4 Basic causes of Acne (and some types of Rosacea) - make sure your dermatologist tests you to verify which type you have. The treatment for each type is completely different. Correct diagnosis of the cause is important to clear the skin condition.
Demodex skin mites are the most under-diagnosed cause of acne and some types of rosaceafor people of all ages. Some more enlightened dermatologists will test for the mites. Many old school dermatologists were taught in school, that the mites were harmless. As such many old schoolers don't believe that the mites can cause any problems and will not bother to test for them. In 2008 an opthalmologist developed Cliradex wipes for his patients with the eye conditions blepharitis demodex / ocular rosacea. Eye doctors began to notice that their patients whose eye lids were infested with demodex mites also had large blackheads and other related skin problems like acne and rosacea.
1. Bacterial infection - should respond to antibiotics (oral or topical) and other acne meds like benzoyl peroxide.
2. Fungal infection - antibiotics will not work. Need anti-fungal drugs
3. Mechanical Acne - caused by exposure to comedogenic chemicals in environment like oil from a restaurant fry cooker.
4. Demodex Skin Mites - microscopic mite that everyone over the age of 18 has. A normal, healthy immune system keeps the mites in check. Mites may get over infested when immune system is low due to illness or extreme stress.
- MItes eat oil and may infest both skin and eye glands any where on the body with oil glands can be infested.
- Symptoms may appear on one side of face or all of face and/or scalp, neck and body.
- Pimples, papules, bumps, blackheads, whiteheads or general redness
- May effect eyelids and eyebrows and cause eye redness, styes, and dry eyes including blepharitis demodex/ocular rosacea.
- Symptoms may occur at any age
- May cause redness like rosacea or not.
- Mites live on a 14-24 day cycle and may appear "hormonal" due to their short cyclical life spans.
- Pimples occur when the mites die off.
- 2 kinds of demodex mites:
- Demodex Brevis live in the oil glands and may cause deeper cysts.
- Demodex follicularum live in the follicles
- Standard bacterial or fungal acne medications are not effective, although they may clear some secondary infections that occur along with the mites.
- 2 week combined treatment with prescription Oral Ivermectin and Oral Metronidazole has been shown to be highly effective at clearing.
- Insurance copay on these drugs is cheap: $13.03 USD
- Max full retail on the 2 generic drugs is about $52 USD
- Treatment documented in the May 2013 Journal of Infectious Diseases reporting results on 120 patients with demodex skin mites.
- Link to full journal paper here: https://www.sciencedirect.com/science/article/pii/S120197121201315X
- Link to summary of journal paper here: https://www.ncbi.nlm.nih.gov/pubmed/23294870
- 2 week combined treatment: Using the more effective 2 drug combined treatment (from paper) based on body weight for the oral Ivermectin:
1. Two doses of oral Ivermectin one week apart. Each weekly dose is 200 micrograms Ivermectin per kilogram of body weight. My doctor rounded the dose up some since they tablets are 3 mg - that avoided having to break tablets. 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.
- Non-prescription treatments:
- May help but will not get the mites out of the eye glands.
- Borax (20 Mule Team Borax available in the laundry aisle of most grocery stores at $5.50 per box)
- DIY Borax Shampoo / Face wash ->
- Dissolve 1 Tablespoon Borax per cup of hot water
- let cool and pour mix into clean shampoo bottle
- Use in place of shampoo - let it stay on hair while showering, then rinse
- NOTE: Does not lather but massage into scalp like shampoo
- May also use to wash face.
- DIY Bath Soak for body acne
- In a standard 5 foot bathtub in pleasantly warm (not hot) water dissolve
- Add 1 cup of Borax powder
- Add 1 cup of Dr. Teal's Epsom Salts with moisturizing coconut oil
- Swish water to dissolve and mix the 2 powders
- Wash hair and face in mixture while soaking
- Soak for 30 minutes, shower off after
- Tea Tree oil face wash, tea tree oil moisturizer/ointment
- Products with tea tree oil available from The Body Shop, Derma e, Desert Essence and others.
- NOTE: External use only. Tea tree oil should never be used at 100% strength - it needs to be diluted to no more than a 50% solution or less. Most over the counter cleansers and moisturizers contain about 5-10% tea tree oil.
- Cliradex Wipes
- Good for cleaning eye lids also good for wiping down the face. Contains a 10% tea tree oil extract. Do not get the solution in the eyes - it burns.
- Hypocholorous Spray
- Natural substance made by the human body in response to scrapes and cuts. Kill mites especially in the juvenile stage. Very refreshing, does not burn.
- Available over the counter from Heyedrate and Occusoft (both on Amazon).
- Accutane/Roacutane is a dangerous choice to treat demodex skin mites
- The mites eat oil. Accutane shuts down the oil glands which starves off some but not all of the mites
- Accutane treatment takes months and has many dangerous side effects.
- The 2 week combined treatment focuses directly on the mites and kills the mites off with less chance of side effects.
- Many people seem to have rebounds of skin problems after their first use of Accutane
I am new to all this. I have been diagnosed with rosacea complicated by demodex. It is by far one of the worst experiences of my life, and I survived a brain tumor, brain surgery, and eye issues from the tumor. I am trying to live a somewhat normal life, deal with the anxiety and depression of going from a pretty and fairly unblemished complexion to a cyst filled face on a 45 year old woman. My children are very supportive but my husband thinks I am going overboard. Getting the official diagnosis from my derm helped him to be more supportive and stop saying I was crazy. But it is still hard for a non sufferer to really understand. I bought an enzyme cleaner and clean everything. House, face, body, dog. I have a fantastic dermotologist, but had to travel 2 hours to appointments because she is so far away. She started me on oral ivermectin and topical ivermectin immediately. After reading the info on oral ivermectin and oral metronidazole combo treatment, I called my derm and asked to please let me try it. She agreed and I started yesterday. I appreciate getting all of this vital info on this site and pray that this treatment works for me. I want to return to my wonderful, normal life. I want to participate in life again. Thanks for any support.
What kind of setbacks are you having?
Just be aware that for cases of Demodex Skin Mites, when the treatment causes the mites to die off it can cause apparent pustules. That is actually a good sign as it means the treatment is working and the mites are dying. The mite die offs may continue for up to 2 weeks after the treatment is complete. But after that it should be done. Is this the type of setback you are having? Or is it something else?
I'm having my hormone levels checked to make sure that isn't contributing to these unpoppablebig cysts that pop up on my face and stay for months. My hairline and forehead are much better now but my jawline and chin are horrible. Maybe it was a combination of hormones and demodex? I notice that by the end of my day, my bumps are twice as big as the morning. I use surgical micro tape on my face at night (suggested by someone who did it on rosacea site) so my face is pretty calm and flat in the morning.
I'm having my hormone levels checked to make sure that isn't contributing to these unpoppablebig cysts that pop up on my face and stay for months. My hairline and forehead are much better now but my jawline and chin are horrible. Maybe it was a combination of hormones and demodex? I notice that by the end of my day, my bumps are twice as big as the morning. I use surgical micro tape on my face at night (suggested by someone who did it on rosacea site) so my face is pretty calm and flat in the morning.
Also, thank you for listening. It has been a nightmare and helps to talk with someone about it.
Its a good idea to rule out a hormone issue that could also be contributing to the skin issues. It could be a combination, certainly. I'm glad to see you are able to get tests to determine the cause(s). Over the years my 4 board certified dermatologists just kept playing Russian roulette with a ton of antibiotics and expensive, latest and greatest acne meds that never worked. They never did one test to find out why nothing was working.
I saw the posts on the micro tape too. It makes some sense as it would keep the mites from roaming around to mate at night. That could reduce the future population.