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SIBO/Gut: Why Oral Metronidazole works for some types of Rosacea with Demodex Mites

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  • SIBO/Gut: Why Oral Metronidazole works for some types of Rosacea with Demodex Mites

    Oral Metronidazole is an antibiotic / anti-parasitic drug available since 1960. It has a good safety record and is on the WHO's list of 100 essential medications.

    Oral Metronidazole is highly effective against at least 2 different types of bacteria found to be on the list of bacteria that causes SIBO.

    Bacteroides (a Hydrogen Sulfide gas producing bacteria)
    Eggerthella Lenta (thought to produce little or no gas)

    One or both of these bacteria may allow demodex to get overpopulated. It isn't known if the overpopulation occurs due to something the bacteria produce or something that the overgrowth of gut bacteria suppresses.

    The bacterial connection to demodex skin disease is supported by numerous accounts in medical studies and personal experiences with taking either Oral Metronidazole or the combined treatment of Oral Ivermectin + Oral Metronidazole. None of the studies knew why the Oral Metronidazole works, just that it does work. Researchers discovered that dropping live demodex into 100% pure liquid Metronidazole did not kill the demodex. Some researchers speculated that Oral Metronidazole works due to breaking into 5 metabolytes in the body and must be causing the environment to be lethal to the demodex. My theory is that the Oral Metronidazole kills the bacterial overgrowth in the small intestine which is allowing the demodex to flourish on the skin.

    Some serious research needs to be done on the connection between these 2 bacteria, SIBO and demodex overpopulation on the skin. If this theory pans out, topical treatment can only control or limit the demodex population on the surface of the skin. To rid a person of the demodex infestation, will likely require a targeted antibiotic that is known to be highly effective against the specific bacterial overgrowth. The antibiotic treatment should be followed by healthy eating habits and probiotics to maintain gut health.

  • #2
    I am going to offer a different perspective as to why Ivermectin reduces symptoms in some people.

    In general, I don't believe Demodex play a significant role. I could be wrong, however for me, the evidence is simply not there.

    When someone takes a supplement, or a drug with the idea it is going to resolve X problem due to X reason, and if the person experiences benefits, they usually attribute the resolution to the preconceived idea.
    However, supplements and drugs usually have multiple effects. Ivermectin is one of them.

    Analysis of Rosacea skin shows excessive production of both LL-37 and KLK5, the serine protease responsible for it's cleavage.
    LL-37 is upregulated in response to infection and/or inflammation, including inflammation induced by injury. (Such as IPL or laser treatments. Being hit in the face with a ball. Sunburn. Cosmetic treatments, lotions, potions, chemical peels etc).

    Dysbiosis of the gut microbiome can also induce systemic inflammation, and/or limit it's ability to control and/or resolve inflammation.
    Dysbiosis+genetic predisposition can result in a dysregulation of innate skin immunity.
    As seen not only in rosacea, but also in atopic dermatitis and psoriasis.
    All three have abnormalities of AMP processing.

    Ivermectin inhibits gene expression of LL-37 and KLK5, the major dysregulated immune players in rosacea.
    This results in a reduction or resolution of symptoms. Less likely to be a resolution if significant vasculature changes have taken place, including excessive angiogenesis. Once bad plumbing is in place, flushing, in particular continues irrespective if the original cause has been removed.

    People develop rosacea due to various reasons/causes.
    Such as after a round of antibiotics which disrupt the gut based immune system (at least). Many of these people experience digestive symptoms prior to the onset of rosacea. Antibiotics may produce long lasting changes elsewhere too.

    Some people undergo laser or IPL treatments due to minor redness, a few telangiectasia in the absence of any other symptoms, or simply for cosmetic reasons and go on to develop facial inflammation with or without flushing.
    Let's not forget the vast amount of brimonidine victims, some of whom didn't even have rosacea until they used it.
    Just ONE dose induced severe ongoing flushing hell for many victims.

    Numerous drugs can cause flushing/rosacea, including antidepressant medication, anaesthetics, blood pressure medications, hormones, thyroid medication.
    The list is long. The effects can be rapid, far too quick for a demodex uprising to have taken place.

    It is due to all these reasons and more that I am very doubtful that demodex is a major player, although I have no doubt it can be an opportunist.

    With that said, I am always happy to see people offer hypotheses for this beast of a disease. Without innovative thinkers, we would never gain new insights.

    Just a note. Metronizadole is not a harmless drug. It is a potent neurotoxin. Numerous people have suffered damage from this drug. I never fully recovered from my own personal experience with it. (Nor from the brimonidine adventure).
    I also suffered side effects from oral ivermectin.
    It is always a gamble taking any medication, but these two, are certainly not without side effects. And brimonidine should never be used, by anyone. (Off topic, I realise).

    If I had steered clear of these drugs, I would be in vastly better shape than I am in today.
    Previous Numerous IPL.
    Supplements: High dose Niacinamide, Vit K2, low dose Vit A. Moderate Dose Vit C, Iodine, Taurine, Magnesium. Mod- dose B's. Low dose zinc. Testing Quercetin.

    Skin Care: No Cleanser, ZZ cream mixed with Niacinamide gel 4% and LMW HA 2%, ethyl ascorbate 2%.

    Treating for gut dysbiosis.(This is helping).
    Previous GAPS diet. Have now introduced lots of fibre.
    Fermented Foods. Intermittent fasting -16-18 hours.
    Oral Colostrum. Helps reduce food reactions.

    Comment


    • #3
      Originally posted by Mistica View Post
      I am going to offer a different perspective as to why Ivermectin reduces symptoms in some people.

      In general, I don't believe Demodex play a significant role. I could be wrong, however for me, the evidence is simply not there.

      When someone takes a supplement, or a drug with the idea it is going to resolve X problem due to X reason, and if the person experiences benefits, they usually attribute the resolution to the preconceived idea.
      However, supplements and drugs usually have multiple effects. Ivermectin is one of them.

      Analysis of Rosacea skin shows excessive production of both LL-37 and KLK5, the serine protease responsible for it's cleavage.
      LL-37 is upregulated in response to infection and/or inflammation, including inflammation induced by injury. (Such as IPL or laser treatments. Being hit in the face with a ball. Sunburn. Cosmetic treatments, lotions, potions, chemical peels etc).

      Dysbiosis of the gut microbiome can also induce systemic inflammation, and/or limit it's ability to control and/or resolve inflammation.
      Dysbiosis+genetic predisposition can result in a dysregulation of innate skin immunity.
      As seen not only in rosacea, but also in atopic dermatitis and psoriasis.
      All three have abnormalities of AMP processing.

      Ivermectin inhibits gene expression of LL-37 and KLK5, the major dysregulated immune players in rosacea.
      This results in a reduction or resolution of symptoms. Less likely to be a resolution if significant vasculature changes have taken place, including excessive angiogenesis. Once bad plumbing is in place, flushing, in particular continues irrespective if the original cause has been removed.

      People develop rosacea due to various reasons/causes.
      Such as after a round of antibiotics which disrupt the gut based immune system (at least). Many of these people experience digestive symptoms prior to the onset of rosacea. Antibiotics may produce long lasting changes elsewhere too.

      Some people undergo laser or IPL treatments due to minor redness, a few telangiectasia in the absence of any other symptoms, or simply for cosmetic reasons and go on to develop facial inflammation with or without flushing.
      Let's not forget the vast amount of brimonidine victims, some of whom didn't even have rosacea until they used it.
      Just ONE dose induced severe ongoing flushing hell for many victims.

      Numerous drugs can cause flushing/rosacea, including antidepressant medication, anaesthetics, blood pressure medications, hormones, thyroid medication.
      The list is long. The effects can be rapid, far too quick for a demodex uprising to have taken place.

      It is due to all these reasons and more that I am very doubtful that demodex is a major player, although I have no doubt it can be an opportunist.

      With that said, I am always happy to see people offer hypotheses for this beast of a disease. Without innovative thinkers, we would never gain new insights.

      Just a note. Metronizadole is not a harmless drug. It is a potent neurotoxin. Numerous people have suffered damage from this drug. I never fully recovered from my own personal experience with it. (Nor from the brimonidine adventure).
      I also suffered side effects from oral ivermectin.
      It is always a gamble taking any medication, but these two, are certainly not without side effects. And brimonidine should never be used, by anyone. (Off topic, I realise).

      If I had steered clear of these drugs, I would be in vastly better shape than I am in today.
      Sorry to hear that you may have had a bad reaction to either Oral Ivermectin or Oral Metronidazole. These drugs only work for demodex overpopulation and not other types of rosacea or skin issues. The 2 drugs have low incidence of side effects. Both drugs are on the WHO's List of 100 Essential Medicines due to their positive benefits and 40-60 year track records of highly positive results. That being said, individuals can have bad reactions to any drug, even drugs with good safety records. The 2 drug combined Oral treatment worked for me with zero side effects.

      In your case demodex may not be a major factor. But in my case demodex were definitely a major issue. I had severe Demodex Folliculitis and severe Ocular Rosacea. Topicals helped but couldn't make a dent in resolving the problem. The 2 drug oral treatment worked and worked quickly after decades of being misdiagnosed with acne and allergic conjunctivitis. The misdiagnoses were made by 4 board certified dermatologists who never ran even one test and one board certified opthalmologist who did at least test for a bacterial eye infection. People can be tested for demodex skin mite overpopulation prior to taking a drug. There is no point in taking a drug unless you actually have a problem that drug can treat. Proper testing leading to a correct diagnosis can avoid the problems of taking the wrong drug to treat skin issues. Unfortunately, many doctors just guess and play "Russian Roulette" with drugs and prescribe without running any tests whatsoever to make sure that they are using the right treatment for the actual problem.

      Comment


      • #4
        Sorry to hear that you may have had a bad reaction to either Oral Ivermectin or Oral Metronidazole. These drugs only work for demodex overpopulation and not other types of rosacea or skin issues. The 2 drugs have low incidence of side effects. Both drugs are on the WHO's List of 100 Essential Medicines due to their positive benefits and 40-60 year track records of highly positive results. That being said, individuals can have bad reactions to any drug, even drugs with good safety records. The 2 drug combined Oral treatment worked for me with zero side effects.
        I definitely had a severe adverse reaction to them, confirmed by a neurologist and immunologist. It took me months to get the 'feeling' back in parts of my body and around 3 years to get full feeling back in the tips of my fingers. The upper right cheek took many years to improve, but this was initially damaged due to the brimonidine hell.

        Metronizadole is the standard antibiotic to help clear SIBO (methane dominant) which can result in a clearance of type two rosacea, the P&P type. It is routinely used in a number of digestive complaints.
        The big question you have to ask from a science perspective, is, was the clearance of facial lesions due to diminished communities of demodex, reduced levels of skin microbiota in general, or modified gut flora?
        It could be due to one or all of the above.

        I have had rounds of rifaximin too and that clears outbreaks.
        I have had it alone and also in conjunction with oral vancomycin, prescribed by a gastroenterologist whose interest and research is in FMT's. I declined to have one.
        The result of my many years of antibiotics, including 13 of macrolides for 'rosacea', was a completely dysfunctional gut flora. When I eventually said that is enough (far too late), I developed autoimmunity.

        Treating my gut with diet, fermented foods, supplements and fasting has done more for me than any medical treatment.

        I am not saying rosacea with significant involvement of demodex doesn't exist. It certainly does, but what I am seeing is, as each new idea becomes more popular, a drug follows and because it produces some benefits in a number of people, the cause is stated to be X problem, even when it is just correlation at best.

        I think there is A LOT more to be discovered and learned about this beast of a disease/condition.
        The science surrounding immune function is still very much in it's infancy.

        I do use topicals including ZZ cream, which I couldn't live without, however, if I don't manage my diet, I still get outbreaks of P&P/s, although they are very limited these days.
        Many years ago, when my flushing/inflammation was extreme, a pharmacist compounded a topical ivermectin for me. It didn't help at all. However, my face was also engorged and swollen and I don't believe any topical would have helped back then.

        There are some studies on pubmed which show the over all skin microbiota to be altered in rosacea. There are also differences between type one and two.

        In addition, there are other studies which show the lipids (I think?) to be different in the facial skin of Rosacea and Acne patients. Gut microbes can influence both of the above.
        Thus I do feel there is an infectious/microbial component to both conditions.

        I am very happy to hear you managed to get on top of your own set of symptoms and remain clear?? Your history sounds horrible and to walk away from that must be a huge relief.
        Previous Numerous IPL.
        Supplements: High dose Niacinamide, Vit K2, low dose Vit A. Moderate Dose Vit C, Iodine, Taurine, Magnesium. Mod- dose B's. Low dose zinc. Testing Quercetin.

        Skin Care: No Cleanser, ZZ cream mixed with Niacinamide gel 4% and LMW HA 2%, ethyl ascorbate 2%.

        Treating for gut dysbiosis.(This is helping).
        Previous GAPS diet. Have now introduced lots of fibre.
        Fermented Foods. Intermittent fasting -16-18 hours.
        Oral Colostrum. Helps reduce food reactions.

        Comment


        • #5
          Originally posted by Mistica View Post
          I definitely had a severe adverse reaction to them, confirmed by a neurologist and immunologist. It took me months to get the 'feeling' back in parts of my body and around 3 years to get full feeling back in the tips of my fingers. The upper right cheek took many years to improve, but this was initially damaged due to the brimonidine hell.

          Metronizadole is the standard antibiotic to help clear SIBO (methane dominant) which can result in a clearance of type two rosacea, the P&P type. It is routinely used in a number of digestive complaints.
          The big question you have to ask from a science perspective, is, was the clearance of facial lesions due to diminished communities of demodex, reduced levels of skin microbiota in general, or modified gut flora?
          It could be due to one or all of the above.

          I have had rounds of rifaximin too and that clears outbreaks.
          I have had it alone and also in conjunction with oral vancomycin, prescribed by a gastroenterologist whose interest and research is in FMT's. I declined to have one.
          The result of my many years of antibiotics, including 13 of macrolides for 'rosacea', was a completely dysfunctional gut flora. When I eventually said that is enough (far too late), I developed autoimmunity.

          Treating my gut with diet, fermented foods, supplements and fasting has done more for me than any medical treatment.

          I am not saying rosacea with significant involvement of demodex doesn't exist. It certainly does, but what I am seeing is, as each new idea becomes more popular, a drug follows and because it produces some benefits in a number of people, the cause is stated to be X problem, even when it is just correlation at best.

          I think there is A LOT more to be discovered and learned about this beast of a disease/condition.
          The science surrounding immune function is still very much in it's infancy.

          I do use topicals including ZZ cream, which I couldn't live without, however, if I don't manage my diet, I still get outbreaks of P&P/s, although they are very limited these days.
          Many years ago, when my flushing/inflammation was extreme, a pharmacist compounded a topical ivermectin for me. It didn't help at all. However, my face was also engorged and swollen and I don't believe any topical would have helped back then.

          There are some studies on pubmed which show the over all skin microbiota to be altered in rosacea. There are also differences between type one and two.

          In addition, there are other studies which show the lipids (I think?) to be different in the facial skin of Rosacea and Acne patients. Gut microbes can influence both of the above.
          Thus I do feel there is an infectious/microbial component to both conditions.

          I am very happy to hear you managed to get on top of your own set of symptoms and remain clear?? Your history sounds horrible and to walk away from that must be a huge relief.
          Still clear over 3 years later. I don't take antibiotics unless I have to due to a bad experience with Minocin years ago. Minocin can cause autoimmune problems and central nervous system problems. I agree that they need to do more research and more testing on their patients to get a specific bacteria or condition identified before they treat a patient. Any given antibiotic does not work on every strain of bacteria. Only an antibiotic that is highly effective against a specific bacteria will work to clear it. Rifaximin is excellent for at least 3 types of bacteria: E. Coli, Salmonella and Shigella but ineffective against other types of bacteria that cause SIBO and gut issues. Same for Oral Metronidazole works very well for at least 2 of the bacteria (Bacterioides, Eggerthella Lenta) that cause SIBO. Rifaximin doesn't work on Bacterioides or Eggerthella Lenta. Sounds like you got lucky and had a bacteria that Rifaximin could treat. Ivermectin was originally developed to treat demodetic mange in dogs. Then they found that Ivermectin worked on a multitude of parasites in humans.

          Comment


          • #6
            The problem isn't just SIBO.
            Regarding the gut microbiome in general, it isn't just a matter of what is there and shouldn't be, but also, what should be there and isn't.

            Attempting to kill off X microbe identified as a pathogen is often not successful when trying to put any chronic disease into remission.
            It is about balancing communities.
            If you take enough antibiotics to completely wipe out a community or communities, including those killed due to collateral damage, the problems continue, change or amplify.
            These communities produce lots of useful metabolites.
            Or bad ones, depending on the armies.

            On an interesting note. I was reading anecdotal reports from people who had received FMT's due to C.Difficile. I was previously of the thought that in general these produced a 99% cure rate with no side effects, so it was a eye opener reading about the long term side effects many people experienced, most notably, joint pain and neuropathy, along with fatigue.

            Perhaps in the future, donors will have to be matched to the recipient, much like blood and organ transplants.
            Previous Numerous IPL.
            Supplements: High dose Niacinamide, Vit K2, low dose Vit A. Moderate Dose Vit C, Iodine, Taurine, Magnesium. Mod- dose B's. Low dose zinc. Testing Quercetin.

            Skin Care: No Cleanser, ZZ cream mixed with Niacinamide gel 4% and LMW HA 2%, ethyl ascorbate 2%.

            Treating for gut dysbiosis.(This is helping).
            Previous GAPS diet. Have now introduced lots of fibre.
            Fermented Foods. Intermittent fasting -16-18 hours.
            Oral Colostrum. Helps reduce food reactions.

            Comment


            • #7
              Originally posted by Mistica View Post
              The problem isn't just SIBO.
              Regarding the gut microbiome in general, it isn't just a matter of what is there and shouldn't be, but also, what should be there and isn't.

              Attempting to kill off X microbe identified as a pathogen is often not successful when trying to put any chronic disease into remission.
              It is about balancing communities.
              If you take enough antibiotics to completely wipe out a community or communities, including those killed due to collateral damage, the problems continue, change or amplify.
              These communities produce lots of useful metabolites.
              Or bad ones, depending on the armies.

              On an interesting note. I was reading anecdotal reports from people who had received FMT's due to C.Difficile. I was previously of the thought that in general these produced a 99% cure rate with no side effects, so it was a eye opener reading about the long term side effects many people experienced, most notably, joint pain and neuropathy, along with fatigue.

              Perhaps in the future, donors will have to be matched to the recipient, much like blood and organ transplants.
              I have this bacterial overgrowth. I?m trying to balance it out naturally. I used chuckling goat company. I?m taking turkey tail mushroom and thyme tincture. I?ve so far halved the bacteria. I?m also making my own kefir and sauerkraut to pit good bacteria back in

              Comment


              • #8
                Originally posted by Mistica View Post
                Perhaps in the future, donors will have to be matched to the recipient, much like blood and organ transplants.
                One study by Nature Publishing Group discusses how recent research suggests that humans might be divided into three types of gut bacteria: Bacteroides, Prevotella and Ruminococcus. This may lead to personalizing medical treatment based upon which type gut microbes you predominantly have. [5] "The three gut types can explain why the uptake of medicines and nutrients varies from person to person," reports Jeroen Raes, a bioinformatician at Vrije University. [6] This may develop into a new 'biological fingerprint' on the same level as blood types and tissue types. [7] This may lead to a 'gut type diet' (similar to the blood type diet).
                Do You Have A Gut Feeling About Your Rosacea?
                Brady Barrows
                Blog - Join the RRDi


                Comment


                • #9
                  Originally posted by ElaineA View Post
                  Some serious research needs to be done on the connection between these 2 bacteria, SIBO and demodex overpopulation on the skin. If this theory pans out, topical treatment can only control or limit the demodex population on the surface of the skin. To rid a person of the demodex infestation, will likely require a targeted antibiotic that is known to be highly effective against the specific bacterial overgrowth. The antibiotic treatment should be followed by healthy eating habits and probiotics to maintain gut health.
                  This is, of course, if bacteria is the culprit. How do we know that virus isn't involved? Or another microbe? Western medicine assumes bacteria and focuses on bacteria.
                  There are papers showing antiviral or anti-protozoa treatments improve rosacea, just as antibiotics are used to improve rosacea. Who would sponsor research on what rosaceans want?
                  Brady Barrows
                  Blog - Join the RRDi


                  Comment

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