT INTRALESIONAL INJECTION

Intralesional injection of triamcinolone(TMC)preparations is an effective therapy for cystic acne lesions.However,invasive delivery techniques limit the use of this modality to a relatively narrow class of cases.Skin permeability can be enhanced through creating a lattice of microzones(islets)of light-induced limited thermal damage in the upper layers of epidermis.In this paper,we directly compared safety and efficacy of delivering TMC acetonide with this novel technique versus conventional intralesional injection for treatment of inflammatory acne lesions.A combination of an intense pulsed light system and a specially designed appliqu´e with a pattern of absorbing centers has been used to create the lattice of islets of damage(LID).Quantitative analysis has included estimation of the following parameters:redness,diameter,and height of acne lesions.Clinical photography has been used to document dynamics of lesion development at successive visits(two hours,24 hours and one week post-treatment).Seven subjects have participated in the study.No difference in lesion dynamics between the treatment and control groups was observed at two-hours follow-up.At 24-hours/one-week follow-ups,TMC-injected and TMC-LID-delivered groups have demonstrated 82%/93%and 80%/89%improvement in height of lesions in comparison to control(60%/68%).Delivery of TMC with the newly proposed LID technique is at least as effective as intralesional injection for treating inflammatory acne lesions.Enhancement of skin permeability using LID approach is a promising technique for accelerating delivery of various compounds to their target areas in the skin.

Efficacy and Safety of 30% Supramolecular Salicylic Acid Peeling Combined with Isotretinoin Erythromycin Gel in the Treatment of Moderate-to-Severe Acne Vulgaris: A Comparative Study

Background: Both 30% supramolecular salicylic acid (SA) and isotretinoin erythromycin gel (IEG) have proven efficacy with good safety profiles in the treatment of acne vulgaris. Objectives: This study compared the clinical efficacy and safety of 30% SA peeling and IEG in the treatment of moderate-to-severe acne vulgaris. Methods: Patients with moderate-to-severe acne vulgaris were randomized into 3 groups of 30 persons each, and treated with SA peel, or IEG, or SA combine with IEG (SA + IEG group). Evaluation of acne was done by effective rate and individual lesion counts. And the adverse effects and recurrence were recorded. Results: The SA + IEG group was better in clinical efficacy and treating noninflammatory and inflammatory lesions than that of single treatment group (P 0.05). Conclusion: 30% SA combined with IEG had a significant effect in the treatment of moderate-to-severe acne lesions.

Efficacy of He-Ne Laser in Combination with Topical Clindamycin in the Treatment of Acne Vulgaris (AV)

Objective: To evaluate the efficacy of He-Ne laser in combination with topical clindamycin in the treatment of AV at 108 Military Central Hospital from Oct 2015 to Aug 2016. Subjects and Methods: 61 patients with AV were divided into 2 groups: Group 1: 31 patients were treated with He-Ne laser in combination with topical Clindamycin, Group 2: 30 patients were only treated with topical clindamycin. Laser HE-NE was applied 2 times/week for 6 weeks. Result: After 3 months of treatment Group 1: very good—51.6%, good—48.4%. Group 2: very good—30%, good—50% and moderate—20%. Conclusion: The combination of He-Ne laser with topical clindamycin shows more rapid clinical improvement compared to topical clindamycin alone in the treatment of mild and moderate AV.

Comparison of the Skin Lipid Layer in Acne Vulgaris Patients after Treatment with 50% Lactobionic Acid, Corundum Microdermabrasion and a Combination of Both Means

Background: The uses of lactobionic acid, corundum microdermabrasion, and a combined technique, are treatments supporting therapies for acne vulgaris and seborrhoea. Objectives: The work was conducted to determine the effects of the peeling with lactobionic acid, corundum microdermabrasion, and a combined technique of both means on sebum secretion in acne vulgaris patients. Methods: The peeling with 50% lactobionic acid, the corundum microdermabrasion, and the combined technique were applied to 45 female patients divided into three groups of fifteen people each. Every one treatment was given five times in two week intervals. The measurements of sebum secretion were done within the T- and U-zones using Sebumeter SM15 (Courage & Khazaka, Germany). The last (sixth) measurement was performed two weeks after the last treatment. Results: Decrease in the level of sebum secretion was found during second or third measurement. Two weeks after the last treatment, the biggest decrease in the level of sebum secretion was observed in the patients treated with lactobionic acid, followed by those treated with the combined method. Conclusions: Treatments consisting of the peeling with lactobionic acid, corundum microdermabrasion, or the combined technique, brought significant decrease in the level of sebum secretion. The biggest decrease was observed in the patients treated with lactobionic acid, which being structurally similar to α-hydroxyacids exerts exfoliating properties. The combined method was also effective, because of increased skin penetration of the active ingredients, resulting from the abrasion of stratum corneum during the corundum microdermabrasion. The corundum microdermabrasion alone was the least effective approach.

A Case Report of Concurrent Acne-Related Occurrence Complications: Telangiectasia, Post-Inflammatory Erythema, Post-Inflammatory Hyperpigmentation, and Atrophic and Hypertrophic Scars

Prior to his initial diagnosis, a 21-year-old male had been experiencing facial acne for two years and had been treated by a doctor in private practice. The patient visited our department because the clinical manifestations of mandibular acne did not improve. At the time of initial examination, telangiectasia (TE), post-inflammatory erythema (PIE), post-inflammatory hyperpigmentation (PIH), atrophic scars (ASs), and a hypertrophic scar (HS) with induration were observed on the right neck. We diagnosed this as an acne vulgaris complication. HS lesions were topically treated by injecting triamcinolone acetonide, and the patient was prescribed 8.1 g/day of oral Saireito (Japanese herb). Adapalene benzoyl peroxide gel and topical tacrolimus hydrate ointment were used to treat PIE and TE. Both HSs and PIE improved;however, TE and AS did not improve. Currently, the patient is under observation. We consider this to be a very rare concurrent occurrence of diverse complications of acne vulgaris, and present the following case study.

Cleoderm<up>TM</up>Clarifying Cream: A Novel, Topical Vehicle Using Plant-Based Excipients and Actives Targeting Acne and Oily Skin

Acne vulgaris is the most common skin condition associated with inflammation of the pilosebaceous unit and affects all ethnic and age groups, independent of sex, nationality, or socioeconomic status. Treatment usually includes oral and/or physical and/or topical interventions—the last can be obtained through commercial preparations in fixed doses or as compounded creams/gels, with personalized qualitative and quantitative composition, to be unique to each patient. In this sense, ready-to-use vehicles play an important role as a timesaving strategy and to ensure maximum results from the treatment. In this paper, we present CleodermTM Clarifying Cream, a ready-to-use, functional semisolid vehicle for acne treatments and topical products for oily skin, to be used by compounding pharmacies. It contains ingredients that can potentiate the effects of the active ingredients added, and has a light and pleasant skin feel. The current body of evidence shows that CleodermTM Clarifying Cream can be an important strategy for compounding personalized acne treatments due to its multiple positive roles on decreasing sebum production, lipid peroxidation, and reactive oxygen species, inhibition of Cutibacterium acnes proliferation, and control of inflammation.

Fifty-Six Cases of Acne Treated by Auricular Needle-Embedding

Acne is an inflammatory disease often affecting the boys and girls at the pubescent age, with a tendency of affecting the females aged 30-45 years. We have treated 56 cases of acne by auricular needle-embedding with satisfactory therapeutic results as reported in the following.……

Safety Assessment of a Novel Topical Vehicle for Personalized Treatments in Acne

Acne vulgaris is a common inflammatory disease of the pilosebaceous unit, with a profound impact on the quality of life of patients. In this work, we aimed to study the safety characteristics of CleodermTM, a novel functional semisolid vehicle developed for the compounding of treatments for acne and oily skin. The primary and cumulative irritation and sensitization potential were evaluated in 54 healthy volunteers in a comparative single-blinded study, while the acnegenic and comedogenic potential of the product were assessed in 31 healthy volunteers with combination to oily skin through a non-comparative study. CleodermTM was applied (0.05 g/cm2) in filter paper discs in both studies. For the evaluation of the irritation and sensitization potential, the investigational product, or a control (0.9% NaCl) was applied to the right or left scapular area of the study subjects. No clinical reactions were observed during the induction or challenge phases, suggesting that CleodermTM presents no irritating or allergenic potential. Regarding acnegenicity and comedogenicity, no significant increase in the number of acne lesions linked to the application of the product in four areas of the face was reported, indicating that CleodermTM appears not to display acnegenic and comedogenic potential. Furthermore, over 60% of the study subjects exhibited a decrease in the number of acne lesions after product use. These results show that CleodermTM exhibited no irritating, sensitizing, acnegenic or comedogenic potential, and suggest that it can be considered safe under the study conditions and that the claims dermatologically tested, clinically tested, and non-comedogenic/acnegenic can be supported.

Topical Application of Synbiotic Bacillus Preparations Positively Affects Skin (Micro) Biology

Alteration in skin microbiome profile is involved in many skin conditions, therefore, microbiome modulation is a reasonable target for skin health. Probiotic skincare was suggested, and leave-on synbiotic skincare preparation, blending bacillus spores, as probiotic active ingredient, and inulin sugar, as prebiotic booster, is evaluated, using microarray, 16S gene sequencing, and clinical skin analyses. Topical application of leave-on synbiotic skincare on skin model activates a profound effect on skin biology, expressed in the transcriptome level, with higher than 10% affected genes. The significance of the synbiotic preparation on skin biology was assured, indicating the involvement of major biological pathways. Blending probiotic with Polygonum aviculare plant extract, had triggered a distinct gene expression alteration, demonstrating the sensitivity of skin responses to different active substances. A synbiotic skincare application, had successfully introduced live and active Bacillus probiotics on human skin, detectable days after application was finalized. Following synbiotic application, the microbial content of several microorganisms, related to skin pathologies, was reduced, while the content of bacillus species, representing a healthier microbiome status, was increased, suggesting that frequent application may lead to overall healthier skin microbiome. Acne vulgaris involves unbalanced skin microbiome, with expansion of Cutibacterium acnes. The efficacy of a synbiotic skin cream was assessed to improve acne symptoms, including IGA dermatologist acne severity score, the number of counted acne lesions, measured skin oiliness and skin redness, visual appearance of skin-pores, skin smoothness and softness, and Acne Quality of Life Index.

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

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 42 130 participants in-cluding 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 18 477, suggesting that at least 18 477 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.