Has a dermatologist tested for microscopic demodex skin mites? Other possibilities would include fungal acne or hormonal acne.

The fact that its cyclical and your face looks red in the photos raises a big flag on demodex. If it is Demodex, the good news is there is a highly effective2 week oral treatment for it.

The mites eat skin oil. The miteslive 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 decadesand 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 effectivetreatment 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 treatmentwas 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

Treatment:

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 eachOral Ivermectindose 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 Metronidazoletreatment kills them. The treatmentmay 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.

On 2/3/2021 at 11:47 AM, ElaineA said:

Has a dermatologist tested for microscopic demodex skin mites?    Other possibilities would include fungal acne or hormonal acne.

The fact that its cyclical and your face looks red in the photos raises a big flag on demodex.  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

Treatment:

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.

First off,

Thank you so much for responding with such detail. The fact you took time out of your day to help a total stranger is so nice, I appreciate it so much. I have never heard of demodex mites before and I thought I had tried everything... I™ve never been tested for it. All the dermatologists I™ve ever been to hardly even look at your skin, it™s like they just don™t care. All the things you™re describing though happens to me. I have about a couple days of pretty clear skin, then all of a sudden it™s tiny whiteheads everywhere and I break out for a few weeks and the cycle repeats.

I have horses so I do have some ivermectin. I™ll definitely try this out as I am willing to try anything at this point. Once again thank you for sharing this. I™ll update on progress.  

doesnt look like a normal acne to me, the fact that is a persistent very long-term problem,point out to be a fungal and non-related to acne/staph bacteria.

like Elaine said, its look like a classical demodex outbreak