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carlitascott

New developments in treatment

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I've not been on here in a long time....had Accutane in 2014 for the 3rd time in 15 years, and have since then haven't really done too much to look after my skin. It was the biggest dose for my weight and the worse round for side effects and remission.....remission really only lasted 6 months and steadily got worse until today. 

Having decided I'm done having babies now at 38 I've gone back on the pill despite my reservations.....I'm pretty convinced now my acne is hormonal/stress induced but to be honest I'm not sure being on the pill (dianette) made an awful lot of difference before but I'm trying it. 

Accutane is no go again for me now.....it's not worth the side effects for very little gain, and with a busy job and children I don't have time to manage the horrible side effects. I also can't take tetracylines after having a a really bad reaction to Mino in 2013. 

I have a good skincare regime, but I'm a busy Mum and really can't do anything else positive lifestyle wise but I'm 38, I have to go present in board meetings, doing so with a face full of painful spots is impossible. I also have super crazy sensitive skin so a lot of topicals are pretty scary for me. If anyone has simialr skin and has tried anything which didn't give you horrendous rashes please let me know!

So, I was wondering if there were any new successful developments in treatments that have come around in the last 7-8 years that I could speak to a GP or Dermatologist about  or even new research in terms of lifestyle changes. Ideally serious science backed treatment....I'm old and tired I can't be making apple cider and lemon juice concoctions! 

Thank you x

 

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On 7/15/2021 at 1:05 AM, carlitascott said:

I've not been on here in a long time....had Accutane in 2014 for the 3rd time in 15 years, and have since then haven't really done too much to look after my skin. It was the biggest dose for my weight and the worse round for side effects and remission.....remission really only lasted 6 months and steadily got worse until today. 

Having decided I'm done having babies now at 38 I've gone back on the pill despite my reservations.....I'm pretty convinced now my acne is hormonal/stress induced but to be honest I'm not sure being on the pill (dianette) made an awful lot of difference before but I'm trying it. 

Accutane is no go again for me now.....it's not worth the side effects for very little gain, and with a busy job and children I don't have time to manage the horrible side effects. I also can't take tetracylines after having a a really bad reaction to Mino in 2013. 

I have a good skincare regime, but I'm a busy Mum and really can't do anything else positive lifestyle wise but I'm 38, I have to go present in board meetings, doing so with a face full of painful spots is impossible. I also have super crazy sensitive skin so a lot of topicals are pretty scary for me. If anyone has simialr skin and has tried anything which didn't give you horrendous rashes please let me know!

So, I was wondering if there were any new successful developments in treatments that have come around in the last 7-8 years that I could speak to a GP or Dermatologist about  or even new research in terms of lifestyle changes. Ideally serious science backed treatment....I'm old and tired I can't be making apple cider and lemon juice concoctions! 

Thank you x

 

Rosacea Subtype 2 with papules and pustules is frequently misdiagnosed as ordinary bacterial acne.    It is not acne or caused by surface skin bacteria.    Recent medical research has shown that Rosacea subtype 2 & subtype 3 is frequently caused by Small Intestinal Bacterial Overgrowth (SIBO).  SIBO bacteria effect the immune system allowing the 2 species of human demodex skin mites to get very overpopulated on the surface of the skin.  A healthy immune system normally keeps the demodex mite population under control.  But SIBO suppresses something in the immune system allowing the mites to get overpopulated.  SIBO can be quite effectively treated.   Some antibiotic drugs like doxycycline or minocycline may seem to help at first but don't help in the long run.

Demodex skin mites eat oil and possibly skin cells.  The mites live and die on a 2 to 3 week cycle.  When a die off occurs, pustules of dead mites pop up suddenly.  This cyclical behavior is sometimes confused with hormonal acne.   The mites can cause the following symptoms:  large blackheads, pustules, papules, folliculitis, blepharitis (ocular rosacea), body acne, scalp acne, etc.

Accutane will temporarily reduce the population of demodex by greatly reducing the oil they eat, starving the population down.  Once the Accutane is stopped, the mite population frequently rebounds.  The Accutane just treats the symptoms.  It doesn't kill the demodex.  A rebound after Accutane happened to the patient in this medical study - treatment with Oral Ivermectin cleared up his skin:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5489393/

Oral Ivermectin and topical Ivermectin are effective against to surface demodex.   But you also have SIBO, the demodex can come back.   So treating SIBO effectively is a key to the cure.  The 12 year old in the following medical study was successfully treated with just Oral Ivermectin to kill the demodex.

https://jamanetwork.com/journals/jamadermatology/fullarticle/1784334

Recently SIBO has been strongly connected to Rosacea Subtype 2.   SIBO can be caused by a dozen or more different types of bacteria.   Selecting the right antibiotic for treatment is key.   The gold standard test for identifying the specific bacteria causing the SIBO is the endoscope test.  They run a small flexible tube down the throat into the stomach and small intestine.  They collect a sample of the fluid from the small intestine and culture it to identify what bacteria is present.    Once they know the exact type(s) of bacteria that are overgrown, they can then select the antibiotic that will be most effective against the bacteria causing the problem.  In some cases the patient may have SIFO caused by a fungal overgrowth instead of bacteria.  The endoscope test can identify any fungus present.  SIFO will require treatment with an oral anti-fungal drug effective against the type of fungus identified.    There is also a simpler 3 hour breath test that measures the type of gas emitted after the patient drinks glucose.   The gas test is less specific but can  at least identify general categories of bacteria based on whether they emit hydrogen, methane or hydrogen sulfide gas.

Here's 2 papers that successfully treated patients with Rosacea Subtype 2.    The first paper is the treatment that worked for me.  I had SIBO for decades but it was never connected to all the skin and eye issues that I also had.  I was misdiagnosed separately as having bacterial acne, allergic conjunctivitis, and "it must be a bug or something you ate" stomach issues.

The first paper was comparing the effects of clearing demodex skin mite cause issues with just Oral Ivermectin OR with Oral Ivermectin + Oral Metronidazole.   The 2013 Medical Study published in the May 2013 issue of The International Journal of Infectious Diseases.  At that time they were uncertain as to why the Oral Metronidazole improved the treatment with Oral Ivermectin over just using Oral Ivermectin.   Oral Metronidazole is highly effective against at least 2 of the bacteria that can cause SIBO.  The 2 drug treatment worked for me, clearing up the skin, eye and stomach/intestinal issues that I had literally had for decades.  Cured me in 2 weeks with 2 cheap generic drugs.  Insurance drug copay was just $13.03.

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

Here's a more recent medical study on Rosacea, SIBO and treatment with the extremely expensive antibiotic Rifaximin.  Cured 46% of the patients with Rosacea and all 4 of the study patients with ocular rosacea.   My only objection to this study is that they didn't determine the exact bacteria causing each person's SIBO.  They might have cured all of the patients by using the antibiotic best for the type of bacteria causing each patient's SIBO.  Rifaximin is superb for treating some types of E Coli but not effective at treating other types of bacteria that other antibiotics like Oral Metronidazole treat well.

https://www.jaad.org/article/S0190-9622(12)02330-4/fulltext#:~:text=Of the patients with SIBO%2C 28 were treated with rifaximin,and SIBO reported marked improvement.

Your doctor should be able to test your hormone levels to rule the hormonal acne out.   If you have gastro-intestinal issues, you should get tested for SIBO.   A good dermatologist can test for demodex.

If its SIBO, the treatment with the right antibiotic takes 1-3 weeks.   Oral Ivermectin is typically given in 2 once a week doses.  The first dose kills the living demodex.  The second dose kills any demodex eggs that hatched after the first Ivermectin dose to make sure the mites can't repopulate.    Topical Ivermectin using Soolantra cream takes 16 weeks and is more for milder cases.

In any case, a healthy well balanced diet low in sugar is best.  Probiotics can help get your digestive track straightened out and help maintain the healthy bacteria that needs to be in the intestinal track for a healthy immune system.

For non-irritating, effective, surface skin treatment, you may want to try Hypochlorous Acid (HOCL) Face Spray.   HOCL is a very weak acid identical to that produced by the human body in response to infection.   HOCL is non-irritating and has no safety hazards.  HOCL is highly effective against the 23 strains of bad bacteria that it was tested against.  HOCL doesn't kill the "good" bacteria that needs to be on your skin to keep it healthy.   HOCL also kills fungus, viruses and the juvenile (nymph) form of demodex skin mites.   HOCL is used to sanitize hospital ICUs and operating rooms as well as medical and dental offices.  The medical industry has used HOCL successfully for over 100 years.  Tattoo artists and piercers recommend HOCL to their clients to help them heal up clean.  It works.  I've used multiple brands including Heydrate, Occusoft's Hypochlorm and BrioTech.   Currently using BrioTech because its the most affordable at $11.95 for a 4 ounce bottle.  The others are all good too, just more expensive.

https://www.amazon.com/BRIOTECH-Topical-Skin-Spray-Cosmetic/dp/B00YZDHMWW/

Instructions for HOCL:   Apply HOCL spray to clean skin.  Massage in lightly with clean fingers.  Let dry.  Do not rinse.

Hope this helps.

 

 

 

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On 7/14/2021 at 9:05 PM, carlitascott said:

I've not been on here in a long time....had Accutane in 2014 for the 3rd time in 15 years, and have since then haven't really done too much to look after my skin. It was the biggest dose for my weight and the worse round for side effects and remission.....remission really only lasted 6 months and steadily got worse until today. 

Having decided I'm done having babies now at 38 I've gone back on the pill despite my reservations.....I'm pretty convinced now my acne is hormonal/stress induced but to be honest I'm not sure being on the pill (dianette) made an awful lot of difference before but I'm trying it. 

Accutane is no go again for me now.....it's not worth the side effects for very little gain, and with a busy job and children I don't have time to manage the horrible side effects. I also can't take tetracylines after having a a really bad reaction to Mino in 2013. 

I have a good skincare regime, but I'm a busy Mum and really can't do anything else positive lifestyle wise but I'm 38, I have to go present in board meetings, doing so with a face full of painful spots is impossible. I also have super crazy sensitive skin so a lot of topicals are pretty scary for me. If anyone has simialr skin and has tried anything which didn't give you horrendous rashes please let me know!

So, I was wondering if there were any new successful developments in treatments that have come around in the last 7-8 years that I could speak to a GP or Dermatologist about  or even new research in terms of lifestyle changes. Ideally serious science backed treatment....I'm old and tired I can't be making apple cider and lemon juice concoctions! 

Thank you x

 

I 100% understand you. Being male in my early 30s, with low dose Accutane intermitently since 18. Low dose was very very good for me (10 mg a day) since the age of 27, where I increased the dose and experienced skin wrinkles, holes, fissures as a side-effect. Now I cannot take it any more, not even 10mg every third day because of this, also at dose less than 10mg it is not effective, and not worth the facial skin destroying side-effects.

Minocyclin is an excellent option for me. It kept my skin perfect for 18 months (intermittent usage). But its effectiveness definitely decreased. I guess it is bacterial resistance. I had to increase to like 3x50mg day (from the 2x50mg prescribed), which causes minor nausea and big increase of flat moles on my face and body (which I had only a few before). I'm 90% sure that the flat moles (macules) are caused by Minocycline, although my dermatologist said she doubts.

For more sever cases of acne topicals are a plain fraud in my experience :D, they just destroy skin and don't help at all... 

What I found as a very good off-label treatment option for a case like yours is Amoxicillin+Clavunate 1000mg antibiotic pill. It is very effective in my case, with low potential for side-effects (mainly nausea). The problem is, it is taken up to 2 weeks at most. And acne returns like 2 weeks after taking it at most. And phisicians don't want to prescribe it for acne. My general practicioner would rather kill me, and even lies to me that I don't have acne or scars (even though they are prominent) just not to give it to me.

I would suggest you try it for a course of 7 days, along with 10mg accutane twice (or once) weekly (to help with the potential resistance). And then continue accutane at this dosage along with this antibiotic taken like 7-day-course every month, with the intention to reduce it to 7-day-course every 2 months.

If you are in the USA there has been one major "advancement" there in my opinion. It is the Sarecycline antibiotic. But because of your negative experience with Mino, and these are the same class of antibiotic, so it basically bears the same risk as Mino for you. Not sure what your bad experience was if you can share more data? If it was related to the gastro tract Sarecycline should in theory not kill other bacteria in body, like stomach ones, and is much better regarding bacterial resistance. I would talk to your doctor about trying it if the side-effects were not like head pressure and pain (pseudotumor cerebri). Ofc, as I said this is only relevant if you in USA, cause only there it is available.

 

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There are some other research, like topical anti-androgens. This might be a good candidate for you cause you said it is hormonal. Not sure if this has already been FDA approved.

What I'm hoping for is some new breakthrough in the field of human immunity response. I think my case, and the majority of cases (especially severe) is related to the malfunctioning (over-reacting) body's immunity response. There are some experimental therapies that work by targeting that, but I'm not sure anyone would give you that. For example this: https://pubmed.ncbi.nlm.nih.gov/34258349/ and https://pubmed.ncbi.nlm.nih.gov/34085329/. These therapies are mostly tried on these syndromes that include acne. (note that acne inversa is a different medical condition than acne)

 

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Also check https://pubmed.ncbi.nlm.nih.gov/34250269/ and https://pubmed.ncbi.nlm.nih.gov/34242398/ and https://pubmed.ncbi.nlm.nih.gov/30588271/

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In general you can check recent studies here: https://pubmed.ncbi.nlm.nih.gov/?term=acne&filter=years.2021-2021&sort=date

Edited by rapharapha
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