Diagnostic techniques for demodicosis: a systematic review

INTRODUCTION: Demodicosis comprises a spectrum of cutaneous conditions resulting from the overproliferation of Demodex mites. Multiple diagnostic techniques are available, although diagnosis can be challenging due to the presence of these mites as commensals in healthy individuals. Thus, the objective of this review is to evaluate the diagnostic performance of methods used for the diagnosis of demodicosis. EVIDENCE ACQUISITION: A search was conducted on articles published between 2000 and 2025, using PubMed, Embase, Scopus, Cochrane Library and Dialnet to identify studies on diagnostic methods for cutaneous demodicosis. Of 1765 records screened, 18 studies met the inclusion criteria, focusing on diagnostic accuracy. EVIDENCE SYNTHESIS: A total of 3 cross-sectional, 8 prospective, 3 retrospective, 2 case-control studies and 2 controlled clinical trials have been included. These studies evaluated the diagnostic performance of standardized skin surface biopsy, direct microscopic examination, dermoscopy, reflectance confocal microscopy and molecular techniques in a combined population of 2187 patients. Direct microscopic examination and dermoscopy have been the most frequently used techniques in the enrolled studies. Among the genetic techniques, next-generation sequencing and polymerase chain reaction have been assessed. To our knowledge, this is the first systematic review dealing with diagnostic methods for demodicosis. CONCLUSIONS: Due to the heterogeneity of the included studies, identifying an optimal diagnostic method remains challenging. Therefore, diagnostic approaches should be selected according to clinical context and resource availability.