Rosacea - can this be Demotex induced?

[Reddevil]

Dear all,

I've been scanning and reading about all the threads from the last years
Just to give you my story: I've always had quite a good skin (except for the acne in my puberty years), just some oily nose and forehead but nothing too serious. More than 2 years ago, I noticed my upper temples getting slightly redder permanently, but I never really cared about it. I also got very dry skin, combined with the oily nose and forehead ('mixed' skin) Starting from last year, it got worse and worse and I started using a lot of OTC creams that didn't seam to work at all. I began to notice very small thread veins on my nose and cheeks, of course making the redness worse.

Last month I went to a dermatologist who diagnosed me with Rosacea (something I already diagnosed myself with after a lot of reading on Dr. Google) .
He prescribed me a 0,75% Metrodinazol creme and SVR Sensifene (some calming creme/lotion). I've been on it now for a month but I don't see any improvement - I even think it got worse. Besides from the very red cheeks and nose including some whiteheads, I do have some very small pimples on my forehead but nothing too serious. I now started using Cetaphil cleanser the last couple of days, hoping this will work a bit on the pimples.

I've included a picture below:
20180725_085049.jpg

Do you think it could be Demotex induced and that I should ask my derm for a Ivermectine cream? Or do the symptoms look different (not that much P&P's) that it could be something else? Will IPL/laser be the only solution you think (since I have the many spider veins).

Thanks for your suggestions!

[RedRecluse]

Do you think it could be Demotex induced...

Yes, almost certainly.

Rather get ZZ Cream. It's better than Ivermectin/Soolantra.

[ElaineA]

Studies have shown that topical metronidazole cream/gel (aka metrogel, etc) isn't very effective against demodex. Oral Metronidazole has proved effective in medical case studies reported on the web.

Oral Metronidazole (3 times a day for 2 weeks) + Oral Ivermectin (2 once a week doses based on body weight) worked for me. I had a severe case of misdiagnosed demodicosis/rosacea and ocular rosacea caused by demodex skin mites. The 2 week oral treatment was incredibly effective for me and finally knocked out the ocular rosacea. The oral treatment can kill the mites down in the oil and meibomian (oily tear) glands. I've been clear for 5.5 months now - first time in many years.

Tea Tree oil face wash and 5% tea tree oil night moisturizer/ointment can help reduce the demodex population. Demodex mites are active at night. Using the tea tree oil moisturizer/ointment helps to ruin their love life reducing their population.
Cliradex wipes containing a 10% tea tree oil extract are also helpful for both skin and eyes. A few cautions about using Tea Tree Oil products: 1. For topical use only - its toxic if ingested. 2. Don't use topical tea tree oil at full strength - it is safe at 50% dilution or less. 3. With Tea tree oil products, be careful not to get it in your eyes. Most commercial products use tea tree oil at 10% or less concentration which is strong enough.

Here's the posting with a list of commercially available tea tree oil products:

https://rosaceagroup.org/The_Rosacea_Forum/showthread.php?38671-List-of-Commercial-Tea-Tree-Oil-based-products&highlight=tree

I've never used the ZZ cream, but many people swear by it. ZZ contains both sulphur and Zinc Oxide which the mites don't like.

[Reddevil]

....

Thanks for your answer ElaineA! (and RedRecluse). What makes you think that it is indeed Demodex infestation? Were your symptoms comparable? I'm doubting since I don't have the P&P's that seem to be typical with other people...

[RedRecluse]

Thanks for your answer ElaineA! (and RedRecluse). What makes you think that it is indeed Demodex infestation? Were your symptoms comparable? I'm doubting since I don't have the P&P's that seem to be typical with other people...

I see a pustule on your right cheek? Your nose also looks like how mine did. Very similar symptoms.

[atlas222]

Hi Reddevil, your skin looks a lot like mine. Where in Belgium are you based?

[atlas222]

Hi ElaineA,

Besides the combination treatment of oral metronidazole and ivermectin, did you change anything about your skin care routine? Do you have oily skin? If so, has that changed since you had the treatment? I am curious because my skin totally cleared when on the same treatment as you then had a relapse.

[RedRecluse]

Hi ElaineA,

Besides the combination treatment of oral metronidazole and ivermectin, did you change anything about your skin care routine? Do you have oily skin? If so, has that changed since you had the treatment? I am curious because my skin totally cleared when on the same treatment as you then had a relapse.

Ivermectin eventually stops working in some people. I'm not sure how widespread it is and if it happens to all or some. I'd imagine that's the cause of your relapse.

Not sure about the effectiveness of oral Metro. Hopefully better than topical which is ineffective.

[atlas222]

Hi RedRecluse, after I finished the treatment, I started using the zz cream on a daily maintenance basis. After a few weeks, I noticed that the pustules were coming back. They were fewer than before so it did not bother me that much. Then one day, I decided to remove some facial hairs using twizels because they looked oddly thick and swollen. On some of those hairs that I extracted, the root was covered in a long thick semi transparant body that was clearly visible to the naked eye. As I don't own a microscope, I could not tell for sure what it was, but as my skin bleeded and hurt, my assumption was that there were multiple demodex mites clogging my pores. In the days that followed, I had very irritated skin, more pustules as well as red patches and itchy skin. It could be that my hairs blocked my pores so that the demodex had protection and could stay lodged in my skin without the cream penetrating deeper, but that is again only an assumption. The thing I had been doing wrong all along is that I would wash my face daily with warm water, sometimes with a little bit of soap in the shower, assuming that whatever zz cream residue left would be washed away, yet it was likely providing further nurishment to the mites. I am back to where I was two years ago, except for having a better daily cleanse routine thanks to the advice of a valuable forum member, hence my question to ElaineA about the oily skin.

[RedRecluse]

Hi RedRecluse, after I finished the treatment, I started using the zz cream on a daily maintenance basis. After a few weeks, I noticed that the pustules were coming back. They were fewer than before so it did not bother me that much. Then one day, I decided to remove some facial hairs using twizels because they looked oddly thick and swollen. On some of those hairs that I extracted, the root was covered in a long thick semi transparant body that was clearly visible to the naked eye. As I don't own a microscope, I could not tell for sure what it was, but as my skin bleeded and hurt, my assumption was that there were multiple demodex mites clogging my pores. In the days that followed, I had very irritated skin, more pustules as well as red patches and itchy skin. It could be that my hairs blocked my pores so that the demodex had protection and could stay lodged in my skin without the cream penetrating deeper, but that is again only an assumption. The thing I had been doing wrong all along is that I would wash my face daily with warm water, sometimes with a little bit of soap in the shower, assuming that whatever zz cream residue left would be washed away, yet it was likely providing further nurishment to the mites. I am back to where I was two years ago, except for having a better daily cleanse routine thanks to the advice of a valuable forum member, hence my question to ElaineA about the oily skin.

It sounds like your facial hairs may have been pili multigemini hairs?

Many hairs throughout the body have those little sacks at the roots?

How long did you try ZZ Cream for? And how did you use it, apply it, when, etc.? It should be used without any other products, soaps, cleansers. Nothing. For at least 2 months.

Are you sure your symptoms were not prolonged die-off symptoms?

It's strange that ZZ Cream was ineffective for you. Did you ever apply Soolantra ('Ivermectin cream') to your face?

Perhaps you're right that there's something different with your face's skin's barrier, which is why oral Ivermectin worked for you.

[atlas222]

Hi RedRecluse,

What I had at the root of the hairs did not look like pili multigemini at all, in fact I was able to remove the thick layer with my fingertips. I am quite convinced they were demodex (and since they were visible to the naked eye, LOTS of them).

I have used the ZZ cream since July of last year. Prior to that, I was on Soolantra for about two months but I quit because my skin was irritated and kept having new pustules every day. I applied the ZZ mixed with a little water once a day before bed and sometimes on pustules during the day to make them dry quicker. I personally think that I should have cleansed properly every evening/morning while using the zz because the zinc oxide would stay on the skin and possibly got trapped in my facial hairs, thus creating further mess. Then again, none of this solves the problem of oily skin and its vicious cycle.

[ElaineA]

Hi ElaineA,

Besides the combination treatment of oral metronidazole and ivermectin, did you change anything about your skin care routine? Do you have oily skin? If so, has that changed since you had the treatment? I am curious because my skin totally cleared when on the same treatment as you then had a relapse.

I do have oily/combination skin - always have had since age 12 when this all started shortly after the severe viral infection(s) that lead to the severe demodex issues. The demodex treatment study paper published in the 2013 issue of the Journal of Infection Disease did say that 2 people initially cleared up after the oral treatment but did relapse a short while later. The 2 relapse patients were given a second round of treatment and did go into remission after that.

I had switched from Biore Charcoal cleanser to Neutrogena Hydro Boost cleansing gel. I like the Neutrogena cleanser better but I don't think that made a huge difference to the mites. Its just a good cleanser that doesn't over dry my skin.

I had severe ocular rosacea caused by demodex and very long term skin issues as well. I call it all demodicosis which is the generic term for a demodex infestation. My latest (5th) dermatologist calls it rosacea Type 2 and ocular rosacea.

When I figured out that my severe eye issues were caused by demodex, I first tried tea tree oil masks ( 50% tea tree oil mixed with either 50% castor oil or 50% grapeseed oil to dilute the tea tree oil - later I added a drop of clove oil and a few drops of peppermint oil). I was doing the tea tree oil masks for 30 minutes twice a day or as tolerated since this mask is very drying in spite of the oil. The oil masks did help reduce the surface infestation on my skin but did not clear it up. I also added Cliradex wipes on my lids and face twice a day for about 4.5 months to try and kill off the demodex in my eyelid glands and pores. While my skin and eyes were better, I could not stop using the Cliradex Wipes for more than a few days without the ocular rosacea flaring backup. I finally asked my family practice doctor for the Oral Ivermectin and Oral Metronidazole prescriptions which knocked the demodex out for me. It was the only way to kill the demodex down in the glands. I was still having some die offs up to 2 weeks after completing the oral treatment. I have been clear for 5.5 months now.

Still using the Neutrogena Hydro Boost Cleansing Gel and sometimes the Hydro Boost Gentle cleansing lotion if my skin is a little dry. I've been following that with Epionce Lytic Tx twice a day, followed by the Epionce Renewal Lite Moisture Lotion to clear my severely congested pores. My AquaFacial tech recommended the Epionce products and said it would help normalize the oiliness. Mid day (or after work), I wash with Neutrogena Hydro Boost product, use the Neutrogena Multi-Vitamin serum followed by the Hyro Boost Water Gel moisturizer and Hydro Boost eye cream. The Hydro Boost moisturizers are light and have hyaluranic acid which helps your skin retain moisture.

Now, I always use a clean towel every day for drying my face after washing. The mites can live on a wet towel for up to 54 hours. Some people change their pillow cases daily too. The jury is still out as to how long the mites can live on a dry pillow case.

[Reddevil]

And what about the broken capillaries? I guess they won't disapear (or become less) without any laser treatment, right?

[RedRecluse]

Hi RedRecluse,

What I had at the root of the hairs did not look like pili multigemini at all, in fact I was able to remove the thick layer with my fingertips. I am quite convinced they were demodex (and since they were visible to the naked eye, LOTS of them).

I have used the ZZ cream since July of last year. Prior to that, I was on Soolantra for about two months but I quit because my skin was irritated and kept having new pustules every day. I applied the ZZ mixed with a little water once a day before bed and sometimes on pustules during the day to make them dry quicker. I personally think that I should have cleansed properly every evening/morning while using the zz because the zinc oxide would stay on the skin and possibly got trapped in my facial hairs, thus creating further mess. Then again, none of this solves the problem of oily skin and its vicious cycle.

Pili multigemini would be various hairs in one pore. They usually have the appearance of a single thick hair, which is actually made up of several hairs joined into what appears to be one. Pili multigemini isn't to do with how the roots appear, at least in my question.

Was it something similar to this? Outer root sheath? http://www.regrowhair.com/wp-content.../fue_illus.jpg

Did you ever try mechanical or chemical exfoliators? I used to use lactic acid on my face which would turn me bright red for 3 days. I would peel on the 3rd/4th day and my skin would be great afterwards.

I'm wondering if something like that would help to remove this oily layer of your skin and help to penetrate into the deeper layers, roots, etc.

[atlas222]

Hi ElaineA,

I used off label ivermectin / metro and really don't feel like trying it again. Good job on convincing a physician to prescribe the drugs
What is the reasoning behind you current skin routine? Are the products oil free, and are you not worried to feed the mites again?

Hi RedRecluse,

No, mine did not look like pili multigemini at all. I will have to take a close up photo the next time I extract one of these nasty things.

I am not sure I need to remove the oily layer of my skin with more chemical exfoliators. My skin barried might be damaged and my oil glands produce way too much oil (likely due to demodex brevis?). Has anyone been able to clear their skin with low dose roaccutane without aggravating their rosacea symptoms?