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Thread: Piroctone Olamine for MGD/eye problems

  1. #11
    Senior Member Tom Busby's Avatar
    Join Date
    Apr 2013


    I kept contemporaneous notes of my observations, which are pasted below. "Collarettes" are the same as cylindrical dandruff on the eyelashes. Nothing at all happened for the first 22 days, so there aren't any notes for that time.

    Notes – Initial test of topical piroctone olamine

    Day 23 from 12.12.14 starting date with piroctone olamine shampoo/shower gel. Clearance of itching at eyelid margins. Perhaps piroctone olamine is birth control for demodex because demodex has 23-day lifespan.

    Began using piroctone olamine lotion.

    A patch of cylindrical dandruff came off left upper lash. Perhaps unmated females have a lifespan > 23 says.

    1.16.15 – Day 34
    Significant reduction of bloodshot eyes. Increased tear production.

    Significant increase in tear production while sleeping. Upon waking, eyelashes crusted thickly, right eye only.

    Significant decrease in crusty eyelashes upon waking.

    Possible J. Herxheimer reaction = hot sinuses. Slightly crusting eyelashes on waking. Increased eye redness. Perhaps unmated females die at day 45. Perhaps D. brevis dies at day 45.

    1.28.15 – Day 46
    Huge tear production at night. 5-inch circular wet spot on pillow. No crusty eyelashes at all.

    Slight nosebleed, interior of right nostril, on waking, posterior to papule on right side of nose. Previous incidents of dried blood evident here for 5+ years.

    Sebaceous glands at margins of top eyelids, green gray wax scraped off.

    5-6 collarettes scraped off. Swollen eyelids and lower margins shrinking slightly. More gooey secretions than expected, but are located below/above same areas where wax was scraped off yesterday.

    Puffy ridges at outer eye-corners disappear. Clogged pores under lower eyelashes scraped off.

    2.12.15 – Day 60
    Normal tear flow evident in response to heavy cigar smoke = a new sensation. Pustule on right upper eyelid broke, and scab formed, and so did pustules at lip corners.

    Scraped off very hard dry collarettes from upper eyelashes. Expressed waxy substance from inner eyelash area. Papule on right lower lip that bleeds and scabs over.

    Scraped off extremely hard dry dots from upper, outer eyelashes.

    Scraped off hard dry dots from lower eyelashes.

    2.17.15 – Day 65
    Scraped off tiny, scaly, soft patches at inner upper eyelids, medium weight fluid expressed from meibomian glands. Papules at corners of lips healing/receding. Removing greasy, hard scale at top/bottom of eyelids. Eyebrows yielding waxy scrapings.

    Crusty bits scraped off bottom eyelashes. Papule on left lower lip nearly healed. Another papule on left lower lip merely peeled off with no bleeding.

    Papules above eyebrows bled, scabbed up, and began healing. Silvery skin at outer angles of eyes flaking off. Eyes less red. Still scraping bits off eyelashes.

    Perhaps scraped off last hard bit off left upper eyelid.

    2.22.15 – Day 70
    Large hard papule on right forearm, near anti-cubital fossa, scraped off. Scaly patches at outer corners of eyes became evident. Still scraping off collarettes from eyelashes.

    Small papule on right cheek receding.

    First time, no crusty eyelashes on waking! Upon washing plus lotion, soft debris washed out of eyelid follicles.

    Papule plugs at lower lashes, lip-corners and chin are scraped off. Very slight bleeding and dot-like scabs at lip corners and chin.

    3.08.15, and week preceding. Includes Day 90
    Papule on right side of nose about 20% smaller, after slight bleeding and expression of light fluid. Color returning to limbal rings of iris that were previously faded at top and bottom of cornea. Lips are free of excess keratin plaques and eroded-looking lesions/ulcers. Papules scraped off front of neck at t-shirt collar-line. Red eye symptoms continue receding. Internal nasal hair follicle papule no longer bleeding. Under eye swelling nearly gone.

    3.15.15, and week preceding.
    Hard cap scraped off of papule on right side of nose. Margins of lips have fewer sebum plugged pores. Small plaques (4-6mm) scraped off edges of lip area and crease area of chin. Eye redness, continual reduction. Lower eyelid swelling appears to be gone. Mis-directed eyelashes tending to straighten out. Clean eyelashes upon waking. Papule on left cheek and right forearm scraped off with minor bleeding. Last of hard cuff scraped off right upper-outer eyelash margin. Lower left posterior eyelid nearly free of telangiectasia – not so much reduction in right lower posterior eyelid telangiectasia.

    Significant scraping of follicle plugs along upper eyelids.

    3.22.15, Day 100, and week preceding.
    Thin keratinized pore-plugs expressed from eyelids and eyelash, and side of nose. Papule on right lower lip broke open and bled. Pair of papules at outer angle of right eye bled very slightly, after plastic-sticky cap over them scraped off 2 days previous. Continual reduction of lower eyelids (palpebral) swelling. Slight reduction of large papule at inner angle of right eye. Tear quality now better than artificial drops. Tear quantity greatly increased. Spider veins on upper cheeks and nose are receding.

    Scraped off 12-15 tiny plugged pores around eyelashes. I feel like this is probably 99% cure.

    12-15 extremely tiny, hard pore plugs fall out by themselves, from the eyelid margins.

    3.29.15, and preceding week
    Papule on side on nose broke and bled slightly. Erosions on lips filled out. Papules on chin broke and bled. Eyelid margins scaled slightly and cleared – apparent 100% clearance. On 3.29 apparent J. Herxheimer reaction as eyelids felt feverish. Large papule at inner angle of right eye nearly gone. Pore plugs on lips totally gone.

    Two slight papules remain, at right nose and angle of right eye. All other signs apparently clear.

    4.12.15, Day 120, includes previous 2 weeks
    Two papules slowly diminishing but still visible. 20-30 microdots scraped off margins of eyelashes. Keratin patches at outer edges of eyes scraped off. I appear to be nearly clear. Limbal rings that had faded at the tops are dark now.

    4.19.15, and preceding week.
    Approximately 2-3 microdots scraped off every day by margins of eyelids. Small 10 mm circles of frosty skin, circled by red-dot racetrack connections among 10-12 inflamed pore microdots on back of hands and fronts of knees. Frosty skin evident for about 7-10 days and then flaked off. Frosty skin found at outer angles of eyelashes and nearby to 40mm. Significant reduction of papule at inner eyelash angle of right eye. I describe the canthi or canthus as the angles of the eyelids, as using the term angle of the eyelids is logical and understandable.

    4.26.15, and preceding week
    1-2 microdots scraped off each day by margins of eyelids. Elephant skin at upper eyelids beginning to recede. Frosty skin and red racetracks about the knees healed and gone. Slight continual reduction of two papules at interior corner of right eye and right side of nose.

    5.11.15, Day 150, and preceding two weeks.
    Approximately 1-2 hard microdots scraped off every day by margins of eyelids. Small, incremental improvement of skin texture at approximately ½-inch circular patch, 20-40 mm anterior to outside corners of each eye, (elephant-skin) disappearing, particularly after hiking/sweating profusely. Incremental reduction of red veins in sclera, which are less noticeable. Able to wear contact lenses for the first time in approximately ten months. Small clogged pores at corners of lips number only two now, as four tiny clogged pores broke and bled slightly, and healed. Slight (<5%) reduction of two facial papules. Very thin layer of loose keratin around ankles, heels and toes scraped off.

    5.17.15, and preceding week
    Very few remaining microdots scraped off of margins of eyelids, perhaps 10 in total. Near complete resolution of elephant skin at upper eyelids. Some might have called this orange peel skin or peau d’orange, but there is no dimpling in my case, and elephant skin is more accurate due to the prevalence of creases around the slightly thickened, raised, puffy skin. Elephant skin patches at outer angles of eyes slowly receding. Remaining red veins in sclera are probably non-treatable baseline redness due to age or fevers through the years. Able to wear contact lenses with ease. Clogged pores at corners of lips are absent. No reduction of two facial papules. Light layers of frosty tiny scales at interdigital areas of right hand, and at left thumb, scraped off throughout the week with light grattinage.

    5.24.15, and preceding week
    No microdots remain sticking to margins of eyelids. All elephant skin gone from upper eyelids, and nearly all elephant skin gone at outer corners of eyes. Cobblestone feel to posterior of upper inner eyelids, adjacent to cornea, disappearing, along with significant reduction in remaining baseline redness in sclera that I had previously thought to be untreatable. Significant (>10%) reduction of papule at inner angle of right eye. Slight (>5%) reduction of papule above nasiolabial fold on right side of nose. Hands are free of frosty tiny scales.

  2. #12
    Senior Member
    Join Date
    Apr 2015


    Wow, Tom, I'm out of words. Thank you SO much! This is such an interesting read, and really gives me hope!

    I see similar signs when I wake up as well: right eye only crusting of eyelashes and less bloodshot eyes than before. Right eyelid a little less red than before. And really watery eyes at night, but not every night. I had a very interesting conversation with a user on PM, and he pointed out that this excess tear production might be because of dust mite allergy (which I have), but I've been very careful to change pillow covers every second night or so, so not entirely sure, though.

    I'm about at day 13 today, so I'll start to keep my own log starting today, and see how things develop.

  3. #13
    Senior Member
    Join Date
    Apr 2015


    So, an update on my part. I've been to a dry eye clinic today. But first, I wake up with dandruff on eyelids some mornings. Looks like this:

    Whether this is cylindrical dandruff or not, I don't know. It washes of easily in the shower, though, and the eye doctor I saw today said cylindrical dandruff is quite hard to get off.

    Anyway, they took pictures of my meibomian glands, which showed that they some were very "short" and some were just gone. He said they could not be restored. He said the atrophy was most likely due to isotretinoin treatment, but could not rule out demodex playing a role. I think it is weird that 6 months after isotretinoin treatment I was fine, and had no eye problems, but after starting soolantra treatment eye problems returned. He could not explain this. Nor can I.

    I got a list of things to try:
    1) increase omega-3 intake
    2) eye drops with Dexamethasone, 3 times a day for 10 days
    3) Oftagel, eye drops
    4) doxy for 3 months
    5) massage of eyelids, he said specific "masks" were the best
    6) sterilid eyelid cleanser (for demodex)

    So, I already eat a lot of fish. And doxy I'm really sceptical about taking.

    Any input from you guys will make me really, really happy!

  4. #14
    Junior Member
    Join Date
    May 2017
    Country: United States


    Thanks for posting. Please keep us informed of your progress. I will have to go back to the ophthamologist. He said last month that I didn't have occular rosacea. Now it's worse.

  5. #15
    Senior Member
    Join Date
    Jul 2013
    Country: Canada


    Regarding ocular Demodex, I usually use Cliradex but stopped a few weeks ago and bought a "alternative lid wipe which has some TTO" My eyes got progressively worse so I started using Cliradex again. I also clean them with Selsun Blue which helps. Also started back on the omegas. Ocular is the worst.

  6. #16
    Junior Member
    Join Date
    Jul 2017


    Quote Originally Posted by Tom Busby View Post
    Yes sejon, I added piroctone olamine about 2 years after I found climbazole was effective against seb derm induced by an allergic reaction to malassezia -- red bumps and thickened skin were resolved with climbazole.
    Tom, is it possible for the problem to be in only one eye? My right eye is more or less fine, but my left eye is redder and it feels like there is something in the lower lid. Stretching my lower lid provides very temporary relief. When stretched the location on my eyeball where this imaginary foreign sensation under my lid may be I can see is red. It's a very annoying, constant feeling that is worse at night.

    I've also been treating my face very successfully for about 100 days with on and off treatments for my eyes and I think my lashes have grown longer because of it. Still this problem though.

    I used Cliradex several months ago and it made both eyes look terrible. Stung when applied and left my eyes dry and looking ridiculously red until I stopped. I'm not sure how it's the go-to treatment.

    I'm thinking of using Kelual DS cream, but do you have an opinion on bicarbonate of soda?
    Last edited by Nik89; 7th March 2018 at 11:23 PM.

  7. #17
    Senior Member Tom Busby's Avatar
    Join Date
    Apr 2013


    Hi nik, in my experience demodex and malassezia skin conditions are very nearly symmetrical, so it sounds like you have something tiny stuck on the inside of your left eyelid.

    For example, two types of cactus (Prickly Pear and Cholla) found in the entire American southwest, have glochids, which are numerous, almost invisible barbs on the ends of each spine. Glochids feature a tiny hook at the end of each barb, so they don't fall out, ever, and they don't breakdown in the skin over time -- they have to be manually removed.

    See an opthamologist, who will use a slit lamp magnifier to find whatever is stuck in your eyelid and remove it. Your eyes are really important and if I'm right, this is not treatable at home

    Bicarbonate of soda will increase the pH of a mild acid or a neutral solution by about 1 pH-number if you add 1% of bicarb -- that all it will do and that's not useful for any skin condition. Bicarb will never increase the pH above about 8.3, because it's a fairly mild base, so it won't harm your skin, but it won't do anything either.

    If you want to try a stronger base, then you need sodium carbonate, and a 1/100th gram scale because it's much stronger than bicarb.

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