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Persistent Acne - Hormones, DIM, Vitex, Suggestions?

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Hi everyone,

I was hoping for some general thoughts and advice about my acne.

I've had blood work and a urine sample done where nearly everything (minus estrogen, which is annoying) checked for, and I am NOT lacking in anything... the doctor said I was actually very healthy. 

Does that mean my acne ISN'T hormonal? (I've spoken to a few doctors now, and they are rarely any help and still won't refer me to a derm, even though I've struggled with mod to severe acne for twelve years now).

My breakouts are primarily cystic and around the sides of my chin, jawbone, and mouth, with some smaller pimples on my forehead and cheeks. 

I have been taking DIM for just over a year, which worked amazingly for about eight months... and now, even with drastically increasing the dosage, my cystic jaw acne is back (as well as the little zits in other places).


I have, what I think, is a pretty solid skin care regimen: 


Paula's Choice cleanser (acne prone skin),

PC toner with niacinamide,

5% bp (drugstore brand),

Reversa moisturizer w/ hyaluronic acid for oily/acne prone skin


PC cleanser followed by oil-based cleanser (so a double cleanse as one cleanse doesn't get off the concealer I use to cover my acne), 

PC toner,

bp %5 when breaking out (if skin is somewhat clear, I will just spot treat with bp or skip altogether)

Inkey retinol (currently awaiting a higher dose of retinol in the mail from PC)


I have already tried monocycline (10 years ago, stopped working within a year), Green Cream (stopped working after five years), birth control (didn't work at all and interfered w/ my antidepressants), adapelene (no noticeable difference), topical isotrentinoin (zero difference)


My questions are...

1) Any similar experiences? (I'm a 30 y/o female, if that makes a difference)

2) Any experience w/ DIM? 

3) Any experience with Vitex? (I am thinking of adding this)

4) Recommendations? 

5) Did your hormones and everything test perfectly fine but you still had "hormonal acne"? - what did you do?


Thank you for anything you can offer me.

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Do you eat dairy products(milk, cheese etc) regularly ? I've seen many examples where women have been able to eliminate acne just by removing dairy/gluten/refined sugar from the diet. American standard diet is one of the reasons why people develop all these food sensitivities, as not all of us have good genetics that would allow us to poison our bodies for decades without any consequences.

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Find a dermatologist who knows how to test you for microscopic Demodex Skin Mites.  Demdex can cause acne like symptoms.  The skin mites eat oil.   The condition may respond initially to antibiotics or anti-fungal drugs since the demodex can track bacteria or fungus around the skin and back down into the pores and oil glands when they come out to mate at night.

Demodicosis can be cyclical, since demodex live on a 2-3 week cycle.  When they die they create pustules that look like acne pimples.  That can be confused with hormonal acne by doctors who only do visual exams.  That is why it is important to find a doctor who will actually test for demodex or at least is willing to treat the possible condition.  They have to take a skin sample and manually count the mites under a microscope.  The skin sample is collected by either a very light skin scraping or better a sticky microscope slide pressed to the skin for 1 minute (like a pore strip).   Regrettably, not all dermatologists are as knowledgeable about demodex as others.  Demodex were first discovered on human corpses in 1840 and thought to be harmless.  They are until they get overpopulated.  Overpopulation can start when the immune system is down due to illness or stress.

I had problems with demodex for decades.   It was misdiagnosed by 4 board certified dermatologists as bacterial acne.  The last one reviewed my records and said "gee maybe its hormonal".  It wasn't hormonal for me either.   None of the many antibiotics, retinoids, or prescription benzoyl peroxide products ever worked.  Minocin did seem to help at first.   

Symptoms may include some or all of the following:  blackheads, papules, pustules, folliculitis, scalp acne, body acne, blackheads in outer ears, telangectasias (broken capillaries), red eyes, dry eyes, your skin may or may not be red, it may be worse cyclically due to the mites dying on their 2-3 week life cycle.   

Print out a copy of the following medical article to take to your doctor.  My Family Practice doctor prescribed it for me.  He knew that I had skin problems for years.  I took the 2 week, 2 drug oral treatment described in this paper.   It worked - nothing else ever worked.   The medical journal article describes a properly done medical study on treating demodex:   

"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"


This 2 drug oral prescription treatment uses 2, safe, inexpensive generic drugs:  Oral Ivermectin + Oral Metronidazole.  Cost with insurance copay about $13.03 USD or about $52 cash USD full retail.  Taking both oral drugs provided far better clearance of the mites than taking Oral Ivermectin alone.

Prescription Treatment options 

1. 2 week full body Oral Treatment (best and fastest)  Oral Ivermetin (in 2 once a week doses based on body weight) + 3 times daily dose of Oral Metronidazole.   The first dose of Oral Ivermectin kills the current adults.  The second dose a week later kills any new mites from the eggs that have hatched.  Oral Metronidazole as it breaks down in the body creates 5 metabolites that are believed to create a bad environment for the demodex.  NOTE: Topical Metronidazole gel does not work - you have to take the oral drug to get the metabolites to kill the mites.

2.  Topical (Expensive and slow):  Soolantra Cream (1% Ivermectin) - Soolantra Retail costs up to %500-$600 per tube.  May be muh cheaper with insurance copay.  Takes 16 weeks of nightly use.  Due to expense if you have body or scalp symptoms this will not likely be a cost effective solution.  Best for milder cases isolated to the face.

Over the Counter Support Options:

1.  Use a clean towel every day.  Demodex can live on a wet towel for up to 54 hours.  Demodex die at 58 degrees C.  So washing towels and bed linens in an automatic clothes washer and dryer should eliminate the mites from towels and bed sheets.
2.  Wash face at night before bed with a commercial Tea Tree Oil based face wash (Desert Essence, The Body Shop and the eye eco brand are all good).
3.  Spray face after washing at night with Hypochlorous Acid Spray ( Heyedrate or Occusoft, both are good).  Let dry before using face serum and/or moisturizer.
4.  Ivermectin Horse Paste (1.87% Ivermectin) available from Amazon for about $5 for a small tube.  Stronger and cheaper than Soolantra.  People have reported good results with this more cost effective option.  Use at night - that is when the mites are active.  
5.  Intense Pulsed Light Treatment (IPL) - IPL has been shown to kill the mites.  The mites don't like light.

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