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Thread: Piroctone Olamine for MGD/eye problems

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    Default Piroctone Olamine for MGD/eye problems

    I dont know whats wrong with my eyes, or what I have exactly. Other than that I suspect demodex to be the culprit. But I've applied Tom's piroctone olamine / climbazole mct cream on eye lids and margin for 1.5 weeks maybe. I often wake up with really teary eyes, and my sleep is just really bad because of the eyes. Has anybody experienced this?
    Tom: how did you react at night treating for MGD?

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    Just to clarify, the cream is great, I'm just suspecting this is some demodex reaction. I had a equal/similar eye reaction when I started applying Soolantra all over my face (not on eyelids and eye margins).

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    I was applying climbazole and piroctone olamine all over my face (but avoiding the eye area) for many months and started developing irritation around my eyes as well. In my case, the eyes themselves didn't get red, but small patches of irritated skin developed near them -- very much like what you see if you do an image search for "periorbital dermatitis" -- with occasional red bumps on the eyelids.

    Applying the climbazole/piroctone olamine around the eyes didn't resolve the issue, although using Elidel (pimecrolimus) cream for a few days cleared them up pretty efficiently. But I continued developing this irritation regularly until I stopped applying the climbazole/piroctone olamine all over my face. I haven't applied it this way in several months, and haven't developed any periorbital irritation since then.

    I also suspect it was a demodex issue, which might be because applying climbazole/piroctone olamine to the entire face alters its microfloral composition. After experiencing this, I decided that if I apply any antifungal treatment it should be limited to the areas affected by seborrheic dermatitis, instead of also applying it to healthy skin ("if it ain't broke don't fix it").

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    Quote Originally Posted by sejon View Post
    I was applying climbazole and piroctone olamine all over my face (but avoiding the eye area) for many months and started developing irritation around my eyes as well. In my case, the eyes themselves didn't get red, but small patches of irritated skin developed near them -- very much like what you see if you do an image search for "periorbital dermatitis" -- with occasional red bumps on the eyelids.

    Applying the climbazole/piroctone olamine around the eyes didn't resolve the issue, although using Elidel (pimecrolimus) cream for a few days cleared them up pretty efficiently. But I continued developing this irritation regularly until I stopped applying the climbazole/piroctone olamine all over my face. I haven't applied it this way in several months, and haven't developed any periorbital irritation since then.

    I also suspect it was a demodex issue, which might be because applying climbazole/piroctone olamine to the entire face alters its microfloral composition. After experiencing this, I decided that if I apply any antifungal treatment it should be limited to the areas affected by seborrheic dermatitis, instead of also applying it to healthy skin ("if it ain't broke don't fix it").
    I'm not completely sure if i follow exactly what you conclude. Do you think you developed demodex overpopulation because of climbazole/piroctone olamine, or because you think that climbazole/piroctone olamine provoced a demodex reaction? But interesting what you write, indeed. Tom also mentioned something similar: malassezia f. producing some acid which demodex does not like, thus keeping demodex population in check, so only treating with climbazole might have this effect. But that is why piroctone olamine is added, because it is anti-demodectic.
    https://www.google.com/patents/US20160287566

    In my case, I've suspected my skin suffering from too much demodex, and piroctone olamine / ivermectin provoking a reaction. And my symptoms are very similar to MGD.

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    The only thing I can conclude is that the periorbital dermatitis was caused by applying climbazole & piroctone olamine to the entire face, because as soon as I stopped doing that, it rapidly resolved. Any conclusions beyond that, such as the theory that Malassezia and demodex serve to keep each other's populations in check to an extent, would be purely conjectural. But it is quite possible.

    The idea that it's just a reaction caused by massive demodex die-off wouldn't chime with Tom's experience, if I remember correctly, for the simple fact that he had eye irritation before adding piroctone olamine to his lotion. Before that, the only active antimicrobial in it was climbazole -- therefore there wouldn't have been anything that would be killing demodex. He added piroctone olamine later, apparently because he thought it would help to treat the eye irritation, and in his case it did. (Tom can correct me if I'm wrong, but that's what I remember him saying.) In my case, piroctone olamine didn't seem to prevent or treat it, even when I made sure to apply it around my eyes.

    That said, Tom is the only source I've ever found claiming that piroctone olamine has activity against demodex. Throughout the medical literature, piroctone olamine is only mentioned for its antifungal properties.

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    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.

    Initially my only thought was that piroctone olamine would be useful because climabazole applied to the full body, leave-on plus rinse-off, can be used only at a small concentration, in my opinion 0.08%, to stay within the EU guidelines for OTC cosmetics, in order to have a 100 to 1 safety margin. Simply put, I was curious about alternatives to climbazole.

    Piroctone olamine was selected because it has very large safety ratio, even at 1%, of about 3000 to 1. Also, the US health care system is so expensive and completely fails to deliver results, (outside of life-threatening conditions and/or trauma), that buying a kilo of piroctone olamine for $500 seemed worthwhile. I never expected it to clear up my eyes, until it did. I use only my own topical products, a lotion and a shampoo, so I'm able to determine if something I add makes a difference -- piroctone olamine certainly did.

    My problem of dry, red eyes was vexing, but the principal loss was merely wearing glasses instead of contacts, which wasn't a huge problem -- more annoying was people asking me if I smoked marijuana, which I don't.

    In December, 2014, I made a batch of MCT shampoo/shower gel and added 0.14% piroctone olamine -- the concentration was based on 2x the concentration of climbazole. Malassezia's metabolic process produces azelaic acid, which tends to suppress demodex, but not completely.

    On day-23 after formulating the shampoo with 0.14% piroctone olamine, I was surprised to find that my eye problems were definitely resolving. I already knew a little about demodex, and with more reading, I concluded that my eye problems were caused by demodex lodging inside the meibomian glands.

    My conclusions are based primarily on the 2011 Mebomian Gland Workshop research articles, which to summarize, state that about 80% of dry eye problems are caused by demodex and their debris clogging these sebaceous glands, and on what I experienced -- the visible and obvious unclogging of my mebomian glands, with 23-day and 45-day clearing-events, of increased oil flow, and resolution of dry eye conditions.

    The meibomian glands are visible around the inner margins of the eyelids, and can be expressed to examine whether the glands are producing abnormal wax-like junk, or normal oil. That, plus the information that the maximum life span (not normal life cycle) of unmated demodex folliculorum is estimated to be 23 days, resulted in my conclusion that piroctone olamine treats meibomian gland dysfunction resulting from an abundance of demodex and the debris resulting from their death -- they have short life spans and no excretory opening.

    My conclusions are based on research articles, applied logic, and observations on myself. Other than that, yes, piroctone olamine is generally described as an antifungal only.

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    Quote Originally Posted by sejon View Post
    ...would be purely conjectural. But it is quite possible.
    Tell me something that is not in science!

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    Thanks Tom, for giving a thorough explanation

    Quote Originally Posted by Tom Busby View Post
    My problem of dry, red eyes was vexing, but the principal loss was merely wearing glasses instead of contacts, which wasn't a huge problem -- more annoying was people asking me if I smoked marijuana, which I don't.
    You did not experience any reaction other than gradually getting better, or?

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    Thanks for chiming in, Tom. It is certainly noteworthy that you, rednessator, and I have all developed eye irritation after applying climbazole all over the face. That said, my irritation manifested a bit differently, in the sense that redness of the eye itself wasn't the main problem for me, but instead I developed little rashes near the eyes, and occasional red bumps on the eyelids. I don't have any photos but a Google image search for "periorbital dermatitis" turns up extremely similar cases, like the one I've attached here.

    periorbitaldermatitis.jpg

    These rashes developed at around 7-8 months into regular climbazole & piroctone olamine treatment (when I first started treatment I had used the Bioderma Sensibio DS cream, which also contains climbazole and piroctone olamine). The rashes would heal over the course of a few days but then reappear elsewhere a week or two later. I noticed that pimecrolimus cream (Elidel) helped a lot to speed their healing -- I had a tube of it leftover from when I tried to treat my seb derm with it (to no effect), so I was glad the cream had finally come in handy for something. But the only thing that cured it completely was stopping the application of climbazole & piroctone olamine to the entire face, which I haven't done in several months now, and haven't experienced a single periorbital rash since, thankfully.

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    Quote Originally Posted by sejon View Post
    Thanks for chiming in, Tom. It is certainly noteworthy that you, rednessator, and I have all developed eye irritation after applying climbazole all over the face. That said, my irritation manifested a bit differently, in the sense that redness of the eye itself wasn't the main problem for me, but instead I developed little rashes near the eyes, and occasional red bumps on the eyelids. I don't have any photos but a Google image search for "periorbital dermatitis" turns up extremely similar cases, like the one I've attached here.

    periorbitaldermatitis.jpg

    These rashes developed at around 7-8 months into regular climbazole & piroctone olamine treatment (when I first started treatment I had used the Bioderma Sensibio DS cream, which also contains climbazole and piroctone olamine). The rashes would heal over the course of a few days but then reappear elsewhere a week or two later. I noticed that pimecrolimus cream (Elidel) helped a lot to speed their healing -- I had a tube of it leftover from when I tried to treat my seb derm with it (to no effect), so I was glad the cream had finally come in handy for something. But the only thing that cured it completely was stopping the application of climbazole & piroctone olamine to the entire face, which I haven't done in several months now, and haven't experienced a single periorbital rash since, thankfully.
    Hm, I have not developed eye irritation after applying climbazole, nor piroctone olamine. I developed dry,red eyelid/eye margins/MGD symptoms after starting on Soolantra October 2016, and Accutane October 2015. So I suspect this is related to demodex. I use piroctone olamine from Tom's cream, on my eyelids, and I actually think my lids have gotten less red. But sometimes I wake up with really teary eyes, and they are still very dry. But I've only used it for about 2 weeks, and I'll give it a try for 100 days or more, to see if this helps me, as it helped Tom. I'm just very curious as to how symptom reduction developed and possible reactions to treatment was for people that got well, from demodex eye infestation.

    What you experience might be something else, but very interesting, though. Maybe this is an malassezzia-demodex imbalance issue as well?

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