Oküler dandrufflu hastalarda Demodex folliculorum ve D. brevis (Acari: Demodicidae) yaygınlığı ve yoğunluğu

Year 2019, Volume: 1 Issue: 1, 23 - 43, 29.01.2019

Yasin Sarı Erhan Zeytun , Salih Doğan , Yücel Karakurt

Abstract

Demodex akarlar (Acari) Demodicidae familyasına mensup mikro eklembacaklı mikroorganizmalardır. İnsanlarda parazitlenen iki türü tanımlanmıştır: Demodex folliculorum ve D. brevis. Günümüzde göz hastalıkları uzmanlarının da dikkatini çeken bu akarların oluşturdukları silindirik, sporadik ve diffüs dandruff gibi göz kapağı hastalıklarının patogenezinde önemi olduğu düşünülmektedir. D. brevis ve D. folliculorum’un ana besin kaynağı folikül içi epitel hücreleri ve sebumdur. Folikül içi epitel hücreleri delip sindirmek için birtakım enzimlere ve delici ağız uzuvlarına sahiptirler. Akarların beslenmesine bağlı olarak oluşan folikül içi hücre atıkları zamanla folikül yüzeyine doğru itilir. Sonuç olarak, bu atıklar kirpiklerin tabanında birikerek dandruff (kepek) oluşturur. Oküler dandrufflu hastalarda Demodex spp. yaygınlığı ve yoğunluğunu belirlemek amacı ile bu çalışma yapıldı. Tanısı göz hastalıkları polikliniğinde konulan dandrufflu 186 hasta ve 183 sağlıklı kontrol çalışmaya dâhil edildi. Bu katılımcıların kişisel bakım ve hijyen uygulamaları, demografik özellikleri, cilt biyofiziksel parametreleri kayıt altına alınıp yüz bölgelerinden (kirpik, kaş ve yanak) örnekler alındı. Çalışmada örnekleme yapılan yüz bölgelerinin tümü değerlendirildiğinde silindirik dandrufflu hastaların %90,9’unda (ortalama 38,39), kontrollerin %83,1’inde (ortalama 21,86) Demodex spp. pozitifliği tespit edildi. Katılımcıların cilt biyofiziksel özellikleri dikkate alındığında, Demodex yoğunluğunun ortalama nem ve sıcaklık değeri düşük, pH değeri yüksek olan hasta ve kontrollerde daha fazla olduğu tespit edildi. Demografik özelliklerde ise yaş artışı ile birlikte Demodex pozitifliği ve yoğunluğunun arttığı belirlendi. Sonuç olarak hastalarda en yaygın oküler şikâyetlerin kaşıntı ve yabancı cisim olduğu belirlenmiş olup oküler dandrufflu hastalarda Demodex spp.’nin çok yaygın ve yoğun olduğu tespit edildi. Bu hastaların klinik değerlendirme ve tedavisinde Demodex akarlarında dikkate alınmasının faydalı olabileceği düşünüldü.

Anahtar Kelimeler: Akar, Demodex, folikül, kaş, kepek, kirpik.

Keywords

Akar, Demodex, folikül, kaş, kepek, kirpik

The prevalence and intensity of Demodex folliculorum and D. brevis (Acari: Demodicidae) in patients with ocular dandruff

Abstract

Demodex mites (Acari) are micro-arthropods belonging to the
family Demodicidae. Two species of these mites have been identified in humans: Demodex folliculorum and D. brevis. It is believed that these
mites are important in the pathogenesis of eyelid symptoms such as cylindrical,
sporadic and diffuse dandruff. The follicular epithelial cells and sebum are
the main nutritional source of these mites. With the help of salivary enzymes
and their mouthparts, they permeate the follicular epithelial cells. The
follicular cell waste formed due to the feeding of the mites are moves towards
the follicle surface, and as a result of it accumulates at the base of the
lashes and form dandruff. This study was performed to determine the prevalence and
intensity of Demodex spp. in patients
with ocular dandruff. A total of 186 patients with ocular dandruff and 183
healthy controls were included in the study. Personal care and hygiene
practices, demographic characteristics and skin biophysical parameters of these
participants were recorded, and samples were taken from the facial areas
(eyelash, eyebrow and cheek). In the study, Demodex
positivity was detected in 90.9% of the cylindrical dandruff patients (mean
38.39) and 83.1% of the controls (mean 21.86). When the skin biophysical
properties were taken into consideration, the density of Demodex was higher in participants with low moisture and
temperature values and high pH values. On the other hand, Demodex positivity and density were increased with age of the
participants. The most common ocular complaints were itching and foreign body
sensation. Demodex mites were found
to be very common and intense in the patients with ocular dandruff.
Accordingly, Demodex mites should be
taken in to consideration during the clinical evaluation and treatment of these
patients.

Keywords

Demodex, follicle mite, dandruff, eyebrow, eyelash

References

• Akbulatova, L.K. 1963. The pathogenic role of Demodex mite and the clinical form of demodicosis in man. Vestnik Dermatologii i Venerologii, 40: 57-61.
• Aksakal, M. 2014. Investigation of Demodex spp. in patients with postadolescent acne. Unpublished Medicine Speci-ality Thesis, Mustafa Kemal University Tayfur Sökmen Medicine Faculty, Hatay, 58 p. [In Turkish]
• Akilov, O.E. and Mumcuoğlu, K.Y. 2003. Association be-tween human demodicosis and HLA class I. Clinical and Experimental Dermatology, 28: 70-73. doi: 10.1046/j.1365-2230.2003.01173.x
• Akilov, O.E. and Mumcuoğlu, K.Y. 2004. Immune response in demodicosis. Journal of the European Academy of Dermatology and Venereology, 18: 440-444. doi: 10.1111/j.1468-3083.2004.00964.x
• Aktaş, O. 2009. The distribution of Demodex folliculorum in Van province. Unpublished M.Sc. Thesis, Yüzüncü Yıl University, Institute of Health Sciences, Van, 40 p. [In Turkish]
• Altınkurt, E., Müftüoğlu, O., İstanbullu Tosun, A., Aydın, R. and Avcı, Ö. 2017. To investigate the relationship be-tween the grade of blepharitis with presence of Demodex spp. in patients with chronic anterior blepharitis. Jour-nal of Ophthalmology, 26: 181-186. [In Turkish] doi: 10.5336/ophthal.2016-52878
• Alver, O., Kıvanç, S.A., Budak, A.B., Tüzemen, N.Ü., Ener, B. and Özmen, A.T. 2017. A clinical scoring system for di-agnosis of ocular demodicosis. Medical Science Moni-tor, 23: 5862-5869. doi: 10.12659%2FMSM.907824
• Arıcı, M.K., Sümer. Z. and Toker. M.İ. 2005. The prevalence of Demodex folliculorum in blepharitis patients and the normal population. Ophthalmic Epidemiology, 12: 287-290. doi: 10.1080/092865805910057
• Aycan, Ö.M., Otlu, G.H., Karaman, Ü., Daldal, N. and At-ambay, M. 2007. Frequency of demodicosis in various patient and age groups. Turkish Journal of Parasitology, 31 (2): 115-118. [In Turkish]
• Aycan Kaya, Ö., Atambay, M. and Daldal, M. 2012. Preva-lence of Demodex folliculorum and Demodex brevis in the eyelash follicles of healthy subjects. Journal of the Faculty of Veterinary Medicine, Kafkas University, 18: 57-60. [In Turkish] doi: 10.9775/kvfd.2011.5980
• Aytekin, S. and Göktay, F. 2015. Demodicosis. Journal of Dermatology Special Topics, 8 (3): 35-41. [In Turkish]
• Aytekin, S., Yaşar, Ş. and Göktay, F. 2017. Demodex infesta-tions. Journal of Dermatology Special Topics, 10 (2): 169-174. [In Turkish] Bhandari, V. and Reddy, J.K. 2014. Blepharitis: always re-member Demodex. Middle East African Journal of Oph-thalmology, 21 (4): 317-320. doi: 10.4103%2F0974-9233.142268
• Bochkov, A. Synopsis of the described Actinedida of the world, family Demodicidae In: Hallan J. (ed.), Synopsis of the described Arachnida of the world. http://bug.tamu.edu/research/collection/hallan/Acari/Family/Demodecidae.txt
• Bonnar, E., Eustace, P. and Powell, F.C. 1993. The Demodex mite population in rosacea. Journal of the American Academy of Dermatology, 28 (3): 443-448. doi: 10.1016/0190-9622(93)70065-2
• Cengiz, Z.T., Yılmaz, H. Özkol, H.U., Ekici, A. and Ödemiş, N. 2014. The prevalence of Demodex sp. in patients admit-ted to the parasitology laboratory of the Dursun Odabaş Medical Center in Yüzüncü Yıl University, Van. Turkish Journal of Parasitology, 38: 9-11. [In Turkish] doi: 10.5152/tpd.2014.3407
• Cheng, A.M., Sheha, H. and Tseng, S.C. 2015. Recent advanc-es on ocular Demodex infestation. Current Opinion in Ophthalmology, 26 (4): 295-300. doi: 10.1097/ICU.0000000000000168
• Clark, C. 2011. Rosacea: causes and treatments. The Phar-maceutical Journal Online, 1-4.
• De Venecia, A.B. and Siong, R.L. 2011. Demodex sp. infesta-tion in anterior blepharitis, meibomian-gland dysfunc-tion, and mixed blepharitis. Philipp Journal Ophthal-mology, 36: 15-22.
• Demirdağ, H.G., Özcan, H. and Gürsoy. Ş. 2016. The effects of sebum configuration on Demodex spp. density. Turk-ish Journal of Medical Sciences, 46: 1-7. doi: 10.3906/sag-1504-77
• Demmler, M., Kaspar, H.M., Möhring, C. and Klauss, V. 1997. Blepharitis: Demodex folliculorum, associated germ spectrum and spesific therapy. Der Ophthalmologe: Zeitschrift der Deutschen Ophthalmologischen Gesell-schaft, 94 (3): 191-196. doi: 10.1007/s003470050100
• Desch, C. and Nutting, W.B. 1972. Demodex folliculorum (Simon) and D. brevis Akbulatova of man: redescription and reevaluation. The Journal of Parasitology, 58 (1): 169-177. doi: 10.2307/3278267
• Durmaz, S., Yula, E., Aycan Kaya, Ö., Aksoy Gökmen, A., Kılınç, C., Atambay, M., Ekiz, O., Gözükara Bağ, H. and Pektaş, B. 2015. Sociodemographic characteristics of pa-tients with Demodex brevis and Demodex folliculorum infestation and its association with rosacea and Behçet’s disease. Biomedical Research, 26 (3): 549-555.
• Emre, S., Aycan, Ö. M., Atambay, M., Bilak, Ş., Konuş, İ., Doğanay, S. and Daldal, N. 2008. Demodex folliculorum prevalence among chronic blepharitis patients. Journal of Ophthalmology, 17: 178-181. [In Turkish]
• Emre, S., Aycan, Ö.M., Atambay, M., Bilak, Ş., Daldal, N. and Karıncaoğlu, Y. 2009. What is the of Demodex folliculo-rum in Behçet’s disease. Turkish Journal of Parasitology, 33 (2): 158-161.
• Erbağcı, Z. and Özgöztaşı, O. 1998. The significance of De-modex folliculorum density in rosacea. International Journal of Dermatology, 37 (6): 421-425. doi: 10.1046/j.1365-4362.1998.00218.x
• Fırat, P.Y., Geçit, İ., Depecik, F., Karadan, M., Karcı, E., Kara-man, Ü. and Çalık, S. 2010. Demodex spp. positivity among laboratory staff, kitchen staff, cleaning workers and nurses working in a state hospital. Turkish Journal of Parasitology, 34: 164-167. [In Turkish] doi: 10.5152/tpd.2010.05
• Forton F.M.N. 2012. Papulopustular rosecea, skin immunity and Demodex: pityriasis folliculorum as a missing link. Journal of European Academy of Dermatology and Vene-reology, 26: 19-28. doi: 10.1111/j.1468-3083.2011.04310.x
• Forton, F.M., Germaux, M.A., Thibaut, S.C., Stene, J.J., Bras-seur, T.V., Mathys, C.L., Tytgat, M.D and Laporte, M.F. 2015. Demodicosis: descriptive classification and status of rosacea, in response to prior classification proposed. Journal of the European Academy of Dermatology and Venereology, 29 (4): 829-832. doi: 10.1111/jdv.12926
• Galvis, V., Tello-Hernandez, A. and Rey-Serrano L.A.J. 2011. The prevalence of Demodex folliculorum infection in pa-tients attending a general ophthalmological consultation. Revista De Salud Publica (Bogota, Colombia), 13 (6): 990-997. doi: 10.1590/S0124-00642011000600011
• Gao, Y.Y., Kawakita, T. and Steng, S.C.G., 2005a. High preva-lence of Demodex in eyelashes with Cylindrical Dan-druff. Investigative Ophthalmology and Visual Science, 12, 287-290. doi: 10.1167/iovs.05-0275
• Gao, Y.Y., Di Pascuela, M.A., Li, W., Baradaran-Rafii, A., Eli-zondo, A., Kuo, C.L., Raju, V.K. and Tseng, S.C. 2005b. In vitro and in vivo killing of ocular Demodex by tea tree oil. The British Journal of Ophthalmology, 89 (11): 1468-1453. doi: 10.1136/bjo.2005.072363
• Gao, Y.Y., Pascuale, M., Elizondo, A. and Tseng, S.C.G. 2007. Clinical treatment of ocular demodecosis by lid scrub with tea tree oil. Cornea, 26 (2): 136-143. doi: 10.1097/01.ico.0000244870.62384.79
• Gao, Y.Y., Xu, D.L., Huang, I.J., Wang, R. and Tseng, S.C. 2012. Treatment of ocular itching associated with ocular de-modicosis by 5% tea tree oil ointment. Cornea, 31 (1): 14-21. doi: 10.1097/ICO.0b013e31820ce56c
• Hana, A.G., de la Garza, C.M., Arenas, L.V., Guerrero, C.G. and Gonzalez, S.E. 2004. Prevalence of Demodex folliculorum and Demodex brevis in a Mexican population. Medicina Universitaria, 6 (23): 96-100.
• Holzchuh, F.G. and Hida, R.Y., Moscovici, V.K., Villa Albers, M.B., Santo, R.M., Kara-Jose, N. and Holzchuh, R. 2011. Clinical treatment of ocular Demodex folliculorum by systemic ivermectin. American Journal of Ophthalmolo-gy, 151 (6): 1030-1034. doi: 10.1016/j.ajo.2010.11.024
• Hirst, S. 1919. The genus Demodex Owen studies on Acari. British Museum Natural History, 1, 1-44.
• Hirsch-Hoffman, S., Kaufmann, C., Banninger, P. and Thiel, M. 2015. Treatment options for Demodex blepharitis: pa-tient choice and efficacy. Klin Monbl Augenheilkd, 232 (4): 384-391. doi: 10.1055/s-0035-1545780
• Izdebska, J.N., Fryderyk, S. and Rolbiecki, L. 2016. Demodex castoris sp. nov. (Acari: Demodecidae) parasitizing Cas-tor fiber (Rodentia), and other parasitic arthropods as-sociated with Castor spp. Diseases of Aquatic Organ-isms, 118 (1): 1-10. doi: 10.3354/dao02945
• Izdebska, J. N. and Rolbiecki, L. 2016. A new genus and species of demodecid mites from the tongue of a house mouse Mus musculus: Description of adult and immature stages with data on parasitism. Medical and Veterinary Entomology, 30, 135-143. doi: 10.1111/mve.12167
• İnceboz, T., Yaman, A., Över, L., Öztürk, A.T. and Akısu, Ç. 2009. Diagnosis and treatment of demodectic blepha-rits”, Turkish Journal of Parasitology, 33 (1): 32-36.
• Kabataş, N., Şanal Doğan, A., Kabataş, E.U., Acar, M., Biçer, T. and Gürdal, C. 2017. The effect of Demodex infestation on blepharitis and the ocular symptoms. Eye Contact Lens, 43: 64-67. doi: 10.1097/ICL.0000000000000234
• Karaman, Ü., Çelik, T., Çalık, S., Şener, S., Aydın, N.E. and Daldal, Ü.N. 2008. Demodex spp. in hairy skin biopsy specimens. Turkish Journal of Parasitology, 32 (4): 343-345. [In Turkish]
• Kasetsuwan, N., Kositphipat, K., Busayarat, M., Treekhan, P., Preativatanyou, K., Phumee, A. and Siriyasatien, P. 2017. Prevalence of ocular demodicosis among patients at Ter-tiary Care Center, Bangkok, Thailand. International Jour-nal of Ophthalmology, 10 (1): 122-127. doi: 10.18240/ijo.2017.01.20
• Kheirkhah, A., Casas, V., Li, W., Raju, V. and Tseng, S. 2007. Corneal manifestations of ocular Demodex infestation. American Journal of Ophthalmology, 143 (5): 743-749. doi: 10.1016/j.ajo.2007.01.054
• Kim, J.T, Lee, S.H., Chun, Y.S. and Kim, J.C. 2011. Tear cyto-kines and chemokines in patients with Demodex blepha-ritis. Cytokine, 53 (1): 94-99. doi: 10.1016/j.cyto.2010.08.009
• Koo, H., Kim, T., Kim, K., Wee, S., Chu, Y. and Kim, J. 2012. Ocular surface discomfort and Demodex: Effect of tea tree oil eyelid scrub in Demodex Blepharitis. Journal of Korean Medical Science, 27 (12): 1574-1579. doi: 10.3346/jkms.2012.27.12.1574
• Kosik-Bogacka, D.I., Lanocha, A., Czepita, D., Grobelny, A., Zdziarska, B. and Kalisinska, E., 2013a. Demodex follicu-lorum and Demodex brevis in healthy and immunocom-promised patients. Ophthalmic Epidemiology, 20 (3): 159-163. doi: 10.3109/09286586.2013.789532
• Kosik-Bogacka, D.I., Marcinowska, Z., Lanocha, N., Czepita, D., Kalisinska, E. and Zdziarska, B. 2013b. Occurrence Demodex folliculorum and Demodex brevis among inhab-itants of North-Western Poland. Journal of Laboratory Diagnostics, 49 (3): 195-199. doi: 10.3109/09286586.2013.789532
• Krantz, G.W. and Walter, D.E. 2009. A Manuel of Acarology”, third edition, Texas Tech Universtity Press, USA, 807 p. doi: 10.1653/024.092.0323
• Lacey, N., Kavanagh, K. and Tseng, S.C.G. 2009. Under the lash: Demodex mites in human diseases. Biochem (Lon-don), 31 (4): 2-6.
• Laspina, F., Samudio, M., Arrua, M., Sanabria, R., Farina, N., Carpinelli, L., Cibils, D. and Kaspar, H.M. 2015. Demodex spp. in chronic blepharitis patients. Revista Chilena De Infectologia: Organo Oficial De La Sociedad Cilena De In-fectologia, 32 (1): 37-42. doi: 10.4067/S0716-10182015000200008
• Lee, S.H., Chun, S.Y., Kim, J.H., Kim, E.S. and Kim, C.J., 2010. The relationship between Demodex and ocular discom-fort. Association for Research in Vision and Ophthal-mology, 51, 6. doi: 10.1167/iovs.09-4850
• Liang, L., Safran, S., Gao, Y., Sheha, H., Raju, V. and Tseng, S. 2010. Ocular demodicosis as a potential cause of pediat-ric blepharoconjunctivitis. Cornea, 29 (12): 1386-1391. doi: 10.1097/ICO.0b013e3181e2eac5
• Liang, L., Liu, Y., Ding, X., Ding, X., Ke, H., Chen, C. and Tseng, S.C.G. 2017. Significant correlation between meibomian gland dysfunction and keratitis in young patients with Demodex brevis infestation. The British Journal of Oph-thalmology, 102 (8): 1098-1102. doi: 10.1136/bjophthalmol-2017-310302
• Liu, J., Sheha, H. and Tseng, S.C.G. 2010a. Pathogenic role of Demodex mites in blepharitis. Current Opinion in Aller-gy and Clinical Immunology, 10 (5): 505-510. doi: 10.1097/ACI.0b013e32833df9f4
• Liu, J., Sheha, H., Fu, Y. and Tseng, S.C.G. 2010b. Demodex Blepharitis: This overlooked cause of blepharitis repre-sents a therapeutic challenge. Advanced Ocular Care, 4: 37-39.
• Lopez-Ponce, D., Zuazo, F., Cartes, C., Salinas-Toro, D., Pe-rez-Valenzuela, C., Valenzuela, F., Traipe-Castro, L. and Lopez-Solis, R. 2017. High prevalence of Demodex spp. infestation among patients with posterior blepharitis: correlation with age and cylindrical dandruff. Archivos De La Sociedad Española De Oftalmologia, 92 (9): 412-418. doi: 10.1016/j.oftal.2017.01.001
• Luo, X.-H., Li, J., Chen, C., Tseng, S. and Liang, L. 2017. Ocu-lar demodicosis as a potential cause of ocular surface in-flammation. Cornea, 36: 9-14. doi: 10.1097/ICO.0000000000001361
• Mumcuoğlu, K.Y. and Akilov, O.E. 2005. The role of HLA A2 and Cw2 in the pathogenesis of human demodicosis. Dermatology, 210: 109-114. doi: 10.1159/000082565
• Murphy, O., O’Dwyer, V. and Lloyd-McKernan, A. 2018. The efficacy of tea tree face wash, 1, 2-Octanediol and microblepharoexfoliation in treating Demodex folliculorum blepharitis. Contact Lens and Anterior Eye Journal, 41 (1): 77-82. doi: 10.1016/j.clae.2017.10.012
• Moon, J.H. and Kim, C.J. 2014. Clinical efficacy of polyhexamethylene biguadine lid scrub on Demodex blepharitis. Journal Korean Opthalmological Society. 55 (4): 493-497. doi: 10.3341/jkos.2014.55.4.493
• Nutting, W.B. 1976. Hair follicle mites (Acari: Demodicidae) of man. International Journal of Dermatology, 15 (2): 79-98. doi: 10.1111/j.1365-4362.1976.tb00663.x
• Okyay P., Ertabaklar, H., Savk, E. and Ertuğ, S. 2006. Prevalence of Demodex folliculorum in young adults: relation with sociodemographic/hygienic factors and acne vulgaris. Journal of European Academy of Dermatology and Venereology, 20: 474-476. doi: 10.1111/j.1468-3083.2006.01470.x
• Orak, F., Yıldırım, D., Set, A. and Hasbek, M. 2015. Investigation of Demodex spp. frequency among skin surface biopsy taken from patients. Bulletin of ANKEM, 29 (3): 90-94. [In Turkish] doi: 10.5222/ankem.2015.090
• Özcel, M.A., Turgay, N., İnci, A. and Köroğlu, E. 2007. Medical and veterinary immunoparasitology. Turkish Society for Parasitology Publications, İzmir, 21 p. [In Turkish]
• Özdemir, M. Ö., Aksoy, U., Sönmez, E., Akisu, Ç., Yorulmaz, C. and Hilal, A. 2005. Prevalence of Demodex in health personnel working in the autopsy room. The American Journal of Forensic Medicine and Pathology, 26: 18-23.
• Raghallaigh, S., Bender, K., Lacey, N., Brennan, L. and Powell, F.C. 2012. The fatty acid profile of the skin surface lipid layer in papulopustular rosacea. British Journal Dermatology, 166: 279-287. doi: 10.1111/j.1365-2133.2011.10662.x
• Salem, D., El-Shazly, A., Nabih, N., El-Bayoumy, Y. and Saleh, S. 2013. Evaluation of the efficacy of oral ivermectin in comparison with ivermectin-metronidazole combined therapy in the treatment of ocular and skin lesions of Demodex folliculorum”, International Journal of Infectious Diseases, 17 (5): 343-350. doi: 10.1016/j.ijid.2012.11.022
• Saygı, G., Marufi, M. and Köylüoğlu, Z. 1984. Three Demodex folliculorum phenomena, one detected with cellophone band. Turkish Journal of Parasitology, 7: 137-144. [In Turkish]
• Simon, C.G.T. 1842. Über eine in den kranken und normalen Haarsäcken des Menschen lebende Milbe. Archiv für Anatomie, Physiologie und Wissenschaftliche Medicin, 218-237.
• Sümer, Z., Arıcı, M. K., Topalkara, A., Özçelik, S. and Yıldırım, S. 2000. Prevalence of Demodex folliculorum in patients with chronic blepharitis. Journal of the Faculty of Medicine Cumhuriyet University, 22 (2): 69-72. [In Turkish]
• Tilki, E., Zeytun, E. and Doğan, S. 2017a. Prevalence and density of Demodex folliculorum and Demodex brevis (Acari: Demodicidae) in Erzincan province. Turkish Journal of Parasitology, 41 (2): 80-86. [In Turkish] doi: 10.5152/tpd.2017.5156
• Tilki, E., Zeytun, E. and Doğan, S. 2017b. Species list of the family Demodicidae (Acari). III. International Congress on Zoology and Technology, 12-15 July, Afyonkarahisar, Turkey, 81.
• Tighe, S., Gao, Y. and Tseng, S.C.G. 2013. Terpinen-4-ol is the most active ingredient of tea tree oil to kill Demodex mites. Translational Vision Science and Technology, 2 (7): 1-8. doi: 10.1167%2Ftvst.2.7.2
• Türk, M., Öztürk, İ., Şener, A. G., Küçükbay, S., Afşar, İ. and Maden, A. 2007. Comparison of incidence of Demodex folliculorum on the eyelash follicule in normal people and blepharitis patients. Turkish Journal of Parasitology, 31 (4): 296-297.
• Unat, E.K., Yücel, A., Altaş, K. and Samastı, M. 1995. Unat's medicine parasitology, fifth edition. İstanbul University Cerrahpaşa Medicine Faculty Foundation Publications, 15: 206-208 pp. [In Turkish]
• Rufli, T. and Mumcuoğlu, Y. 1981. The hair follicle mites D. folliculorum and D. brevis: biology and medical importance. Dermatology, 162: 1-11. doi: 10.1159/000250228
• Wesolowska, M., Knysz, B., Reich, A., Blazejewska, D., Czarnecki, M., Gladysz, A., Pozowski, A. and Misiuk-Hojlo, M. 2014. Prevalence of Demodex spp. in eyelash follicles in different populations. Archive Medical Science, 10 (2): 319-324. doi: 10.5114%2Faoms.2014.42585
• Yamashita, LS.F.D.F., Cariello, A.J., Geha, N.M.A., Yu, M.C.Z. and Hofling-Lima, A.L. 2011. Demodex folliculorum on the eyelash follicule of diabetic patients. Arquivos Brasilerios de Oftalmologia, 74 (6): 422-424. doi: 10.1590/S0004-27492011000600008
• Yazar, S., Özgün, H. and Çetinkaya, Ü. 2008. Investigation of Demodex sp. using cellophane tape method among university students. Turkish Society for Parasitology, 32 (3): 238-240. [In Turkish]
• Yazar, S., Kuk, S., Doğan, S. and Şahin, İ. 2012. The incidence of Demodex spp. in patients who came to Erciyes University Medical Faculty Parasitology Department between 2002-2011. Journal of the Faculty of Veterinary Medicine, Kafkas University, 18 (Supplement-A): A101-A103. [In Turkish] doi: 10.9775/kvfd.2011.6063
• Yula, E., Aycan Kaya, Ö.M., Atambay, M., Doğanay, S., Daldal, N. and Ayhan T.E. 2013. What is the importance of Demodex folliculorum and D. brevis in the etiology of blepharitis? Journal of Medical Sciences, 33 (2): 420-424. [In Turkish] doi: 10.5336/medsci.2012-29698
• Zeytun, E. and Ölmez, H. 2017. Demodex (Acari: Demodicidae) infestation in patients with KOAH, and the association with immunosuppression. Erzincan University Journal of Science and Technology, 10 (2): 220-231. [In Turkish] doi: 10.18185/erzifbed.335850
• Zeytun, E. 2017. Demodex (Acari: Demodicidae) infestation in the elderly and its relationship with the skin parameters such as moisture, pH, and temperature: a cross-sectional study. Turkish Journal of Geriatrics, 20 (2): 142-150.
• Zeytun, E., Tilki, E., Doğan, S. and Mumcuoğlu, K.Y. 2017. The effect of skin moisture, pH, and temperature on the density of Demodex folliculorum and Demodex brevis (Acari: Demodicidae) in students and staff of the Erzincan University, Turkey. International Journal of Dermatology, 56: 762-766. doi: 10.1111/ijd.13600
• Zhao, Y., Guo, N. and Wu, L. 2009. The effect of temperature on the viability of Demodex folliculorum and Demodex brevis. Parasitology Research, 105 (6): 1623-1632. doi: 10.1007/s00436-009-1603-x
• Zhao, Y.E., Guo, N. and Wu, L. 2011. Influence of temperature and medium on viability of Demodex folliculorum and Demodex brevis (Acari: Demodicidae). Experimental and Applied Acarology, 54 (4): 421-425. doi: 10.1007/s10493-011-9445-5