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Here's a link to a medical study on a patient with demodex who was first treated with isotretinoin (Accutane) but relapsed after treatment withdrawal.   His family physician referred him to knowledgeable dermatologist who ran tests for bacteria, fungus and finally demodex skin mites.  Only the mite test was positive.  The anti-parasitic treatment for microscopic demodex skin mites worked - his skin cleared.  Still clear at the one year follow up.


Before getting treatment with isotretinoin (Accutane), make sure the dermatologist has tested you for a microscopic demodex skin mite infestation first.  They should also test for a bacterial and a fungal infection.  If they are trying to diagnose hormonal acne, make sure they test your hormone levels including your thyroid.

The 2 week anti-parasitic treatment for demodex is safer, faster and far more effective than taking the potentially dangerous drug  isotretinoin.  The anti-parasitic treatment also works better for demodex by killing them directly.   Demodex eat skin oil.  Isotretinoin reduces the oiliness of the skin which deprives the mites of their food source but, it does not directly kill the mites.  When taking isotretinoin,, starvation causes the population of mites to drop and the skin appears better for a while.  After stopping the isotretinoin treatment, the mite population can rebound and the skin problems are back. 

The same problem of mite rebound may occur when taking birth control pills to control sebum production and reduce acne issues.  If the underlying cause of the acne are demodex skin mites - as soon as the birth control pills are stopped the oil production increases and the mite population rebounds.

Symptoms of Demodex Skin Mites include:  large blackeads, pustules, papules, red cysts, folliculitis, pink or red irritated eyes, styes on eye lids, scalp acne, body acne, occular rosacea (blepharitis demodex), cyclical acne, dry itchy skin or scalp, blackheads on the outer ear.   You may have some or all of these symptoms.  Symptoms may appear cyclical since the mites live and die on a 2 to 3 week cycle.  Acne may appear better for a week or so until the mites start dying off again causing pustules of dead mites to appear.

There is a 2 week, highly effective, cheap, 2 drug oral, anti-parasitic treatment for demodex.  It was published in the May 2013 International Journal of Infectious Diseases by 5 doctors.  It is a proper medical study on 120 patients.  

2 Week Anti-parasitic treatment consists of taking 2 inexpensive, generic anti-parasitic drugs:  
1.  Oral Ivermectin:  Two doses, one week apart (each dose based on body weight at 200 micrograms per kilogram of body weight) - Take one dose on Day 1 and the second on Day 8.
2.  Oral Metronidazole at 250 mg 3 times a day (with food, no alcohol while taking or for 72 hours after the last tablet).  

Both drugs have good safety records and are on the WHO's list of 100 essential medications. 

Link to the medical paper  "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"     URL:  


NOTE: The anti-parasitic treatment only works on parasites.  Bacterial, Fungal, Demodectic and Hormonal acne all have different causes that require different treatment to clear up your skin.  That is why it is very important to get tested properly in the beginning.  The wrong treatment will not fix the problem

If the link is broken, Google the title of the paper to find it.


Edited by ElaineA
Fixed typos.
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