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I am 23 years old woman from India. I have oily combination skin. I always get this acne from 3-4 months, I had some serious acne issues in 2019, Did isotretinoin course for 6 month in small dosage(20mg/day for first month and 10mg/day later).


My acne cleared. And they returned around in October.. but these acne are different, earlier I used to get mostly cystic. These acne that I get now are not very long lasting, have this pus and they heal, but they keep recurring at same place on forhead and right cheek. My left cheek us flawless without any.


I am using this salicylic and Glycolic acid facewash from 2-3 months.. and moiturize my skin religiously.


It looks really bad because of that pus and skin is so red around it.. and the old marks aren't healed properly.


Any help will be appreciated.


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Did they test you for demodex skin mites?    These are microscopic skin mites that everyone has.  They aren't a problem until they become overpopulated.   The mites eat skin oil.   isoretinoin (Accutane) reduces the amount of oil available to the mites and starves off the population.  But it doesn't necessarily kill the entire population.   They can come back after the isoretinoin is stopped.

It is common for demodex to appear cyclical and to reoccur in the same places on the skin.

If it is Demodex, the good news is there is a highly effective 2 week oral treatment for it.   

The mites eat skin oil.  The mites live and die on a 2 to 3 week cycle.  When the mites die they create pustules also known as a die off.   Skin can look okay for a week and then boom a mite die off hits and you have a bad breakout.    I had demodex for decades and it was misdiagnosed by 4 board certified dermatologists as bacterial acne.  Their diagnosis was based on brief visual exams.  They never tested me for anything.  When one prescription drug or antibiotic didn't work, they just prescribed something else.

If it is demodex there is a 2 week, 2 drug combined highly effective treatment with cheap and safe generic drugs that really works.  It was what finally cured me after literally decades after being treated with antibiotics (including minocycline), retinoids, benzoyl peroxide , etc. - none of which ever worked.  The treatment consists of Oral Ivermectin and Oral Metronidazole.   The treatment was published in a proper medical study in the May 2013 International Journal of Infectious Diseases.  If necessary, print the paper out and show your doctor.  The link to the paper is here: https://www.sciencedirect.com/science/article/pii/S120197121201315X


1.  Oral Ivermectin Doses:  2 once a week doses of Oral Ivermectin based on body weight:   200 micrograms Ivermectin per kilogram of body weight.  That worked out to 12 mg per dose for me.   My family doctor prescribed this treatment for me.  He rounded up the Ivermectin dose a little so that it was a multiple of 3 mg to avoid having to break the 3 mg tablets.   Take the first dose on day 1.  Take the second weekly dose on Day 8 of treatment.  Take each Oral Ivermectin dose on an empty stomach with a big glass of water.

2.  Oral Metronidazole Doses:   250 mg of Oral Metronidazle, 3 Times daily.  Take with food.

Topical treatments that can help over time and will support the oral treatment while in progress:

1.  Wash with:  Tea Tree oil face wash (The Body Shop makes several, Desert Essence Original Face Wash, and others are available)

2.   Wipe clean face with:  Cliradex Wipes and allow to dry - Use one wipe after washing face morning and night.  

3.   Hypochlorous Acid (HOCL) Face Spray - (0.01%-0.02% concentration).  The HOCL spray can be massaged around face with clean fingers to ensure an even coating.  HOCL is soothing, non-irritating and non-allergenic to skin - contains the identical HOCL chemical produce by the human bodies white cells.   Kills 99.9% of bad bacteria, kills fungus and viruses, kills juvenile demodex skin mites reducing the population over time.  Doesn't kill the "good" bacteria needed for healthy skin.  Tattoo artists and piercers swear by HOCL to help their clients heal up without infection.  Hospitals use HOCL to disinfect ICU and Operating Rooms.  Medical and Dental offices use HOCL to disinfect their treatment rooms.  HOCL has been in use for over 100 years in the medical industry - it works.  BrioTech Labs sells spray bottles on Amazon for $6.95 per 2 ounces or $11.95 for 4 ounces).  Other brands available on Amazon include Occusoft Hypochlor, Heyedrate Lid and lash cleaner, etc.

4.  Use a clean towel for the face daily as demodex skin mites can live on a wet towel or washcloth for up to 54 hours.

5.  Ordinary washing of towels and other linens in a standard washer/dryer at 59 degrees Centigrade will kill demodex.  So you don't need to do anything special with laundry other than frequent laundering especially of the towels.

If you can't get to a doctor, there is one other topical non-prescription option that can help.   Soolantra Cream (Topical Ivermectin 1%) is an expensive prescription drug frequently prescribed for treating demodex skin mites.   The over the counter option is to get the Ivermectin Horse Paste (Durmectin, etc) from Amazon at about $5-$7 per small tube.  Its 1.87% Ivermectin in a paste form.   Use it on a clean face at night before bed.  The mites come out at night, so that is the best time to treat them.  Doctors prescribe the topical Soolantra treatment at night for 16 weeks.   Its slower than the oral treatment but can be very effective.

Just be aware that while being treated for demodex, the topical Ivermectin or Oral Ivermectin- Oral Metronidazole treatment kills them.  The treatment may temporarily cause what appears to be a bad breakout.   That is an excellent sign that the treatment is working.  Stick with it until they are all dead.

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Here's some further evidence that isoretinoin / Accutane treatment temporarily helps make a demodex infestation look better.  This patient relapsed after completing the isoretinoin treatment.   Antibiotics didn't help.  Family doctor tried that first then isoretinoin.   Dermatologist ran tests and diagnosed the demodex skin mite overpopulation / infestation.   Treatment with the right anti-parasitic drugs cleared his skin.


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