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Dermatologists Please Read: Rosacea, SIBO, Demodex, Eggerthella Lenta, Oral Metronidazole Treatment, the Gut Connection

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Possible explanation of why Oral Metronidazole can be highly effective at clearing the skin of demodex skin mite infestations.

Case:  UK patient suffering from sudden onset of Rosacea Type 2 with Papules & Pustules,  Ocular Rosacea / Blepharitis Demodex, and seborrheic dermatitis after respiratory illness with antibiotic treatment.   Long term problems with gastritis for 20+ years.  Topical treatment with Soolantra helped but did not clear demodex.  Oral treatment with just Oral Ivermectin caused many mite die offs but did not clear demodex or blepharitis.   Finally got a SIBO test.   It was positive for Eggerthella Lenta and E. Coli.  The bacteria, Eggerthella Lenta, hasn't been studied much.

Oral Metronidazole has been successfully used to clear demodex skin and eye infestation for some time.  But no one understood why Oral Metronidazole worked.   Researchers tried dipping live demodex in 100% pure liquid metronidazole and it did not kill the mites.  Topical metronidazole is very slow at best at treating demodex.  Yet combining Oral Metronidazole with Oral Ivermectin in a 2 week treatment has been shown in one medical study to be HIGHLY effective at greatly reducing or eliminating demodex skin mites.   Link to the medical study on Oral Ivermectin + Oral Metronidazole treatment here:


Oral Metronidazole is 99% effective at clearing both Eggerthella Lenta and Bacterioides infections associated with SIBO.  In cases of rosacea patients with Small Intestine Bacterial Overgrowth (SIBO) who also have demodex skin mites, using the combined 2 week  treatment of Oral Metronidazole with Oral Ivermectin may work by clearing a gut infection of Eggerthella Lenta and/or Bacterioides while the Oral Ivermectin kills off the topical adult breeding demodex population.  This treatment worked for me after decades of being misdiagnosed with bacterial acne and treated a variety of ineffective antibiotics, retinoids, benzoyl peroxide, etc.  My symptoms were identical to Rosacea Subtype 2 with papules & pustules (aka demodicosis). 

Challenge to the Medical Community:  The study of Eggerthella Lenta and Bacterioides and their impact on the skin biome and demodex population would be a really good research topic for dermatologists, medical schools, etc.  The big question is how is an overpopulation of Eggerthella Lenta and/or Bacterioides gut bacteria facilitating the overpopulation of demodex on the skin?

Article on SIBO and Rosacea:

Edited by ElaineA
Added Bacterioides as another SIBO bacteria cleared by Oral Metronidazole
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