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Microscopic Demodex Skin Mites misdiagnosed as fungal infection in 4 cases

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Microscopic Demodex Skin Mites misdiagnosed as fungal infection in 4 cases.  Appearance of skin condition was similar to a fungal infection.

All 4 were initially misdiagnosed and treated with anti-fungal drugs or antibiotics.  Treatment with the anti-parasitic drug Ivermectin cleared the skin of all 4 patients. 

3 of 4 cases tested postive for demodex with a test.  The 4th case didn't test positive but treatment for 2 years with other drugs did not clear the skin.  They finally treated patient 4 with Oral and topical Ivermectin and the condition cleared up quickly.

There are 2 types of microscopic demodex:  Demodex Follicularum and Demodex Brevis.  The smaller Demodex Brevis live deeper in the skin, down in the oil glands.  Demodex Brevis are more difficult to diagnose with a surface skin test.  Demodex Follicularum are longer and live in the pores, especially around hair follicules.  At times the longer Demodex Follicularum can be seen sticking out of the pore, when viewing the skin under high magnification.  It is possible the 4th case did not test positive due to it being caused by Demodex Brevis down in the oil glands instead of closer to the skin's surface.  The treatment is the same for both types of human Demodex mites.

It is important that dermatologists do a thorough work up including tests for bacterial, fungal, demodex skin mites and if necessary hormone levels tests and a thyroid level test.  Demodex infestations may appear cyclical and may be misdiagnosed as hormonal acne based on a visual and history only exam.   A doctor cannot be sure what is really wrong until they perform scientific tests to nail down the diagnosis.  Otherwise, you can spend years and a lot of money being treated for the wrong skin condition. 


2 Oral Treatment Options:  Oral Ivermection alone OR 2 drug combined treatment Oral Ivermectin + Oral Metronidazole 
Oral Ivermectin treatment for demodex is typically 2 doses one week apart.  Each dose is based on the patient's weight at 200 micrograms per kilogram of body weight.    For oral treatment of Demodex, combining the 2 weekly doses of Oral Ivermectin with a 2 week daily treatment of Oral Metronidazole was more effective than Oral Ivermectin alone.  In the 2nd study Oral Metronidazole was also prescribed as  250 mg, 3 times a day with food and no alcohol during treatment or for 72 hours after the last tablet.

Oral Ivermectin is an anti-parasitic drug that has been around for about 40 years.  Oral Metronidazole has been around for about 60 years.  Both drugs have good safety records.  Both drugs are on the WHO's list of 100 Essential Medicines.  Both drugs are available as a cheap but highly effective generic drug. 

Medical Study:  Combined 2 drug treatment for Demodex Skin Mites: "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"



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