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Thread: Signs of Demodex

  1. #1
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    Default Signs of Demodex

    Hey guys,

    So i'm really confused about if I have demodex or not. I can't get a skin test here unfortunately, no derm will do it.
    But here is some of my history which makes me think possibly demodex:

    - used to have extremely oily skin, and I was WICKED flakey
    - started taking spironolactone to lower testosterone (i had twice the normal amount - im a female) and BAM! No more crazy oily skin, just regularly oily skin. However, STILL flaking lots.
    - First thing I was given when I had a big rash from using stupid acne products the derm gave me - hydrocortizone - BAM next day skin not flakey
    - continue using it...skin back to flakey...
    - So then tried a bunch of other stuff, but let's move on to related issues....
    - Went on the honey mask trial - a lot less flaking then before, but STILL lots of flaking!!! I felt when it was really bad and felt like a layer (this was long time ago, it's always just flakey without a stuck layer feeling) it helped to get rid of that
    - Exfoliating doesnt help, just gets the top layer of flakes mostly gone, but then there are more flakes underneath!
    - My skin feels itchy when it rains (relation to demodex at all??)
    - My skin is flakey everywhere not just seb derm areas (so whole forehead, not just eyebrows, whole cheeks, chin, nose..)
    - Adding thick creams in the past for supposed "dry" skin never helped
    - I have flakes all in my eyelashes for as long as I can remember.
    - I have flakes in my head too, especially at front of head where hair starts
    - Insides of ears are flakey too (not noticeable but when I clean my ears MAN the flakes just start pouring out!)
    - Also when it rains by face feels more irritated and red (blotchy red than flushy) and i get breakouts
    - Bumps in non-rosacea area that arent super inflamed (sides of face, like jaw line)


    So do you think based on this that I have demodex or seb derm?
    Other seb derm treatments I've tried include Elidel (no help there), Clarifoam - great at helping smoothing skin but not really changing flakiness a whole lot

    Sorry for the novel , thanks for reading

  2. #2
    Senior Member Brady Barrows's Avatar
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    Default Demodectic Rosacea

    Has your physician ruled out SD? Your description points to SD but you may also have a high demodex density count .

    I have always been puzzled at why physicians, particularly dermatologists, will not test for demodex. There is a lot of evidence that a certain percentage of rosaceans are suffering from demodectic rosacea.

    Frank Powell, MD, who served on the NRS ‘expert committee‘ that classified rosacea says in his book, “There is no laboratory test or investigation that will confirm the diagnosis of PPR. Specific investigations may be required to rule out similar appearing conditions (many of which will be identified by listening carefully to the patient’s medical history and examining the skin lesions). These include skin swabs for bacterial culture, skin scrapings for the presence of demodex mites, scrapings for fungal KOH and fungal culture, skin biopsy for histologic examination, (and rarely culture) skin surface biopsy for demodex mite quantification, patch tests, photopatch tests, and very rarely systemic workup wih appropriate blood tests and radiological examinations.” [1]

    Another report about diagnosing says, “Potassium hydroxide examination, standardized skin surface biopsy, skin biopsy, or a combination of these are essential to establish the diagnosis.” [2]

    There are likely more reports published about demodectic rosacea than just about any other subject on rosacea. [3]

    If enough rosaceans insist on getting a test to rule out demodectic rosacea there would be more data on this subject to establish what percentage of rosacea patients are suffering from demodectic rosacea. Keep search for a physician who will do this test for you.

    End Notes

    [1] Rosacea Diagnosis and Management by Frank Powell
    with a Contribution by Jonathan Wilkin

    [2] Demodicosis: a clinicopathological study.
    Hsu CK, Hsu MM, Lee JY.
    J Am Acad Dermatol. 2009 Mar;60(3):453-62

    [3] For a partial list click here
    Last edited by Brady Barrows; 11th April 2011 at 06:30 AM.
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  3. #3
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    Default

    i've tested positive for demodex (i live in Europe, and it wasn't hard to get tested).
    i have rosacea (a combination types I and II); no flakiness or itchiness;
    sometimes i get a tingly/crawly sensation that may be related to flushing rather than to mites.

    the dermatologists i've consulted who believe enough in a demodex/rosacea link to have me tested
    think one application of permethrin 5% should eliminate all the mites permanently.
    they also had me try clotrimazole and crotamiton before giving up.
    i guess the idea is something like: "since we can't treat them effectively, just ignore them".
    and it is true that a lot of people have demodex without having any skin problems.

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    Post The two tests for demodex

    The two tests for demodex:

    One school of thought is to do the density count. The other school of thought is to perform an empirical test by applying a cream like permethrin or crotamiton daily for 2-3 weeks and see if anything unusual happens.

    The first way, counting mite densities, is not too helpful. A person may have many mites or only a few, but the density test provides no indication if you have a problem with the demodex. It merely counts mites in a random column of extracted skin. A nice number is produced for a graph for some researcher's paper. Worse yet, a doctor may even deny treatment to you if the number does not pass some arbitrary threshold.

    The second way, the empirical test, is more helpful. If something unusual and significant happens when applying the cream, like a sudden improvement or worsening, then the problem is likely to be linked to the death of demodex. If nothing happens, then demodex is not a problem and can be excluded.

    I believe papulopustular rosacea (PPR) is the same thing as what Brady Barrows describes as demodectic rosacea. I believe it is an allergy to demodex or to a bacteria associated with demodex. Some people are allergic, others are not. Unlike other common allergies, this allergen is stuck in your skin as you cannot just choose to avoid demodex. It becomes necessary to kill all the mites to bring relief or to suppress the symptoms with a perpetual course of antibiotics. The symptoms of PPR, the red skin, dry skin, blepharitis, and the relentless onslaught of mosquito bite-like papules that sting/tickle are classic allergy symptoms. Once all the mites are dead and are out of your skin, these symptoms will stop and the skin will return to normal.

    If the empirical test is positive, I recommend trying ivermectin or benzyl benzoate. Permethrin and crotamiton alone are not effective enough to completely clear the skin of demodex.

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    Default

    Thanks guys,

    So should I try that ivermectin cow injection (lol) or any other suggestions?
    Also my skin is VERY sensitive, so nothing that would burn or irritate.
    Lastly, do symptoms get worse at first or better right away? Cause if it's an irritation of the rosacea how will i know if thats it or its killing the mites.

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    Quote Originally Posted by snuffleupagus View Post
    if it's an irritation of the rosacea how will i know if thats it or its killing the mites.
    that's what i always wonder, snuffleupagus.
    in other threads about ivermectin and demodex, some people have reported pretty unpleasant effects -
    but how do we know whether to brave that out as a necessary die-off phase before things improve,
    or whether it's an indication that what we're using is the Wrong Stuff and we should stop using it?


    Quote Originally Posted by Wistar View Post
    ... the empirical test, is more helpful. If something unusual and significant happens when applying the cream, like a sudden improvement or worsening, then the problem is likely to be linked to the death of demodex. If nothing happens, then demodex is not a problem and can be excluded.
    ... well, but there are also cases that aren't that clear-cut.
    i had some kind of reaction when i used permethrin every two nights, but was it die-off or just irritation?
    our friend flying_er also had reactions when he used ivermectin but it wasn't very clear what was going on.

    Quote Originally Posted by Wistar View Post
    I believe papulopustular rosacea (PPR) is the same thing as what Brady Barrows describes as demodectic rosacea. I believe it is an allergy to demodex or to a bacteria associated with demodex. Some people are allergic, others are not.
    and then there's me, who has both demodex and p&ps, but not itchy mosquito-bite-like ones.
    so are the demodex to blame or not?

    i do have some liquid ivermectin, but right now my skin is behaving itself fairly well,
    so i'm not ready to risk making things worse. maybe during the summer when i have a break from work ...

  7. #7
    Senior Member Brady Barrows's Avatar
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    Default Your Worthy post....

    Wistar,

    I found your comment on demodex testing worth consideration so much that I added your comment with a footnote (#9) on my post about demodectic rosacea. By the way, I wasn't the first one to name it demodectic rosacea. It was Gerg Plewig, M.D. who wrote the first classic book on Acne and Rosacea with Dr. Kligman and will be soon releasing an updated version.
    Brady Barrows
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    So any suggestions on what should be my first try?

    I'm so confused if its demodex or seb derm.

    A seb derm definition:
    Seborrheic dermatitis is a common, chronic condition that occurs in areas of the skin where there are large oil glands—the middle of the face, behind the ears, and especially on the scalp (dandruff). The condition is characterized by waxy scale and reddened skin areas. It affects approximately 3% to 5% of the population, most commonly men, and peaks in infancy and middle age.

    Now this is where I am confused. My skin is flakey ALL over. I've seen numerous pics of people with sebderm and i see they have flakey-red skin right by the nose and eyebrows. My face can be having a good day (pretty clear, calm) yet i will be flakey everywhere - cheeks, chin, nose, eyebrows, forehead, etc.

    So what do i have is the million dollar question here!!!!

    Also - i've been doing honey masks for the last little while every number of days. WEll i did one last night and as per usual (argh) i got a nice flush afterwards. So basically the flush started with the honey mask on and continued when i washed it off. Well today i wake up with LOADS of p&ps - especially around the nose, eyebrows area...so does this point to it NOT being seb derm??

    Thank you!

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    Bump!

  10. #10
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    I think Wistar answered your post. There is also information in the Ivermectin thread regarding demodex symptoms.

    No one on the internet can tell you what you have.

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