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I need your help please. I have posted pictures. Could it be Demodectic Rosacea?

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  • I need your help please. I have posted pictures. Could it be Demodectic Rosacea?

    Dear all,

    last November, I moved to New Zealand on a working Holiday visa and developed a facial rash. I have seen several doctors around the country but none of them have been able to make a proper diagnosis on my skin condition.

    Below is a letter written by one of the dermatologists I saw :

    "I first saw patient XXX on XXX for a facial rash of uncertain duration - it had been coming and going maybe for a few months. He had already seen a variety of doctors on his travels around New Zealand and had been given various diagnoses (impetigo, seborrheic dermatitis etc) and a variety of treatments (ketoconazole cream, hydrocortisone cream, fucidin cream, doxycycline tablets, itraconazole tablets, prednisolone cream, flucloxacillin tablets, pimecrolimus cream).

    At the time I first saw him there was erythema and scaling and some pustules in a perioral distribution - it was a bit like a perioral dermatitis except the pustules were bigger than one would expect for that condition and furthermore there was a history of pustules on the forehead which would be an unusual site. It wasnt typical of acne either (no comedones). The pustules seemed a bit large for seborrheic dermatitis also. So it didnt fit neatly with any one condition. I gave him minocycline tabs and did a swab which was negative.

    He was booked for a biopsy on XXX but the rash at that stage was quiescent and I felt that there was a low chance of getting useful information at that stage. The diagnosis is still uncertain - an inflammatory dermatosis with pustules, which includes things like perioral dermatitis, seborrheic dermatitis, rosacea, demodex folliculitis and others); infection has been excluded. A biopsy will give better results if it is done during a flare up phase."

    I am currently traveling around Indonesia and my condition has not improved. This thing is not only very itchy, it is also ruining my self-esteem. I have read about demodectic rosacea and have been using permethrin 5% for about a week now but my skin is at its worst. If it is a mite infestation, is it normal that the skin gets inflamed like this? Thank you so much.


    DSC07494.jpgDSC07510.jpgDSC07511.jpg

  • #2
    Yes, it looks like demodex and therefore it's perfectly normal that permethrin makes it worse at first, as it kills off the mites. This stage can last even for 2 weeks, but then you should get better gradually. Permethrin cream should be only applied once a week, because it can be irritating for the skin and it can be also absorbed systematically.

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    • #3
      Thank you so much, I truly hope it gradually gets better.

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      • #4
        It will. [emoji846]

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        • #5
          Hello,

          Although I have not used permethrin in four days, my skin condition now looks worse than it ever has.
          Has anyone experienced a similar reaction to the product? It is scary to look at and very painful.

          MariaSt, what made you think it was demodex? Thank you.
          Attached Files

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          • #6
            I said that it looks like demodex, because your "rash" and your red pores are characteristic. If you want to confirm this or sthg else, you can go to a microbiologist and perform skin scrappings, cultures,etc. You can also try an ivermectin cream instead of permethrin, because it's less irritating.

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            • #7
              Hello,

              I had a similar thing when I had a flare up months ago but with more extent areas. It was caused by a moisturizer (who apparently feed the yeast) + stress + self esteem down.
              It seems that you maybe have also dermatitis sebboreic (who often coexist with rosacea/demodex).

              Be careful to what you apply on your skin. Some cream make it worse.

              Does it burns?

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              • #8
                There were no flakes before permethrin.

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                • #9
                  Hello,

                  Thanks to you both for your message.

                  Yes, it is burning.

                  Before I started permethrin, I used Crotamiton for about two weeks and noticed much improvement. Then, one day, I decided to shave my beard and the pustules and redness came back a few days later. Although I have been regularly placing the cutting head in boiling water in order to disinfect it, can it be that my electric shaver is also infested?

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                  • #10
                    Originally posted by atlas222 View Post
                    Hello,

                    Thanks to you both for your message.

                    Yes, it is burning.

                    Before I started permethrin, I used Crotamiton for about two weeks and noticed much improvement. Then, one day, I decided to shave my beard and the pustules and redness came back a few days later. Although I have been regularly placing the cutting head in boiling water in order to disinfect it, can it be that my electric shaver is also infested?
                    Is your electric razor totally nickel-free? Allergy to nickel is very common.

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                    • #11
                      Hi Atlas. Wow, I cant believe it. Another guy with exactly what I had. There is a lot of confusion around this disorder cause it mainly affects women and is called Perioral Dermatitis. Antibiotics usually clears it up but like you they didn't work for me. I tried everything else you tried and nothing worked. The more I put on,the worse it got. That's because this condition is a cross between Acne Mechanica and Allergic Folliculitis. Friction, Soaps, shaving, after shave and Occlusion damage the skin barrier and it becomes hypersensitive. Zero therapy (No facial cleansers, no moisturizers absolutely nothing) worked well for me. But it never cleared it totally until I stopped the friction and possible allergic nickel reaction from my electric Shaver. I now use the Philips Oneblade and there is zero irritation. The combination of Zero therapy and the Zero friction from my new electric shaver have given me a clearance that I have never been able to achieve with many oral/topical antibiotics,oral /topical Antifungals, Pimecrolimus,Tacrolimus and every home remedy you have read about on the net. Remember, absolutely nothing on your face, not even water. If you have a girlfriend, then sorry, But no kissing. Zero friction.

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                      • #12
                        Hello, a few months back I asked my dermatologist whether it could be a nickel allergy but she told me that allergic reactions don’t generally cause pustules. Nickel allergy results in eczema at sites in contact with nickel so that wouldn’t explain the distribution of my rash. Also, the rash and pustules seem to appear when I am not in contact with the shaver or products containing nickel.

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                        • #13
                          Your Derm is right. Allergic contact dermatitis(ACD) doesn't generally cause Pustules. This is where Derms around the world end up misdiagnosing people. Because if they did their homework and kept up with research, they would know that ACD can cause Pustules on areas of the body where people would have previously suffered from Acne.

                          Anyway just wanted to add to my previous post that you need to dump your toothpaste too.

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                          • #14
                            Hi Rory,

                            I am sorry for my late reply. I have been traveling for the last few months.

                            There has been improvement on my skin condition. The rash has totally disappeared and my skin no longer burns as it used to.
                            Pustules, however, are still a major issue. I honestly don't think I have perioral dermatitis as my dermatologist found that the pustules were not typical of PD; they are quite large.
                            I have been applying a 5% sulfur cream for the past month but find it ineffective against pustules. I have ordered terpinen-4-ol. We will see if it is of any help.
                            Thanks.

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                            • #15
                              Atlas222, if Crotamiton helped you for the first 2 weeks and then you broke out the 3rd one, it could be that your skin followed the die-off pattern of any anti-demodex treatment and that the shaving your beard had nothing to do with your breakout. If I were you, I would either restart Crotamiton or start using Soolantra.

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