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Thread: Demodex unresponsive to oral ivermectin and topical permethrin

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    Default Demodex unresponsive to oral ivermectin and topical permethrin

    A 53-year-old man had a 6-week history of confluent erythematous papules, pustules, and abscesses of the face initially limited to the
    right nasolabial fold. Histologic investigation revealed a perifollicular infiltrate with lymphocytes, histiocytes, and many Demodex
    folliculorum mites. A large number of mites were seen in skin scrapings. The skin manifestations progressed and persisted for the
    following 5 years and were unresponsive to numerous antiparasitic treatments, including repeated oral administration of ivermectin
    and external application of lindane, permethrin, and benzoyl benzoate. Therapy with oral administration of 250 mg metronidazole
    3 times a day for 2 weeks resulted in rapid and lasting recovery. Demodex folliculitis remains a diagnostic and therapeutic challenge.
    Antiparasitic therapies used against lice or scabies may fail in control of D folliculorum mites. In the presence of clinical and
    microscopic findings typical of Demodex folliculitis or abscesses, treatment failure with acaricidal agents does not exclude the
    diagnosis. Oral metronidazole seems to work in the management of this chronic mite infestation.
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    Thanks for the full article. I had the abstract listed for several years (this was published in 2003), but not the full article which I now have available due to your diligence. I think I have one of the most comprehensive lists on articles about demodex and rosacea. They keep making more and more articles on this subject. You would think that by now, doctors would be convinced that demodectic rosacea is a rosacea variant. Dr. Schaller and Dr. Plewig are both members of the RRDi MAC. Dr. Plewig coined the term demodectic rosacea.
    Last edited by Brady Barrows; 12th July 2014 at 02:23 AM.
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    Quote Originally Posted by GreenGables View Post
    A 53-year-old man had a 6-week history of confluent erythematous papules, pustules, and abscesses of the face initially limited to the
    right nasolabial fold. Histologic investigation revealed a perifollicular infiltrate with lymphocytes, histiocytes, and many Demodex
    folliculorum mites. A large number of mites were seen in skin scrapings. The skin manifestations progressed and persisted for the
    following 5 years and were unresponsive to numerous antiparasitic treatments, including repeated oral administration of ivermectin
    and external application of lindane, permethrin, and benzoyl benzoate. Therapy with oral administration of 250 mg metronidazole
    3 times a day for 2 weeks resulted in rapid and lasting recovery.
    Demodex folliculitis remains a diagnostic and therapeutic challenge.
    Antiparasitic therapies used against lice or scabies may fail in control of D folliculorum mites. In the presence of clinical and
    microscopic findings typical of Demodex folliculitis or abscesses, treatment failure with acaricidal agents does not exclude the
    diagnosis. Oral metronidazole seems to work in the management of this chronic mite infestation.
    This is an interesting suggestion, but the logic escapes me. Can anyone comment further on this point?

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    Thanks Greengables for all the articles you have posted. If you have any on Perioral Dermatitis then I would love to read them too

    Hi Dave. Its an interesting case and exactly how Metronidazole cured this patient is unclear. Demodicosis is said to be as a result of an impaired immune system so Im guessing that Metro somehow rectified this particular problem. If it simply killed the Demodex then the patient would have needed long-term treatment with the drug. Instead he was clear of Demodex 9 months after the Metro. Im guessing that it was a gastro-intestinal infection which lead to immuno-suppression. Looking at this Article reminds me of all the people we read of here everyday who are wrongly diagnosed. It took this patient 5 years and a list of oral and topicals before he found the answer. Not only that but it seems that the answer was stumbled upon since the Author was very surprised at the result of the Metro.

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    Thanks for your take on it Rory - that's really interesting.

    I was pretty baffled because, as you state, anything that works by eradicating demodex is unlikely to work in a single dose - an ongoing routine would probably be required, which clearly didn't happen in this case. But your input has suggested a very plausible alternative explanation.

    This is surely worth a try for anybody who suspects demodex are involved in their problem, given that it's a relatively quick and easy treatment, would you agree?

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    Looking at some of the Russian studies they state that oral Metronidazole is excellent for restoring the mucous membrane of the stomach and intestine. I think H pylori and many other anaerobic bacteria are sensitive to Metro. Its such a shame that the researchers of this study didnt delve deeper into the patients immune system. The mechanism of Metro is not well understood and this study could have helped explain exactly what breakdown of the immune system causes Demodicosis. Also what Metro did to resolve this problem. Instead we are left with a cured patient but no explanation as to how he was cured.

    I agree Dave. There are loads of people here who are using Ivermectin (injectable) on a regular basis to keep their skin free of P&Ps. They also have strict daily routines of cleaning bed linen,clothing and facial cleansing. Two weeks of oral Metronidazole could be the answer for some of them.

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    I don't know if this is a cause of me more of having demodex mites being the issue or not but I noticed I had bothering Rosacea skin at the same time i had an eczema breakout on my hands. All this happened while I was working at a fast food restaurant.

    It was awhile before my hands got totally clear and during that time my hands would go through sort of Rosacea like symptoms.They would be ok for a day and than get all red. This went on for close to a year after quitting before my hands got clear but of course the redness on my face stayed and got worse. I have had 5 ipl treatments done which did help a bit. About 3 years ago. I have kinda just left my face alone and dealt with the occasional flushing/itchy feeling. Just recently I had a bad flush and the redness has increased on the right hand side of my face but not my left side which is so depressing. I like everybody want the best solutions but don't want to spend a fortune for a disease that is not 100% curable.

    Now is it possible I could of got Rosacea from bacteria/Demodex mites from the fast food restaurant? Or is it possible I could of got Rosacea just from steam from the food coming in contact with my face and the raw bacteria coming in contact with my skin which could of spread Demodex mites causing Rosacea? Just curious has anybody else first notice this disease while working in a restaurant?

    I am going to get a demodex mite test and done and I guess pray that the doctor finds a real overload of them and all it would take would be oral metronidazole. I seriously highly doubt that is ogoing to be a miracle for me and it's sad to see there are very few 100% legit real success stories for people who got cured, but when you suffer from itchy ness and a red face everyday with no clear cure all you have is hope.

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    In case this is of interest to anyone, I thought I would post that I have today begun a treatment schedule very similar to the one described here. I will report back with results/observations.


    My treatment is very slightly different, due to issues with dispensage of the precise dose referred to here - while this study suggests 250mg x3 per day (=750mg total p/day), I will be taking 400mg x 2 per day (=800mg total p/day). My derm has also suggested continuing for up to 4 weeks (study states 2 weeks), should I wish to do so.


    I have been away from the online community for several months, due to oral limecycline treatment keeping my symptoms very well in check. However, I have been holding the metronidazole treatment in reserve for some time as my next 'roll of the dice'. Unfortunately my symptoms have re-flared quite severely within a matter of days of discontinuing the limecycline, so here goes.....

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    An update to this as promised.

    I discontinued the oral metronidazole just over a week ago, after 19 days treatment. This substantially exceeds the 14 day treatment referred to in the paper. My derm had prescribed me 28 days supply, however I made the decision to discontinue at the point that I did after discovering that oral metronidazole is not generally given for periods exceeding ten days. I felt that, all things considered, 19 days was quite long enough for this experiment.

    I knew this was perhaps the ultimate long shot (a common two-week tablet course curing me after nearly 8 years? C'mon....!), and sure enough, I cannot say I've noticed any dramatic happenings or improvements yet. I can't even say that this treatment was especially effective at clearing/preventing p&p's.

    Limecycline (which I had been on previously) is extremely effective for me at quickly clearing my skin and keeping it clear. Metronidazole didn't do that. I think it helped a little, but the breakouts continued pretty much throughout treatment. The problem with limecycline is that I seem to suffer very severe flare-up's, very quickly, whenever I try to come off it.

    In any case, this treatment doesn't seem to have given me the miracle cure that it gave the paper's subject. But at least I tried.

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    Well done for giving it a shot Dave. Too few people are willing to try this and its a shame. I dont think Ive ever read of any serious or permanent adverse effects when taking oral Metro for a while. Yet I cant find that many people on the RF search engine that have taken it. I think that Isotretinoin is a much more dangerous drug and yet this Forum and others are full of peoples experience with it.

    BTW I also had great results with Limecycline many years ago. The results wore off pretty quickly once I stopped. The odd thing is that when I went back on Limecycline a few months later it didnt work anymore. I have read a few reports of this where the drug was a miracle at first but then stopped working some time later.

    Triple therapy for H Pylori was the next best thing that I have tried. Total clearance but quickly returning to baseline once I finished. Triple therapy consisted of Proton pump Inhibitor,Amoxicillin and Oral Metro for two weeks. I have recently tried Amoxicillin on its own with only moderate improvement so I can only surmise that most of the benefit came from the oral Metro.

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