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4 Basic Causes of Acne - Make sure they test you for Demodex Skin Mites

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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 for 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


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How can I persuade my doctor to test me for demodex mites? Can they cause clogs in the same pores again and again and again? These granules under sikn or bumps that are filled with long stringy paste stuff?

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Ask the doctor to do the test for Demodex.  He is working for you not the other way around.
The test is simple.  They either stick a sticky microscope slide to your face to collect the sample.  Or, they will do a light scraping test to collect a sample.  Once they have a sample they look at it under a microscope and try to count the mites. 

If they refuse to do the test, ask them one very pointed question:  "If you don't do a scientific test, how can you be sure of the diagnosis - Especially if the existing treatment is not working?".   If that doesn't work, find a different doctor who will do the test.

Another option is to show them the scientific paper in the May 2013 Journal of Infectious Diseases with the treatment that cleared the demodex in 120 patients with various skin problems.
Paper is here:

Yes, they can cause clogs in the same pores over and over again.  Yes, the granules under the skin may have long stringy stuff.    This happened to me. The problem was misdiagnosed for years as acne (bacterial).  None of the standard acne treatments  (antibiotics, retinoids, etc.) ever worked.  Eventually the mites got into my eye lid glands and caused styes on the lids and finally ocular rosacea (blepharitis demodex).

Last year, I found the journal article on the combined 2 week treatment.  My family doctor prescribed the drugs for me.  He knew that I had had unresolved skin issues for years.  The treatment worked.  My skin has been clear for 8+ months.

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