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Small Intestinal Bacterial Overgrowth (SIBO) is found in about 50% of people with Rosacea.  Due to its appearance, Rosacea Subtype 2 with papules and pustules may be misdiagnosed as ordinary bacterial acne.  In SIBO, bacteria can start growing in the wrong part of your gut due to illness, surgery or a structural problem.

That bacterial overgrowth can lead to skin conditions like Rosacea Subtype 2 with papules and pustules that can be misdiagnosed as bacterial acne.  While it looks like bacterial acne, its not.  The surface skin problems are caused by an overpopulation of demodex skin mites.  Everyone typically has a few demodex.  But when those mites get overpopulated they can clog pores with blackheads, create "pustules" of dead mites, may clog your eye's oil glands causing dry, red, irritated eyes, and generally make your skin look bad.  The mites eat skin oil and possibly skin cells and blood.  The mites live on a 2 to 3 week cycle.  When a die off happens, it forms sudden papules or pustules on the surface of the skin.  Demodicosis is the same disease as the more modern named Rosacea Subtype 2.  When the mites start clogging up the oil glands in your eyelids they can cause ocular rosacea (Rosacea Type 3) or what an opthalmologist would call blepharitis demodex.  Telangiectasia  (broken capillaries) may appear on the skin.  Some doctors try to diagnose the problem as "hormonal" acne due to the short cyclical life span of the demodex skin mites causing the 2 to 3 week appearance of the pustules.

Topical treatments like Tea Tree Oil, topical Soolantra ointment with 1% Ivermectin, or topical Horse Paste with 1.87% ivermectin can help reduce the demodex population and improve the surface symptoms.  But if SIBO is the root cause, the mites may rebound and the symptoms can come back.

The healthy type of bacteria in the human gut comprises a great deal of the human immune system.  In the case of SIBO, the bacteria overgrowth is either suppressing the immune system's normal ability to control the demodex mite population.  Or, the SIBO bacteria is producing something that allows the demodex skin mites to get overpopulated.

The following medical study showed that treating and clearing the gut bacteria that is causing SIBO had excellent long term effects on clearing the rosacea and maintaining clear skin when compared to traditional topical treatments.  In this medical study, subjects were treated with the very expensive antibiotic Rifaximin with follow up checks for 3 years.  The treatment was highly successful.

https://www.jaad.org/article/S0190-9622(16)30014-7/pdf

The highly effective, generic, inexpensive, combined 2 drug oral treatment for demodex skin mites includes 2 weekly doses of Oral Ivermectin to kill the mites while taking the antibiotic/anti-parasitic drug Oral Metronidazole for 2 weeks, 250 mg 3 times a day.  Inexpensive generic, Oral Metronidazole is known to be highly effective against at least 2 of the types of bacteria like Bacterioides and Eggerthella Lenta that can cause SIBO.  The expensive Rifaximin is outstanding at clearing SIBO involving E Coli, Salmonella, Shigella bacteria.  Any given antibiotic is only effective against certain types of bacteria.   A SIBO test, that can identify the specific type of bacteria in the gut overgrowth, is critical to prescribe the right antibiotic(s) to clear the SIBO infection.  A lot of the antibiotics used to treat rosacea or acne skin bacteria, like doxycycline, do not work against the common types of bacteria found in SIBO.  The highly effective, inexpensive, 2 week oral treatment for demodex skin mites is in the following medical study paper from the May 2013 issue of The International Journal of Infectious Diseases:

https://www.sciencedirect.com/science/article/pii/S120197121201315X

The 2 drug oral treatment worked for me after decades of having misdiagnosed skin, eye and stomach issues.  I was misdiagnosed as having 3 separate conditions:   bacterial acne, allergic conjunctivitis, and "it must have been something you ate" stomach/gut issues.  SIBO was allowing demodex to flourish on my skin and around my eyes and causing stomach issues.

Accutane can also temporarily work to shut down the oil glands in the skin.   Shutting down the oil glands greatly reduces the oil available for the demodex skin mites to eat.   That may improve the skin's appearance for a time.   However, Accutane doesn't kill the mites directly or solve the underlying gut infection, so the results may not last long.   Accutane also has a lot of bad side effects.    Prior to taking Accutane, it would be wise to get a test for SIBO and for demodex skin mites.  If SIBO is the problem, treat the SIBO.  SIBO treatment is far shorter and likely safer than treatment with Accutane that doesn't really fix the problem.

Eating a healthy "clean" diet with very little sugar and taking probiotics can help maintain a healthy gut.   Many people have been successful in using food with healthy bacteria in it, like kefir yogurt, to maintain good gut health.

Edited by ElaineA
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