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OpulentMargin

Facial cystic acne that won't heal; continues to spread

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Hello.  I am new to the forums, but have been reading a lot of posts.  Sorry for the lengthy case history, but I am at wits end.  

I am 40s male (diabetic, T1) with little prior history of acne.  When I read I usually scratch my nose (itchy) a lot, and so I would sometimes get a cyst or two then which was treated with over the counter benzoyl p until it went away after a week or so.  Until about 2yrs ago...

I began to get painful lesions inside my nose.  Those spread to the outer nose and below eye area within 2 mos.  Went to Dr (primary care) who prescribed myocycline ointment for inside nose, 100mg doxy (2x daily) and clindamycin for face.  Inside nose cleared up but the rest just kept getting worse.

Back to Dr who changed up my antibiotic to Bactrim 2x daily.  Also changed to metronidazole gel.  No changes.  Back to Dr who advised I use a surgical cleanser to 'wipe out' whatever was on my face and referred to me a dermatologist.

The first dermatologist (nurse practitioner at a dermatologist) told me the surgical cleanser essentially nuked my face.  Bad move.  He took a sample and then referred to it as rosacia.  I was given a script for some free products from GenRx (more metridazone 0.75%, a sulfacleanse 8/4 and two antis (doxy AND bactrim daily). Seemed to initially show promise, but then just quit working.

2nd visit to derma the NP took a sample of blood from one of the weeping areas. Put under microscope and said I had an outbreak of demodex mites.  He showed me the lone mite.  I asked if one mite constituted an outbreak to which I got no reply.  He gave me another script for Soolantra 1.0% cream and said use at night.  Once again, I experienced no positive gains from using the recommended treatment.

At this point, I didn't go back to derma bc he didn't seem to have any knowledge of why this was occuring and treatments consisted of whatever was on his limited menu of stuff from a couple of vendors. I spent a few months exploring homeopathic and over-the-counter options.  Increasing fiber content of diet and trying to be more healthy. Nothing seemed to matter.

I then found another derma (unfortunately, another NP; where are the Drs nowadays?!).  On 1st visit took my box full of previous treatments and supplies in to show her what all I had tried. She pulled out the same menu of stuff I had seen before. But said I should think about Accutane.  After trying just about everything with no effect I am skeptical of using such a powerful drug with serious consequences without first understanding what is causing this all of a sudden.
Over 2017 winter holidays my problem took a dramatic turn for the worse. The painful, red pustules and cysts spread to my cheeks and eventually forehead then chin.  I used to have pretty decent skin (oily? very), but now I look horrible to the point I hate to be seen in public.  Going to work even sucks.  I can feel everyone staring or avoiding looking at me.

My last visit to the NP was about 3 wks ago.  She basically told me the only thing left was Accutane and gave me a bunch of lit to read.  Scary stuff. I asked for her to culture some of the material from a site.  SHe was very hesistant, but agreed after my insistence. A week later the results came back as NEITHER fungal NOR bacterial (???!).  That, I really don't understand.

Disgusted? Yes. Very.

Oh. And last week the situation spread to my hairline.  Yesterday, I felt a sore area on my neck/jaw and today have a couple of cysts on upper neck below chin.

I am currently using Bactrim 2x daily (been on this for nearly 2yrs now). I sometimes use a little topical gel anti (does nothing). I apply a tea-tree oil based cystic acne topical at night and leave on all night. I am using tree tree oil shampoo and wash my clothes, sheets and towels in Clear n Free detergent with 10 drops of tea tree oil added.  All this and it just keeps marching on.

Pics show changes from October 2016 to May 2018.

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IMG_0589.JPG.2421adc05234d682ff558d21746c20fc.JPG
 

Edited by OpulentMargin

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First of all, I'm really sorry you're having to deal with this.  Not only does acne affect your self esteem, but cystic acne is PAINFUL.  I've suffered from it since I was a teenager. 
I feel like Accutane is a last ditch effort...the last thing you want to use, because of how harsh it is and the side effects.

My skin has completely transformed by using the Unblemish line by Rodan and Fields.  I highly, highly recommend it....the best part being is, if you're not happy, there's a 60 day money back guarantee. I've attached my 5 month before and after.  If you have any questions, just let me know.  Good luck!

31945364_10160179539595316_5616700845203652608_n.jpg

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Thanks for the suggestions.  That's awesome you got good results.  I have seen tons of commercials for Proactiv and I read the ingredients list of the Rodan and Fields and Proactiv products.  It looks like it is just benzoyl peroxide cream mixed with other inactive ingredients.  The wash only lists an active ingredient of 3% sulfur, and I already have a sodium sulfacetamide 8% and 4% sulfur wash.  I have tried various strengths of BP, sulfur, vitamin A derivitives (eg. Differin, retinA) and salicylic acid treatments with no results.  Any one of those used to work when I would get a bump, but not anymore.

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firstly im not a doctor but from what you said, it doesnt sound like standard acne or rosacea - like you said, it started in one area and then spread, now its in your hairline. (imo Accutane should be a last resort)

being a  diabetic, do you have a bit of a Weak immune system?

also have you researched or tried to get rid of your demodex mites? 

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If the problem is caused by Demodex skin mites, there is a very effective, inexpensive, 2 week oral prescription treatment that may help more than the topical Soolantra which is just Ivermectin in Cetaphil Moisturizer. 

There was a paper published in the International Journal of Infectious Disease in 2013 that reported the results of 2 different oral treatments for demodex skin mites.  The combined 2 week oral treatment was highly effective at putting the demodex infestation into remission or showing marked improvement.
https://www.sciencedirect.com/scienc...0197121201315X

I had a serious Demodex problem that had been misdiagnosed for years as acne and allergic conjunctivitis.  The mites are also known as eyelash mites and can get in your oily tear glands in your eyelids.  None of the acne meds ever worked.  The combined 2 week oral Demodex treatment that worked well for me from the 2013 paper was:

1. Two doses of oral Ivermectin one week apart. Each weekly dose is 200 micrograms Ivermectin per kilogram of body weight. Worked out to 12 mg per dose for me. Take on an empty stomach with a large glass of water.
2. Oral Metronidazole, 250 mg. three times a day for two weeks. Do not drink alcohol while taking oral Metronidazole and for 72 hours after taking the last tablet.

NOTE:  Oral Metronidazole has been shown in other studies to be much more effective than the topical Metronidazole (aka Metro-Gel, etc) against Demodex skin mites.

There are 2 kinds of Demodex skin mites and you can have both.    Demodex Follicularum live in the hair follicles.  Demodex Brevis live down in the oil glands.   Soolantra may not be effective against Demodex Brevis since they live deeper in the skin in the oil glands.   Soolantra can also take up to 3-4 months to work.

If Demodex skin mites are the problem, then the oral treatment may be more effective than the topical Soolantra.   The oral treatment kills both kinds of Demodex and will treat your entire body.  Soolantra only treats the areas that it is applied to and may not help much against the Demodex Brevis in the oil glands.

The mites tend to get overpopulated when your immune system is low.  The diabetes may be affecting your immune system, letting the mites get out of control.   The mites are notoriously difficult to count under a microscope, the mites don't like light so they scuttle to the edge of the slide.

The mites eat oil.   Among other things, Accutane shrinks the oil glands so it may control the mites while you are taking it by depriving some of them of  some of their food.  However, the mites can come back once you stop taking the Accutane.  Accutane would be a last resort - it has serious side effects - not sure how it would impact your diabetes.   

If the primary problem isn't bacterial or demodex, then the other possible infection would be a fungal/yeast infection.  

 

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1 hour ago, ElaineA said:

If the problem is caused by Demodex skin mites..
 


i was also reading up about demodex mites for myself. i was just wondering, other than oral medicine, what topical products work at killing them?

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For over the counter topical treatments, Tea Tree oil facial cleanser and moisturizer are good.
Here's 2 cleansers that I have used:

1.  Desert Essence Thoroughly Clean Face Wash (with Tea Tree Oil) is a Castile Soap based cleanser.  Runs about $9-10 and is available at stores like Kroger, Earth Fare, etc. or online at Amazon.  This one is more drying than the Tranquil Eyes cleanser below.

2.  Tranquil Eyes Foaming Cleanser with 1% Tea Tree Oil by eye eco - available on Amazon or from eye eco.  - This is a bit more expensive than the Desert Essence but contains shea butter and is less drying.

The mites are active at night and come out to mate on your skin - at least the Demodex Follicularum come to the surface.  Its very important to use either the 5% Tea Tree oil moisturizer or ointment even if your skin is oily. 
 
Moisturizer:  Derma e Tea Tree and Vitamin E Antiseptic Cream - Has 5% Tea Tree oil.  

 Ointment:   Desert Essence Tea Tree Skin Ointment - contains essential oils and also has 5% Tea Tree Oil.

Wipes:  Cliradex wipes for the eyes can also be used on the face - contain 10% Tea Tree Oil extract.  Use after washing face. Cliradex is pricey though - $42 for 24 wipes.  Good for ocular rosace / Blepharitis Demodex. 

Several of the essential oils will kill demodex.  Tea Tree Oil, clove oil, castor oil, peppermint, lavender, menthol, camphor oils to name several will kill demodex.  But be careful if you use some of these oils, they are very strong and have to be diluted with a carrier oil like grape seed oil, sweet almond or jojoba oil.  Tea Tree oil must be used at 50% or lower strength.  Clove oil should be diluted to 1% or less.  

The essential oils are for topical use only - do not take internally.  Keep away from your eyes - these oils are eye irritants. 

I have used Tea Tree Oil mixed with either Grape seed oil or Castor oil in a 50-50% mix (50% Tea Tree oil or less if it is too irritating).  You can mix the oils and apply to your face for 15-30 minutes - then wipe off with a paper towel and wash your face.

Edited by ElaineA

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22 hours ago, OpulentMargin said:

Thanks for the suggestions.  That's awesome you got good results.  I have seen tons of commercials for Proactiv and I read the ingredients list of the Rodan and Fields and Proactiv products.  It looks like it is just benzoyl peroxide cream mixed with other inactive ingredients.  The wash only lists an active ingredient of 3% sulfur, and I already have a sodium sulfacetamide 8% and 4% sulfur wash.  I have tried various strengths of BP, sulfur, vitamin A derivitives (eg. Differin, retinA) and salicylic acid treatments with no results.  Any one of those used to work when I would get a bump, but not anymore.

Sorry to hear that! I wish you luck in finding something that works - acne is the worst! :(

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