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Daniel7171

Severe Facial and back Acne Relapsing after Medication - 4-5 years and counting

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Hello Everyone. I am male 23 years old. I have had acne for 4-5 years now. I have exhausted all treatment options (i think),I think I have some rare type of acne which was misdiagnosed. Need suggestion and advice on what to do next.

Let's start from the beginning. So 4-5 years ago, I started getting mild acne on My face , Forehead and severe pimples on My chest and behind the ears on the lower part which would often break by themselves and bleed with no puss. The facial and chest acne however would have puss too. The first medicine I got by myself was topical isotretenoin, I used it for 1 month but no effect so I stopped and consulted a dermatologist and was prescribed Doxycycline  for 3 months and then extended to double dose for another 3 months.. NO IMPROVEMENT. Then I didn't take any medicine for another 6 months trying herbal and homemade stuff to fight the acne but no success and again another dermatologist visit, I given Isotretenoin for 6 months.. Significant improvement, no severe out breaks, got rid off the behind the ear acne and chest acne completely. The acne had left scaring so a laser skin resurfacing was performed (the skin became red then blackish then peeled off in a few days) but that didnt help much with scarring rather made them more prominent pinkish/redish in color as I have a fair skin. Was told that another session of laser would be performed after 3 months but during those 2 months I started getting acne for the first time on my back and again on the face, I was prescribed tropical Isotretinoin for 3 months, not much effect and then I stopped all treatment for 2 years, little acne on the face and a lot on the back but as the back is covered and I was fed up with medicine , I didnt care much. Then again I  started getting acne on the face and this time big cystic acne which would swell up and would break and bleed. Again prescribed isotretinoin for 6 months and then mild acne on face but no improvement whatsoever on the back. Still get big acne on the back, they leave pinkish pegmented scar type of marks. The most effected area is the shoulders to the scapula. 

In the mean time , I have had 3 sessions of IPL laser for scarring on face, 30-40% improvement in scarring reduction but as the scars are in group shape and deep it would need another 2 session to get like 60-70% improvement.

What I have noticed, During treatment, I still get acne but a few, after treatment it relapeses again in  the same way, another thing, I will automatically,without any new treatment, get rid of new acne for  like 20-25 days, then suddenly new acne outbreak, goes away in a week, now new acne again for 22 days and another outbreak, goes away, no acne for 20 days and then again... its like a cycle.

About My skin, I have very oily skin, I can't use any non medicated soap, No fairness or cold creams, no aloe vera extracts. If i use any of these I get white heads within 8 hours but they go away in a few days not like the other acne.

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Have you tried eliminating things from your diet? I don't follow a diet myself because I don't think that's what breaks me out but it may be worth looking into?

Maybe you have allergies to gluten or soya etc. Worth trying

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Acne like lesions have three main root causes:  bacterial, fungal and parasites.  If your dermatologist did not run any tests to determine the root cause of your skin issues, then they need to do that before prescribing more treatment.   The treatment is completely different for each of these causes.

One cause is microscopic Demodex Skin Mites (parasites).  Everybody has them.  Normally a healthy immune system will keep them in check.  If your immune system is down due to illness, stress, bad diet etc., then you may develop an infestation if they get over-populated.  You can get Demodex skin mites in virtually every hair follicle and/or oil gland on your body which would account for the apparent body and ear acne.  Demodex can cause acne, rosacea, ocular  rosacea, blepharitis demodex, etc.

Demodex eat oil.  Demodex Follicularum live in the hair follicles.  Demodex Brevis live in the oil gland.  Demodex mites live on a 14-21 day cycle.  When they die off, they make pustules.  They don't like light and come out to mate at night. 

Accutane drastically reduces the oil that your glands produce.  Accutane may temporarily control the mite population by controlling their food source (oil).  But  Accutane doesn't kill the mites.  So, when you stop taking Accutane and the oil glands return to normal allowing the mite population to rebound.

If Demodex mites are the cause, then there is a cheap, highly effective, 2 week, oral treatment published in the International Journal of Infectious Disease in 2013.  It uses generic Oral Ivermectin and generic Oral Metronidazole.  

The combined oral parasite treatment is what worked for me.  My insurance copay for both drugs was $13.03 - without insurance full retail price was $52 USD.

Treatment:
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.

Link to International Journal of Infectious Disease 2013 article:
https://www.sciencedirect.com/science/article/pii/S120197121201315X

Edited by ElaineA
Added corrected link to article in International Journal of Infectious Disease

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20 hours ago, jPablo said:

Have you tried eliminating things from your diet? I don't follow a diet myself because I don't think that's what breaks me out but it may be worth looking into?

Maybe you have allergies to gluten or soya etc. Worth trying

Thanks for answering, I have tried that, The doctor said there is no need but I read somewhere it might be caused by dairy products so I completely eliminated dairy products for 3 months. No effect. Plus I do not have gluten or soya allergy as well.

19 hours ago, ElaineA said:

Acne like lesions have three main root causes:  bacterial, fungal and parasites.  If your dermatologist did not run any tests to determine the root cause of your skin issues, then they need to do that before prescribing more treatment.   The treatment is completely different for each of these causes.

One cause is microscopic Demodex Skin Mites (parasites).  Everybody has them.  Normally a healthy immune system will keep them in check.  If your immune system is down due to illness, stress, bad diet etc., then you may develop an infestation if they get over-populated.  You can get Demodex skin mites in virtually every hair follicle and/or oil gland on your body which would account for the apparent body and ear acne.  Demodex can cause acne, rosacea, ocular  rosacea, blepharitis demodex, etc.

Demodex eat oil.  Demodex Follicularum live in the hair follicles.  Demodex Brevis live in the oil gland.  Demodex mites live on a 14-21 day cycle.  When they die off, they make pustules.  They don't like light and come out to mate at night. 

Accutane drastically reduces the oil that your glands produce.  Accutane may temporarily control the mite population by controlling their food source (oil).  But  Accutane doesn't kill the mites.  So, when you stop taking Accutane and the oil glands return to normal allowing the mite population to rebound.

If Demodex mites are the cause, then there is a cheap, highly effective, 2 week, oral treatment published in the International Journal of Infectious Disease in 2013.  It uses generic Oral Ivermectin and generic Oral Metronidazole.  

The combined oral parasite treatment is what worked for me.  My insurance copay for both drugs was $13.03 - without insurance full retail price was $52 USD.

Treatment:
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.

Link to International Journal of Infectious Disease 2013 article:
https://www.sciencedirect.com/science/article/pii/S120197121201315X


Thanks a lot for the detailed answer, Yes I have had a blood test before the 1st  isotretenoin course, The oil levels were high. All other levels were normal, I do not remember the name of the particular item that was high but when I asked the doctor he said its oil levels and then asked me what I had for breakfast and lunch.

I read the article and did some google searches for images related this parasite and I think You have diagnosed me because the acne pictures on the back and face are exactly like mine. I will upload My pictures just to be sure and then get to treatment. Please follow up on the pictures I upload. Thanks a lot.

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20 hours ago, ElaineA said:

Acne like lesions have three main root causes:  bacterial, fungal and parasites.  If your dermatologist did not run any tests to determine the root cause of your skin issues, then they need to do that before prescribing more treatment.   The treatment is completely different for each of these causes.

One cause is microscopic Demodex Skin Mites (parasites).  Everybody has them.  Normally a healthy immune system will keep them in check.  If your immune system is down due to illness, stress, bad diet etc., then you may develop an infestation if they get over-populated.  You can get Demodex skin mites in virtually every hair follicle and/or oil gland on your body which would account for the apparent body and ear acne.  Demodex can cause acne, rosacea, ocular  rosacea, blepharitis demodex, etc.

Demodex eat oil.  Demodex Follicularum live in the hair follicles.  Demodex Brevis live in the oil gland.  Demodex mites live on a 14-21 day cycle.  When they die off, they make pustules.  They don't like light and come out to mate at night. 

Accutane drastically reduces the oil that your glands produce.  Accutane may temporarily control the mite population by controlling their food source (oil).  But  Accutane doesn't kill the mites.  So, when you stop taking Accutane and the oil glands return to normal allowing the mite population to rebound.

If Demodex mites are the cause, then there is a cheap, highly effective, 2 week, oral treatment published in the International Journal of Infectious Disease in 2013.  It uses generic Oral Ivermectin and generic Oral Metronidazole.  

The combined oral parasite treatment is what worked for me.  My insurance copay for both drugs was $13.03 - without insurance full retail price was $52 USD.

Treatment:
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.

Link to International Journal of Infectious Disease 2013 article:
https://www.sciencedirect.com/science/article/pii/S120197121201315X

You’re not descrbing acne. You’re describing folliculitis. 

You can tell the difference between acne and folliculitis by looking - folliculitis doesnt have comedones.

OP if you post a good HD picture - i can tell you whether its acne

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The pictures are not too clear as I don't  have anyone right now to take the pictures for me. But  I tried My best

a.jpg

b.jpg

c.jpg

A  clearer picture

d.jpg

6 minutes ago, Benjamin94 said:
Please see the pictures I uploaded

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The last pic is the only one I need. You’ve got comedones - ergo it is acne. I dont imagine Ivermectin and Metro would do you any good at all. 

You have widespread truncal acne. It is rarer than facial acne and only usually seen in males. Androgens are the cause i’m afraid. The best treatment availiable is another course of roaccutane.

What dose were you on previously?

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21 minutes ago, Benjamin94 said:

The last pic is the only one I need. You’ve got comedones - ergo it is acne. I dont imagine Ivermectin and Metro would do you any good at all. 

You have widespread truncal acne. It is rarer than facial acne and only usually seen in males. Androgens are the cause i’m afraid. The best treatment availiable is another course of roaccutane.

What dose were you on previously?

Yeah My testosterone levels were pretty high too, 750 If i remember correctly. I have had two courses of roaccutane, 1 Mg / Day for 3 months and 1 Mg / Day for 6 months. The dosage was right because I had severe dryness on My lips. 

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2 minutes ago, Daniel7171 said:
25 minutes ago, Benjamin94 said:

Yeah My testosterone levels were pretty high too, 750 If i remember correctly. I have had two courses of roaccutane, 1 Mg / Day for 3 months and 1 Mg / Day for 6 months. The dosage was right because I had severe dryness on My lips. 

I’m assuming 750 is ng/dl (rather than nmol) - in which case its normal. 

0.5-1mg/kg is the normal dose. High Dose Accutane (up to 2mg/kg) can be used and might be better at preventing relapses, especially for truncal acne (there are several papers on pubmed about this). The side effects get cranked up a whole notch at these sort of doses though. 

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5 minutes ago, Benjamin94 said:
I’m assuming 750 is ng/dl (rather than nmol) - in which case its normal. 

0.5-1mg/kg is the normal dose. High Dose Accutane (up to 2mg/kg) can be used and might be better at preventing relapses, especially for truncal acne (there are several papers on pubmed about this). The side effects get cranked up a whole notch at these sort of doses though. 

Correction, It was 10 Mg per day, If I use 2mg/kg that would be 120 mg a day.. Won't  that be too high ? And how long should I take these ?
Yeah testeserone  was 750 ng/dl. 

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9 minutes ago, Daniel7171 said:
18 minutes ago, Benjamin94 said:
I’m assuming 750 is ng/dl (rather than nmol) - in which case its normal. 

0.5-1mg/kg is the normal dose. High Dose Accutane (up to 2mg/kg) can be used and might be better at preventing relapses, especially for truncal acne (there are several papers on pubmed about this). The side effects get cranked up a whole notch at these sort of doses though. 

Correction, It was 10 Mg per day, If I use 2mg/kg that would be 120 mg a day.. Won't  that be too high ? And how long should I take these ?
Yeah testeserone  was 750 ng/dl. 
Sorry I assumed 1mg/day meant 1mg/kg/day.

So you were on 10mg - which is actually low dose accutane. Maybe a normal dose course would be advisable 30mg for 2 months 60mg for 3 months. What country are you in? What was the reason they went for such a low dose.

Edit

Thanks a lot for the detailed answer, Yes I have had a blood test before the 1st  isotretenoin course, The oil levels were high. All other levels were normal, I do not remember the name of the particular item that was high but when I asked the doctor he said its oil levels and then asked me what I had for breakfast and lunch.”

Sorry - I’ve found the reason you were given low dose in one of your previous replies.

Your Triglycerides were elevated. 

 

Edited by Benjamin94

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16 minutes ago, Benjamin94 said:
Sorry I assumed 1mg/day meant 1mg/kg/day.

So you were on 10mg - which is actually low dose accutane. Maybe a normal dose course would be advisable 30mg for 2 months 60mg for 3 months. What country are you in? What was the reason they went for such a low dose.

Edit

Thanks a lot for the detailed answer, Yes I have had a blood test before the 1st  isotretenoin course, The oil levels were high. All other levels were normal, I do not remember the name of the particular item that was high but when I asked the doctor he said its oil levels and then asked me what I had for breakfast and lunch.”

Sorry - I’ve found the reason you were given low dose in one of your previous replies.

Your Triglycerides were elevated. 

 

I am from Pakistan and we only have two variations of isotretenoin, 10mg and 20 mg. What should I do now ? Go for a higher dosage ? 

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1 minute ago, Daniel7171 said:
20 minutes ago, Benjamin94 said:
Sorry I assumed 1mg/day meant 1mg/kg/day.

So you were on 10mg - which is actually low dose accutane. Maybe a normal dose course would be advisable 30mg for 2 months 60mg for 3 months. What country are you in? What was the reason they went for such a low dose.

Edit

Thanks a lot for the detailed answer, Yes I have had a blood test before the 1st  isotretenoin course, The oil levels were high. All other levels were normal, I do not remember the name of the particular item that was high but when I asked the doctor he said its oil levels and then asked me what I had for breakfast and lunch.”

Sorry - I’ve found the reason you were given low dose in one of your previous replies.

Your Triglycerides were elevated.

 

I am from Pakistan and we only have two variations of isotretenoin, 10mg and 20 mg. What should I do now ? Go for a higher dosage ? 
You need your Triglyceride level remeasuring. If its normal - go for a higher dose. If its abnormal - it would depend on how abnormal it was - but you would have to be very careful.

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Demodex skin mites can indeed cause blackheads, whiteheads (comedones) and pustules..  Demodex can also cause folliculitis.  Here's a link to an article about Demodex Folliculitis:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5489393/

One of the things opthalmologist have noticed in that patients with blepharitis demodex (ocular rosacea) frequently have big blackheads.  Demodex can also get in the eyelid oil glands and block the ducts causing eye issues with red eyes, dry eyes, blurred vision and styes.

Demodex can track bacteria and fungus down in the hair follicules and may contribute to a secondary infection that way.   The fact that you have observed that the skin condition gets worse on about a 22 day cycle and the mites live 14-21 days is a big clue.  When there is a mite die off they make pustules (its dead mites).

Borax-Epsom Salt bath soak may help the body acne.  Borax kills the mites.  They can get in your hair as well and may cause itchy scalp and itchy skin.  DIY Borax shampoo can help this.  

Borax kills both Demodex and Yeast infections (which can cause seb derm). The Borax bath soak has been recommended for years by OB/GYN doctors for patients with yeast infections.
Borax is large molecule so the human body should not absorb it through the skin.

------------------------------
Here's the bath soak:
------------------------------

If you have any serious health issues, like kidney problems this would not be a recommended treatment. The magnesium in the Epsom Salts may be a problem for some health conditions. As long as you are healthy, this soak should be OK. Talk to your physician if you are not sure if this is safe for you.

For a standard 5 foot bath tub:

1. Fill tub with pleasantly warm water. If the water is too hot, you may pass out or get over heated. Its not the heat, its the borax that will kill the mites.

2. Add 1 cup of 20 Mule Team Borax ( In the US this is available at Kroger and Target in the Laundry detergent aisle for about $4-$5.50).

3. Add 1 cup of Dr. Teal's Epsom Salts with Moisturizing Avocado Oil (about $5 at Kroger) . This ingredient will make your skin moist but the borax is more important. Don't use too much of this as it can make the bath tub slippery when getting out of it.

4. Swirl the water in the tub and break up any lumps in the borax so that it disolves.

5. Get in tub, use the water to wash your face and shampoo your hair and scalp. Borax is a good and simple DIY shampoo. It is also a good water softener. Your skin and hair will feel silky soft after you finish this soak.

6. Soak in tub for 30 minutes. Be careful getting out of the tub - too much Dr. Teal's can make the tub slippery.

You can take a shower after you are done if you like. Some people say that leaving the borax on is better. I've never tried it that way. This soak really soothes itchy scalp and skin caused by demodex mites.

-----------------------------------------------------
Here's the simple DIY Borax shampoo:
-----------------------------------------------------
Mix 2 TBSP Borax to 2 cups of hot water. Break up the lumps as needed. Borax disolves better in hot water. Let it cool enough to use. You can put this in an old shampoo bottle. Shake well before using.
NOTE: This is "no poo" non-lathering shampoo. Borax shampoo is great for curly or regular hair. It doesn't lather but just massage it in the hair and scalp like regular shampoo. Your hair will feel slippery.

It helps to leave it on the scalp and face while showering, then rinse.
This works well for me.

Recipe and blog article on the good things about borax shampoo are here:
http://sustainingourworld.com/2014/0...-healthy-hair/

Other web sites report that OB/GYN's suggest the Borax Soaking Bath for yeast or Candida infections. Borax could help people with seborrheic dermatitis in their scalp and face. Borax and Epsom Salt baths work well for body demodex mites causing body acne like lesions and itchy skin.
https://www.earthclinic.com/cures/ye...fection10.html


 

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I am confused about this Demodex, I see I have almost all the symptoms of Demodex, Is there a test I can do to confirm ??
Regarding the triglyceride test, I will do it again and talk to My doctor for a higher dose of Isotretenoin 

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Dermatologists have several methods of testing for Demodex.  Basically you have to collect some from your skin in an area where you suspect high activity.  Put the results on a slide for a microscope.   Put the slide in the microscope. Then try and count them.   Counting them can be tricky because the mites do not like light, so they will move to the edge of the slide.

Some people have gotten USB microscopes to try and do the count at home.  The link in method 1 below  gives the instructions.

Several different methods for collecting the mite sample from your skin:
1.  Use a gel face cleansing mask to collect the sample.  Here's a link to someone who did this on the Rosacea forum.  Demodex can cause both acne and rosacea.   https://rosaceagroup.org/The_Rosacea_Forum/showthread.php?34700-Cheap-and-easy-home-test-for-Demodex
2.  Use a face pore strip like Biore - this might work.  Wet the face with warm water, apply the pore strip and let it dry  

Doctors typically use one of the following methods - although I have no details on the exact method:
1.  Skin scraping - best done by a doctor.
2.  Use a sticky substance on the slide and apply the slide directly to the skin to collect the sample.

If it is demodex the oral ivermectin + oral metronidazole 2 week treatment works by killing the parasites in the entire body.  The oral metronidazole works much better and faster than the topical metronidazole to kill demodex.   

Isotretenoin can be really dangerous with many bad side effects, please be careful with it! 

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Current biomedical opinion is that demodex is not the cause of acne.

Its thought it could possibly be involved in Rosacea pathology, but even there it remains only a hypothesis.

Demodex Folliculitis is extremely rare.

Isotretinoin (an acne medicine) cleared your spots previously. That and the fact that your skin has the characteristic appearence of acne and not folliculitis means that i think it is a safe conclusion that it is acne.

Metronidazole is a very strong drug. Far more toxic in many ways than isotretinoin.

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Thanks a lot guys, so I am going to see the doctor in a few days and I will discuss all this stuff with him. Will update here afterwards. Thanks  a lot for Your time and effort

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