Did your dermatologist ordoctor who prescribed the Accutane run any tests first to determine the cause of the skin issues? Bacteria, fungus and microscopic demodex skin mites are 3 different causes of acne like lesions on the skin. All 3 causes feed off of the oil in the skin. That's why Accutane can appear to help since it greatly reduces the skin oil but doesn't directly kill or eliminate any of the 3 possible causes. In the case of demodex, the Accutane starves the mite populationand reduces it, but doesn't necessarily eliminate the demodex. After you stop the Accutane, the demodex population can rebound.

I had demodex skin mites for decadesstarting just before turning 12. 4 board certified dermatologists all did quick visual exams and misdiagnosed bacterial acne. The never ran any tests to determine the cause. When one prescription didn't work, they just kept writing new prescriptions.

A good diagnosis based on skin test would help determine the cause. The treatment for each of the 3 types of acne is completely different for each type.

For fungal acne there are topical and oral treatments available.

Demodex skin mites live and die on a 2 to 3 week cycle. When they die they form pustules (a die off) and papules appearing like other types of acne. Signs of Demodex Skin Mites include; cyclical appearance - skin looks okay for a few days or weeks and then boom! A die off happens and pustules start appearing. Other symptoms MAY include: large blackheads, papules, pustules, eye redness, itchy skin, skin redness (optional), eyelashes falling out, scalp acne, body acne.

If it is demodex there is a 2 week, 2 drug combined highly effectivetreatment with cheap and safe generic drugs that really works. It was what finally cured me after literally decades after being treated with antibiotics (including minocycline), retinoids, benzoyl peroxide , etc. - none of which ever worked. The treatment consists of Oral Ivermectin and Oral Metronidazole. The treatmentwas published in a proper medical study in the May 2013 International Journal of Infectious Diseases. If necessary, print the paper out and show your doctor. The link to the paper is here: https://www.sciencedirect.com/science/article/pii/S120197121201315X

Treatment:

1. Oral Ivermectin Doses: 2 once a week doses of Oral Ivermectin based on body weight: 200 micrograms Ivermectin per kilogram of body weight. That worked out to 12 mg per dose for me. My family doctor prescribed this treatment for me. He rounded up the Ivermectin dose a little so that it was a multiple of 3 mg to avoid having to break the 3 mg tablets. Take the first dose on day 1. Take the second weekly dose on Day 8 of treatment. Take eachOral Ivermectindose on an empty stomach with a big glass of water.

2. Oral Metronidazole Doses: 250 mg of Oral Metronidazle, 3 Times daily. Take with food.

Topical treatments that can help over time and will support the oral treatment while in progress:

1. Wash with: Tea Tree oil face wash (The Body Shop makes several, Desert Essence Original Face Wash, and others are available)

2. Wipe clean face with: Cliradex Wipes and allow to dry - Use one wipe after washing face morning and night.

3. Hypochlorous Acid (HOCL) Face Spray - (0.01%-0.02% concentration). The HOCL spray can be massaged around face with clean fingers to ensure an even coating. HOCL is soothing, non-irritating and non-allergenic to skin - contains the identical HOCL chemical produce by the human bodies white cells. Kills 99.9% of bad bacteria, kills fungus and viruses, kills juvenile demodex skin mites reducing the population over time. Doesn't kill the "good" bacteria needed for healthy skin. Tattoo artists and piercers swear by HOCL to help their clients heal up without infection. Hospitals use HOCL to disinfect ICU and Operating Rooms. Medical and Dental offices use HOCL to disinfect their treatment rooms. HOCL has been in use for over 100 years in the medical industry - it works. BrioTech Labs sells spray bottles on Amazon for $6.95 per 2 ounces or $11.95 for 4 ounces). Other brands available on Amazon include Occusoft Hypochlor, Heyedrate Lid and lash cleaner, etc.

4. Use a clean towel for the face daily as demodex skin mites can live on a wet towel or washcloth for up to 54 hours.

5. Ordinary washing of towels and other linens in a standard washer/dryer at 59 degrees Centigrade will kill demodex. So you don't need to do anything special with laundry other than frequent laundering especially of the towels.

If you can't get to a doctor, there is one other topical non-prescription option that can help. Soolantra Cream (Topical Ivermectin 1%)is an expensive prescription drug frequently prescribed for treating demodex skin mites. The over the counter option is to get the Ivermectin Horse Paste (Durmectin, etc) from Amazon at about $5-$7 per small tube. Its 1.87% Ivermectin in a paste form. Use it on a clean face at night before bed. The mites come out at night, so that is the best time to treat them. Doctors prescribe the topical Soolantra treatment at night for 16 weeks. Its slower than the oral treatment but can be very effective.

Just be aware that while being treated for demodex, the topical Ivermectin or Oral Ivermectin- Oral Metronidazoletreatment kills them. The treatmentmay temporarily cause what appears to be a bad breakout. That is an excellent sign that the treatment is working. Stick with it until they are all dead.