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ElaineA

Before going on Accutane/isoretinin get tested for Demodex Skin Mites and/or a Fungal Infection

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Before going on Accutane/isoretinin get tested for Demodex Skin Mites and/or a Fungal Infection

The very common, microscopic Demodex Skin Mites can cause acne like blackheads, whiteheads, pustules and papules.  The mites eat oil.  There are 2 kinds that live on humans.  Demodex Brevis live in the oil glands.  Demodex Follicularum live in the pores.  The mites live and die on a 2 to 3 week cycle.  The mite life cycle may make the condition appear to get better and worse on a cyclical basis.  The cyclical behaviour may cause the skin condition to be blindly labeled "hormonal".  The mites can get in every oil gland and pore in your body leading to not only facial acne, but body acne, scalp acne and red dry eyes (ocular rosacea / blepharitis demodex).

Because they eat oil, taking Accutane can starve the mite population down by reducing their food supply.  However, Accutane won't kill all of the mites.  Once Accutane is stopped, the mite population may rebound.  To properly treat the mites, you need an anti-parasitic treatment.  Antibiotics, anti-fungal, and topical anti-bacterial acne medications are useless against these parasites.

A knowledgeable dermatologist can test for the mites by collecting a sample.  The test is either a light skin scraping or putting cyranoacrylic glue on a microscope slide, sticking it to an affected area on your skin briefly and pulling the slide off.  Then they try to count the mites from the sample.  Counting the mites under a microscope is very tricky, the mites don't like light and scuttle to the edge of the microscope slide.  Demodex brevis can be more difficult to diagnose since they are down in the oil glands.  Some dermatologist will prescribe an anti-parasitic treatment to eliminate the possibility of demodex rather than try to test for them.

There is a highly effective, inexpensive, oral, anti-parasitic drug treatment to kill off the demodex skin mites.  It takes 2 weeks.   The treatment was published in a medical study in the May 2013 issue of The International Journal of Infectious Diseases. The paper showed that the best results were obtained from the combined 2 drug oral treatment of Oral Ivermectin and Oral Metronidazole.    2 once a week doses of Oral Ivermectin are taken on day 1 and day 8.  Oral Ivermectin dosage is based on body weight - 200 micrograms per kilogram of weight.  Oral Metronidazole is taken at 250 mg, 3 times per day with food for 2 weeks.  Oral Ivermectin and Oral Metronidazole are available as cheap generics.  Both drugs are on the WHO's list of 100 Essential Medications and have excellent safety records.  These are prescription drugs and should be taken under the treatment of a physician in case of a rare allergy or reaction.

Here's the link to the paper - cut and paste into your browser if it doesn't work directly.  Or Google the title:  "Evaluation of the efficacy of oral ivermectin in comparison with ivermectin–metronidazole combined therapy in the treatment of ocular and skin lesions of Demodex folliculorum"
https://www.sciencedirect.com/science/article/pii/S120197121201315X

The other possibility is that you might have a fungal infection.  Some types of fungus eat oil as well.  In this case, an anti-fungal treatment is needed.  

Accutane may be treating the symptoms with a rather dangerous drug.  Accutane's dangerous side effects are well known.  But unless you get to the root cause of the problem, Accutane isn't likely to cure it.

I was misdiagnosed for decades with bacterial acne.  Treated with every antibiotic and topical acne medication available.  None of them ever worked.  None of the 4 board certified dermatologists ever ran a single test to find out why the treatment didn't work.  They just kept writing new prescriptions for the latest and greatest treatment for the wrong skin condition.  It train wrecked my skin and eventually my eyes.   The doctor works for you, not the other way around.  Make them test to find the real cause.  If they won't do a test, find a new doctor.

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