Demodex Mites: Ivermectin Effective Treatment ?

Written by on August 30, 2007 with 47 Comments

Linda Sy MD,
Date: Fri Dec 1, 2000

Hello Annie,

Welcome. I have just read your message with interest and am impressed with your enthusiasm to share your treatment with the group. You also seem to be committed to your research, what with all the work required, not to mention the liability. You cannot find a more intelligent group to test your treatment plan. Rosacea is an enigma to me and I am sure, to many colleagues. I for one, would be interested in the outcome of your informal study.

Demodex folliculorum has been mentioned as an aggravating factor to rosaceans for many decades and yet, I have not seen any formal double blind study done on this front. (This supports the wisdom of independent research funding by rosaceans). As you have presented, articles have been published, reporting individuals (a number of whom are immunocompromised) who responded to rx of demodex. The rx’s were not cures but nevertheless, afforded some form of control to otherwise refractory situations. I do not think your hypothesis is without merit. As a matter of fact, at the end of this message, I have copied an article reporting a case rx’d successfully with oral Ivermectin & topical Permethrin. Months ago, I sent a copy of this article to a group member with very resistant case of folliculitis.

However, I’m not sure that it is wise to have someone self- treat without the supervision of an attending physician. Luckily, here in the U.S., 5% Permethrin (Elimite Cream) is only available by prescription. I have given this topical medication to many patients for scabies but not for rosacea. Other than a few cases of contact or irritant dermatitis, I have not seen any serious side effects. However, my patients have only used it no more than 2-3 times at most.

I don’t know what the side effects of long-term use are; considering the hypersensitivity, easier penetrability (hence, increased absorption) and vascular lability of inflamed rosacean skin. I personally believe demodex mites are incidental parasites that prey on compromised skin causing secondary symptoms, not unlike bacteria & fungi. They are not the primary cause of rosacea. Therefore, I suspect that not all rosaceans have demodex as a relevant factor.

If I may, I would like to offer some suggestions:

  1. Limit participants to those who were unresponsive to all the usual treatments.
  2. Ask participants to solicit the cooperation and supervision of their respective dermatologists. By that, I mean – if possible, get a KOH skin scraping (a common procedure in a derm’s office) to establish the presence of florid demodex population. There may be some resistance to this but I believe many physicians will have the interest of their patients at heart and the curiousity to find out if this works.(I know of some colleagues who have given this treatment for rosacea). Thus, if there is any acute reaction, a physician is available and responsible to take care of the problem.
  3. Participants try the Permethrin on a small area of face first, to determine if any immediate severe problem exists.

Here is the article which appeared in JAAD:

Treatment of rosacea-like demodicidosis with oral ivermectin and topical permethrin cream

JAAD, November 1999, part 1 . Volume 41 . Number 5 Christa Forstinger, MD Harald Kittler, MD Michael Binder, MD Vienna, Austria, and Boston, Massachusetts

A 32-year-old man presented with a chronic rosacea-like dermatitis of the facial skin and the eyelids. The skin disorder had been present for 4 years and was unresponsive to multiple previous treatment attempts. Skin scrapings and a histologic examination of a biopsy specimen from the affected area revealed the presence of numerous Demodex mites. The patient was treated with oral ivermectin and subsequent topical permethrin resulting in complete and rapid clearing of the folliculitis. We believe that this case supports the view that Demodex mites may be pathogenic when they are present in large numbers. Oral treatment with 200 µg/kg ivermectin with subsequent weekly topical permethrin showed impressive treatment efficacy in a case refractory to conventional treatment. (J Am Acad Dermatol 1999;41:775-7.)

Demodex folliculorum, a 0.3-mm long Acarus mite, is the most common ectoparasite of man. Because of its ubiquitous nature, infestation with this organism is recognized as a normal occurrence. However, there have been numerous clinical observations linking the presence of Demodex mites at extremely high-density colonization with various skin disorders. Demodex mites have been suggested as the causative agent in rosacea, perioral granulomatous dermatitis, blepharitis, and pustular folliculitis. Demodicidosis has been associated with AIDS and chemotherapy for malignant diseases.

We describe a patient with the clinical and histologic features of demodicidosis, in whom rapid and complete recovery was achieved by a single oral dose of the antiparasitic agent ivermectin and subsequent treatment with topical permethrin cream.

A 32-year-old white man was seen with a 4-year history of a slowly progressive and pruritic facial eruption. Apart from mild seborrheic dermatitis on the scalp, he had no history of skin disease.

Physical examination revealed a diffuse erythema localized on the cheeks, the nose, the forehead, and the glabella. There were scattered 2 to 3 mm erythematous papules and follicular papulopustules with eczematous lesions and scaling. Blepharitis and 3 external chalazions were noted on the upper eyelids (Fig 1, A and B).

The retroauricular region, neck, and chest were not affected. The rest of the physical examination was within normal limits. The patient noted moderate to severe pruritus in the affected regions.

Laboratory findings including routine blood counts and acute phase proteins revealed no abnormalities. Enzyme-linked immunosorbent assay for HIV was negative. A skin test for recall antigens was positive for several antigens.

A 10% potassium hydroxide preparation of skin scrapings from the cheek showed many Demodex mites but no yeast or fungal elements. Histopathologic examination of a biopsy specimen obtained from the left cheek revealed features of both rosacea and seborrheic dermatitis and enlarged hair follicles containing structures of D folliculorum (Fig 2). Because of the long list of previous unsuccessful treatment attempts the patient received a single oral dose of 200 µg/kg of ivermectin (Mectizan; Merck, Inc, Whitehouse Station, NJ). Topical treatment consisted of applications of a bland oil-in-water preparation and was applied for 1 month after treatment with ivermectin.

Within 2 weeks after initiation of treatment the patient noticed a remarkable reduction of pruritus; within 4 weeks there was noticeable reduction in the size and intensity of the inflammatory response (Fig 1, C and D). Skin scrapings were negative for Demodex mites.

To prevent reinfestation 5% permethrin cream was prescribed for once-weekly use and was initiated 4 weeks after ivermectin treatment. Subsequent examinations during the past year showed excellent control of the disease. Repeated scrapings remained negative for D folliculorum. The patient in this case report presented with an unusual long-lasting history of rosacea-like dermatitis of the face and eyelids. For 4 years his skin condition had been diagnosed as rosacea, seborrheic dermatitis, or an allergic dermatitis of unknown cause. As a consequence, treatment was attempted with topical and oral antibiotics including metronidazole, topical ketoconazole, etretinate, and topical corticosteroids. Finally, the patient decided to treat his skin condition with homeopathy and diet. This attempt was also without success.

Ivermectin is a semisynthetic product from Streptomyces avermitilis, a potent macrocyclic lactone disaccharide antiparasitic agent used to prevent and treat parasitic infestations in man and animals. The compound has activity against internal and external parasites and has been found effective against arthropods, insects, nematodes, filarioidea, platyhelminths, and protozoa. Ivermectin, initially applied extensively to control loiasis and bancroftian filariasis, is increasingly used for the treatment of scabies in immunocompetent and immunocompromised patients. In this case a single oral dose of 200 µg/kg ivermectin effectively led to substantial clinical improvement within 1 month. Repeated skin scrapings remained negative for Demodex mites. The 10-year history of the use of oral ivermectin to control onchocerciasis indicates that it is a safe drug. In our case, neither the patient nor the investigators noted any adverse reaction. Meinking et al recently reported that ivermectin showed no residual activity 2 months after a single dose. To prevent reinfestation with Demodex mites, 5% permethrin cream was prescribed for once-weekly use.

Linda Sy M.D.
Linda Sy Skin Care

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About the Author: David Pascoe started the Rosacea Support Group in October 1998. .

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47 Reader Comments

  1. susan ricart says:

    I will 53 years old this coing November and have suffered with rosacea for approximately 7-8 years. I first noticed it when I moved from Ohio to San Diego during the El Nino and put vitamin C treatments from a dermatologist on my skin. The treatment seemed to aggravate my “pimples”. Another dermatologist diagnosed me with rosacea and I began topical Metrogel that helped. I then started HgH injections (very low dosage) from another doctor and noticed that my Rosacea virtually disappeared. That was early on. Now, it seems the condition has worsened. I recently stopped the HgH injections (about a month ago) and my skin gets a lot of tiny blackheads and whiteheads, very noticable flushing and redness, and the occassional pustule and watery pimple. No matter how well I wash my face there are are clogged pores. I have always had remarkably good skin, smooth, translucent, and finely textured. I never had facials because I never really needed them so this is unnerving. What is really concerning me is my itchy, red eyes. It is hard to wear any kind of eye make-up. In reading your internet article, I’m wondering if I could be a candidtate for the Ivermectin, Permethrin treatment. Right now, I am taking Cefalexina 500mg. (I can’t remember the English name for this. It’s a pretty general antibiotic I got when I cut my finger and the doctor in the hospital prescribed it. I noticed my skin cleared up so I saw online that it was also used in Rosacea therapy). I just am not a big fan of ingesting 3-4 of these tablets a day. I still will sometimes flush and my pores are still clogged. I also noticed that before my menstrual periods my Rosacea is at it’s peak so I control it with this antibiotic and Metrogel. I also must say that about 5 years ago I was getting the telagen….lasered on my face but stopped with that because they always came back eventually. My skin condition isn’t much affected by the cleansers I use. I am done seeing conventional dermatologists that don’t think outside the box. Obviously, Metrogel isn’t enough. I think this has something to do with the immune system and possible mites. Any advice would be appreciated.

  2. ANNA LOSONE says:

    After experiencing acne/rosacea type symtoms for three months, I finally decided to go see a dermatologist to find out what was itching on my face.
    KOH showed demodex mites I was treated with elimite and oral ivermectin, recurrence after 1 month. I am currently using the elimite cream bid for 14 days, 4 to go, with high hopes. My derm says if after treatment follow up appt. shows demodex on the KOH, then they will treat me again with oral ivermectin. THANKS!

  3. Hi Anna,

    Great that you found a derm who would support oral ivermectin, topical elimite for your rosacea symptoms. Hopefully your rosacea symptoms were also relieved at the same time as eliminating the demodex.

    davidp.

  4. Debra says:

    Need info about demodex treatment for acne and hair loss

  5. maureen says:

    I’m elated to have come across this site, and even more surprised to see Dr. Linda Sy’s name on it.
    I used a soap and shampoo from a chinese Dr. who also stated that Rosacea could be caused from these mites. I also feel like I have traveled the world looking for evey possible treatment to help.
    I totally plan on seeing a Dermatologist as soon as I can to see if I could try this treatment plan
    No one has anything to lose by trying this, but maybe every thing to GAIN especially our HAPPINESS back and to just be normal

    Wish ME LUCK MAUREEN

  6. maureen rosky says:

    Hi , Saw my Derma dr. last month would not let me try the oral Ivermectin and topical Permethrin. His words were oh we don’t use that.
    I will look for someone else.
    Maureen

  7. maureen rosky says:

    Hi Anna,
    I have had rosacea for many many years. Would you be willing to share who your Derma Dr. is? Here is my e-mail. maureenrosky@yahoo.com
    Thanks
    Hope to hear from you.
    Maureen

  8. Rosa says:

    I’m convinced topical Metronidazole works by disrupting Demodex Folliculorum (hair follicle mites).

    http://www.rosacea.org/rr/2004/spring/article_2.php

    Furthermore, topical Metronidazole will NOT work by disrupting Demodex Brevis (oil gland mites) because it can not penetrate down in to the sebaceous glands that they dwell in.

    Demodex Folliculorum (hair follicle mites)
    Treatment = topical Metronidazole

    Demodex Brevis (old gland mites)
    Treatment = systemic Accutane

    Treatment for the infections (pimples) caused by the mites dragging and burrowing bacteria commonly found on human skin can be helped by antibiotics. Antibiotics for Rosacea or Acne is just curing the symptom, NOT the cause of the problem. MITES!

    These mites become UN-commensal parasites when they reach large numbers.

    Many things can lead to large numbers (otherwise known as an infestation – weaken immune system due to illness, stress, age, poor diet, etc.

    http://skindisease.suite101.com/article.cfm/demodex_spp_face_mites

  9. Rosa says:

    I forgot to include…

    Demodex Folliculorum (hair follicle mites)
    Treatment = topical Permethrin

    Demodex Brevis (old gland mites)
    Treatment = systemic Ivermectin

    But good luck finding a Dermatologist who isn’t living in the dark-ages about the link between Demodex mites and Rosacea / Acne.

    It blows my mind that the Demodex mites (found on 80-90% of all human beings and the other 10% are infants) are not even illustrated in medical texts:

    http://en.wikipedia.org/wiki/Human_skin#Skin_layers

    They are leaving out a proven component of human skin! MITES!

  10. Helen says:

    Hi there,

    Please can someone tell me how long to leave the permethrin on for? I want to try the once weekly application but want to do it right! 🙂

    Thanks!

  11. Doug says:

    Look at this study. Uses oral Ivermectin and very effective. However, this study used 2 doses instead of one. You do one dose and wait 3-4 days and then do another dose. The size of the dose depends on your weight.

    Seems like it would be harmless to try. Thoughts? Any guinee pigs? 🙂

    Method for treating rosacea using oral or topical ivermectin..

    BACKGROUND OF THE INVENTION

    This invention relates to a method for treatment of rosacea (acne rosacea) in humans employing orally-administered or topically-applied ivermectin. By reducing or eliminating Demodex folliculorum organisms from affected skin areas, this method reduces clinical signs of rosacea which are primarily due to allergic and vasomotor responses of the body to the organism in susceptible persons.

    Rosacea, originally termed acne rosacea, is a chronic inflammatory skin condition affecting the face and eyelids of certain middle-aged adults. Clinical signs include erythema (redness), dryness, papules, pustules, and nodules either singly or in combination in the involved skin areas. Eyelid involvement may be manifested by mild conjunctival irritation or inflammation of the meibomian (oil) glands on the eyelid margin. Chronic eyelid irritation can result in loss of eyelashes. No visual impairment accompanies the eyelid irritation. Chronic involvement of the nose with rosacea in men can cause a bulbous enlargement known as rhinophyma. In the classic situation, the condition develops in adults between the ages of 30 and 50. While certain lesions of rosacea may mimic lesions of acne vulgaris, the processes are separate and distinct, the principal differences being the presence of comedones (whiteheads and blackheads) only in acne vulgaris and not in rosacea, the characteristic mid-facial localization and flushing of rosacea not seen in acne, and the potential for eyelid involvement in rosacea which never occurs in acne. In fact, the clinical observation has been made that persons who have classic acne vulgaris as teenagers rarely, if ever, develop full-blown rosacea as adults.

    The etiology of rosacea has been a frequently-discussed topic in medical circles but little consensus has ever been reached. The prominent presence of erythema (redness) and flushing of the face of affected persons with aggravation from heat, sunshine, and alcohol has focused attention on this aspect of the disease. However, treatment with medications to block such vasomotor flushing have no effect on other aspects of the disease such as papules and pustules. Treatment with oral antibiotics has been shown to effectively block progression of rosacea through a poorly-understood anti-inflammatory mechanism, but studies have shown that thee medications do not act by killing either bacteria or Demodex folliculorum organisms in affected skin. Reaction to the presence or metabolic activity of Demodex mites in facial follicles has been discussed as a cause of rosacea, but previous studies where topical miticides have been used have shown inconsistent and marginal results. Dietary avoidance of spicy foods and alcohol which cause flushing provides at most temporary symptomatic relief from rosacea. An excellent review of current knowledge in treating rosacea was written by Jansen and Plewig in their chapter titled “Rosacea” in Clinical Dermatology (Philadelphia: Lippincott-Raven Publishers, 1997; chapter 10-7.)

    Ivermectin (22,23-dihydroavermectin B1) is a safe and effective orally-administered antiparasitic drug that paralyzes and kills treated organisms by increasing cell permeability to chloride ions which in turn overpolarizes nerve and muscle cells. It is a broad-spectrum member of a family of lactone antibiotics known as avermectins which are produced by cultures of the bacterium Streptomyces avermitilis. It has been used orally in animals and humans to prevent and treat a variety of parasites including Strongyloides stercoralis and Onchocerca volvulus. Campbell wrote an informative review of the use of ivermectin in human parasitic diseases (“Ivermectin as an Antiparasitic Agent for Use in Humans,” Annual Review of Microbiology. 1991. 45: 445-74.) Studies have shown effectiveness in treating human infections with Sarcoptes scabei and head lice. Demodex folliculorum could logically be expected to be killed by ivermectin also since it, like Sarcoptes scabei, is classified among the members of the mite family. Related art specifying products or methods for treating rosacea has not claimed that any beneficial effects of the disclosed agents had anything to do with elimination of Demodex folliculorum from the skin of affected individuals. In U.S. Pat. No. 5,654,013, Taylor and Bass disclosed a method of reducing inflammation in rosacea involving lightly rubbing a block of crystalline sodium chloride over moistened skin in affected areas. No claim was made for any antibiotic effect on bacteria or ectoparasites in the skin. In U.S. Pat. No.3,867,522, Kligman discloses the abrasive use of sodium chloride crystals rubbed over affected skin in acne and related disorders, again with no intended antibiotic effect and with the goal of treatment being the lessening of the severity of the disease and not a permanent or even a temporary cure.

    BRIEF SUMMARY OF THE INVENTION

    The current invention involves treating rosacea by the oral or topical use of ivermectin. By effectively reducing or eliminating the population of Demodex mites in affected skin areas, this treatment achieves a more complete remission of clinical signs and symptoms of the disease than any previously described method.

    DETAILED DESCRIPTION OF THE INVENTION

    In the preferred embodiment of this invention, ivermectin is administered orally to a patient with active rosacea in a dose of about 200 micrograms per kilogram of body weight per dose. Because the target organism, Demodex folliculorum, is an ectoparasite in the mite family, an effective treatment must be capable of eradicating the entire life cycle of such a microscopic insect, including egg, larval, and adult stages. For this reason, this embodiment treats such rosacea patients with at least two doses timed so that between three and seven days separate the doses. Such spacing allows time for Demodex eggs to hatch into immature mites that are killed before they can mature into egg-producing adults. While two doses has been demonstrated to be quite effective, in unusual cases where absorption is impaired, as many as four doses at three- to seven-day intervals could be employed. After ivermectin carries out its miticidal activity on skin Demodex folliculorum organisms, inflammatory responses to them begin to diminish but remnants of the dead mites still elicit some flushing and lesion formation until the cleanup processes of the body remove them, a process requiring six to eight weeks. During this initial phase of ivermectin administration, conventional anti-rosacea medications such as oral tetracycline and topical metronidazole can be employed to suppress early flareups and to give early clinical response. No such medications are needed to treat manifestations of rosacea after six to eight weeks have elapsed. After prolonged intevals of freedom from rosacea symptoms, should classic signs begin to reappear, treatment can be repeated. Such retreatments should not be necessary more than one or two times per year.

    In an alternative embodiment, ivermectin is formulated into a cosmetically-acceptible topical lotion, cream, or gel and applied to skin affected by rosacea. Because of the well-known barrier effect the skin presents to the penetration of topical medications, such a route of treatment with ivermectin would be anticipated to require once- or twice-daily applications for as long as four weeks to achieve sufficient follicle penetration and effective miticidal activity. A topical formulation that could achieve this effect would contain about 1-5% ivermectin and could be enhanced in penetration if the active agent were encapsulated inside microliposomes. Such a topical treatment would likely need to be repeated more frequently than the preferred oral embodiment, but a disease-free interval should be achieved by each course of therapy.

    EXAMPLES

    Three adult rosacea patients with varied clinical presentations and with varied disease durations are selected to illustrate the disclosed invention. These patients’ cases illustrate the effectiveness of ivermectin treatment on the different clinical manifestations of the disease.

    Patient 1

    This 44-year old Caucasian female had exhibited clinical evidence of rosacea for 1-2 years and had been treated with limited success with oral tetracycline, topical and oral metronidazole, and cortisone creams. Her facial skin exhibited mid-facial erythema and flushing with papule and pustule formation. In addition, her eyelids exhibited chronic blepharitis and repeated loss of eyelashes, which is quite typical of rosacea. She was treated with ivermectin, 200 micrograms per kilogram of body weight in each of two oral doses with an interval of four days between doses. Oral tetracycline was continued at a dose of 500 milligrams per day for the first 30 days after ivermectin was given and then was discontinued. After a mild initial flareup of mid-facial papules, the condition improved rapidly to the point that by 60 days no papules were present, all eyelashes were growing back, and she had no more flushing with heat or spicy foods. Symptoms had not returned after three months.

    Patient 2

    This 33-year old Caucasian female had the acute onset of papular and pustular rosacea involving nearly all of her cheeks and chin two months prior to her evaluation. Marked itching and redness were present, but no eye symptoms were noted. Ivermectin in two 200 microgram per kilogram oral doses given three days apart was administered along with a four-week course of oral tetracycline. The clinical signs abated quickly, with itching being gone after one week and papular lesions clearing by three weeks. At two months from the onset of treatment and one month after cessation of tetracycline, no clinical signs or symptoms of rosacea remained.

    Patient 3

    This 65-year old African-American female had suffered from severe papular and pustular rosacea of the mid-face and nose for 15 years. Tetracycline, in doses of 500-1000 mg per day had proven to be the only partially-effective medication for her. Oral ivermectin was administered in two 200 microgram per kilogram doses given four days apart and tetracycline was continued for one month in a dose of 500 mg per day. Followup at three months from the start of ivermectin therapy revealed only mild hyper-pigmentation at the sites of previous inflamed papules and pustules. The patient reported that no new lesions had been noted for six weeks prior to that 3-month evaluation.

    While these examples illustrate the preferred embodiment of this invention, the treatment of rosacea using oral ivermectin, exposure of Demodex mites to ivermectin from any route of administration will result in the elimination of the organisms and secondary amelioration of the signs of inflammation that are typical of rosacea. Therefore, the topical use of ivermectin in any vehicle that allows it to adequately penetrate into skin follicles to reach the level occupied by Demodex folliculorum will be an effective treatment for rosacea and is considered to be entirely within the scope of this invention. Changes of dosages, dosing schedules, concentrations, vehicles, and frequency of repetition of ivermectin regimens are also not considered to be outside the scope of this invention.

  12. Christine says:

    I feel like something moved in and took residence on my scalp about 5 months ago. It started with a twinge here & there…pretty random. I would run to the mirror to see if there was indeed something crawling on my scalp but I couldn’t see anything. It progressed to mild itchiness, then it became more extreme and constant. I’ve tried dandruff shampoos, tea tree oil..combind with shampoo, vinigar rinses, etc which offer some temporary relief (vinigar & tea tree oil)..but the itch still comes back in force. All of these I tried after going to the dermatologist who couldn’t see anything either, but did prescribe minecycline & topical steriods together. It cleared it up…but once off the minecycline, it came back to the same extent as before. It gets worse if I exercise and my head gets hot or sweaty.
    I did some reasearch on line and found the “mite” theory which seems to make perfect sense, but the doctor is saying these are there no matter what, and I must have just developed a sensitivity to them, rather than they just moved in and took up residence (which is what I really feel happened). She also says there is no permanent cure for it if it is demodex mites and there is no way to scrape or take a picture to find out what it is. How could this be? I’ve seen pictures and I’ve heard of scrapings, and I’ll pay to have an analysis done…I just need help! From this article, it seems like Ivermectin might be the way to go, but I don’t have,, not have I ever had rosacea or skin issues. I really feel it was introduced by my hairdresser. I’m off to buy pyrethrin…but I could really use some help/advice on where to start and who to talk to. I can’t live like this!

  13. M.R. says:

    I think you all should be looking into the ZZ cream by demodex solutions, that’s where I’m going for this problem. Permethrin is toxic, and I can’t use it more than a couple times, which doesn’t address the mite life cycle.

  14. Mary says:

    hi there

    I wanted to thank everyone for offering me hope. I have always had transient facial rednes and blotchiness. I was prescibed an Rx steroid cream…BIG MISTAKE! i withdrew and developed steroid induced roscaea. Thought my problem was bad before the steroid cream…now it is unbearable. My derm MD (not the one who prescribed the steroid cream) made me go cold turkey on the stuff and now I am miserable. Never looked worse! the redness and irritaion are much worse when there is a flare-up. been off the Triamcinolone crean since January. I now am CONVICED there is a demotex population fluorishing on my face. Mostly cheeks and chin areas as I never used the topical steroids on my forehead or perihery of my face. Without rambling here, I am glad to be educated about these organisms that may very well be the culprit… It all makes sense now. Where can I get this ant-demotex Rx? i don’t think my current MD would ever prescribe as it prescribed to treat scabies. I am sure the AMA would not recognize this as a standard treatment here in the USA. I am a registered Nurse and I am somewhat skeptical regarding the usual methodologies of modern medicine. I would appreciate any advice you could provide.

    Thank you again!

    Mary

  15. heather says:

    I am 38 yrs old have always had really clear skin except for the usual puberty acne years back. all of a sudden started getting rosacea on my face i basically just had a little bit of redness quite a bit of flushing. the redness was only on one side of my face though and then i started getting all these pimple looking itchy bumps. i got metrogel from my family dr. it didnt really do much at all. And everything aggravates it. then i went to derm. and she gave me doxycycline. it didnt help either. I just happened to stumble accross this website one day looking for other avenues of treatment. I work for six drs at a family practice and i dont have much faith in drs. I thought there had to be another answer. So anyways i came across this website. Wow it made total sense to me because it felt like something was biting me and makiing my face itch. And it just kept getting worse and worse. So I went back to my family dr and told her about this and she agreed to let me try the permethrin cream she had never heard of this. I have been using this cream for about 2 months now. but instead of the once a week thing i started using it everyday for about a week or so and now i am just using it like every other day. I stopped taking the doxycyline. The other day I got a compliment on how pretty my skin looked. I havent heard that for a long time. It got to the point where I didnt want to go out anywhere looking the way I did. Everyone in my life couldnt see it but i could and it affected me greatly. i will continue to use the cream for the six months and forever if i need to. I asked a pharmacist if it was harmful he said it was not. it is made from some kind of plant. This was the answer!!!!!!! Thank God for this website. And the more I use it the better it gets. In the past couple of weeks I have sunbathed with no breakout, I have had spagetti, pizza, fries no breakouts. I am sooooooooooo happy.

  16. heather says:

    Another thing my only complaint is that now i feel that it is still on my head because i have been getting these huge itchy pimples on my scalp so i am wondering if i need to treat my scalp too?

  17. mary says:

    i had the severe head itchies for years and went to quite a few Drs who treated me with pills for delusional behavior instead. I had scalp lesions, and tiny black dots on my scalp. pillowcase, and inside tee shirts near the upper back area. a lab said the black dots were “vegetable matter”. Personally, i think it was demodex excretion. I know for a fact i had something, and did my own skin scrapings, and saw demodex. it was certainly more apparent at night in the dark. I couldnt wear a hat, because that would activate them due to creating darkness on my scalp. I took ivermectin, which 20 minutesvafter i took the pill, it felt as all hell had broken loose. felt like total scalp activity, and things hopping off to escape the medication. there was nothing visible of course, although it felt like there should have been. ivermectin made me feel initially better, but i had to take matters into my own hands and used something called Rotenone. A pyrmethrin that i dont recommend, since it is toxic, however i couldnt live the way i was with the itchies.It did cure me. prior to that, the huge numbers of demodex created a reaction in my body, where the antihistimanines went into action. this response also set up an autoimmune condition in my body where i started losing pigment, and joints aching, etc. Once i cured myself, it all disappeared. This was all many years ago. I am still ok, although recently i think i am feeling a build-up again.

  18. jim says:

    Hey, mary, I’ve been looking for help because i also think i got demotex and I may try to buy whatever you tried and see whether it can help me.

    I have scrawling and inching feeling over my body…The back of my scalp have bumps which i believe is created because of the mites and i really want to do whatever i can to get rid of them.

    I really need any help that anyone can offer…How to get rid of these mites or at least, keep them at the minimum.

  19. Caroline says:

    I have had rosacea for at least 5 years. After reading these posts (and other studies) I asked my derm to prescribe 5% Permethrin Cream. I started using it and noticed improvements almost immediately. Subsequently, I then got another flareup (flushing, pimples, etc.) so asked to try the oral route (Ivermectin/Stromectol) to complement the cream. I have taken one round of Stromectol as described in earlier posts, e.g, 1 dosage of 4 pills (for 150 lbs.) followed by another 4 days later. My skin is MUCH better. In fact, I noticed this morning how smooth it was when washing my face. (No more of those little micro bumps….) Also, I notice that I no longer have facial itching (which was driving me nuts…..) I have tried a lot of other options (Finecea, Oracea, Sodium Sulfacetamide) which I think still have benefits, but NOTHING has worked as well. Currently, using Permethrin 1x day plus Finecea on the typical problem spots. I hope this helps someone. I’m going to ask my derm for refills for the Stromectol.

    I don’t care if Demodex is the cause—for me it seems to aggrevate the Rosacea. So if I can lessen the symptoms –that’s a good thing!

  20. Linda Cutright says:

    I have been having problems with my face for the pass 4 years….I had livestock and lots of dogs…When one of our dogs started have skin problems we took him to the vet. He was put on antibiotics and he did get better. Ever since then I have had trouble. I use Permethrim and ivermetrim all the time with my stock…I don’t have livestock any more…but do have dogs. My doctor gave me antibiotics for 2 months and my skin cleared up…but, as soon as I quit it for 7 days the problem was back. Is the meds I use for my animals safe for humans…this problem seems to be over the head of my doctors. I have told them I thought it had something to do with my dogs or livestock. Mites seem sensible to me. I will try a new doctor…but seems like they only have one thing in mind…coming back again and again. NO time or money for that.

  21. Comment via email from Heather.

    “i have heard of ivemectin being used on people and that it worked well. i have used the permithrin cream 5% and it did not harm me the pharmacist said it would not harm me. it worked good. better than metrogel or anything else. except for now iam using rosacea ltd. it is all natural and so far is working the best out of anything.”

  22. Brady Barrows says:

    Aloha Dave,

    Isn’t it spelled Permethrin?

    http://en.wikipedia.org/wiki/Permethrin

  23. mary says:

    Ivermrctin did not work for my scalp and I took it many times.

  24. mary says:

    Goodwinol shampoo for dog demodectic mange has rotenone in it.

  25. Linda cutright says:

    Thank you for all the info..Heather has gave me some more avenues to try..I have tried tea tree oil and it did help …but doesn’t last…I’m trying to get the right program …at night or in the morning or both…I will try permithrin cream and see what happens…what do I have to lose..I don’t have any trouble with my scalpe. just my cheeks and chin…comes and goes…mostly comes…tea tree oil made my face feel smooth…hasn’t in years…thank you all again..

  26. Merry says:

    Hi my name is Merry. I had nose surgery last jun/11 I have been suffering of red marks on my right cheek and some red areas on my left cheek. I have been going to drs since last July. Some of drs have said its rosacea, some of them said its acnes from nose surgery. They prescribed me Doxycn and oracea which none worked for me. I an new to this site. I really want to know how I can use the tea oil.. Also, I am kind of thinking,, I may have the Demodex mites. Thank you.

  27. Linda cutright says:

    Hi Merry…I found tea tree oil in a cream..you can get in at vitamin world…I can’t believe how good my face is now. Tea tree oil also kills Demodex mites. I use it every other day…I have fair skin and every day dried my face out. It took about 3 weeks before my face cleared up completely…hope it works for you.

  28. Merry says:

    Tanq so much for reapplying Linda. I bought the tea tree oil not the crean. It’s been 2weekly that I m useing it. The first week my face was better, now it’s more red and bumps appeared on my face..the thing is, I don’t even know that I have demodex mite or no.

  29. jim says:

    can someone tell me which tea tree oil are you using, and where can i buy it??

  30. Merry says:

    Jim,, I bought it from wholefood market. It’s a 100% tea tree oil,, $10 box.

  31. Linda cutright says:

    You can get tea tree oil almost everywhere..drug stores, safeway even has it here in my town. I can’t use it every day or my face would get red and flaky…more bumps too. I use it every other day, and that has worked for me..I’m not sure what was wrong with mine face…mites or something else…I just know it is better…completely cleared up. I use the cream…it is just tea tree oil 100% and aloe and some other creams…hope it works for you …I feel so much better now..good luck

  32. hopeforcure says:

    Many thanks to all who’ve contributed to this topic!

    Can someone please recommend a specific tea tree oil product(s) that works well to fight Demodex mites, but also has a mild scent?

    More info on my history follows:

    I’ve tried many things since I started suffering from Demodex mites. (Occasional itching/crawling/biting sensations started a year ago; I thought it was due to other things.) A horrible infestation broke out in February 2012, after a traumatic event that may have compromised my immune system.) My dermatologist (who published a paper years ago re: treating an AIDS patient with Demodex mites) doesn’t want to prescribe Ivermectin, so he’s given me 4 topical steroid products (which I’ve read can make the problem WORSE, since the mites like hormones; I’ve used those products only sparingly) along with Permethrin 5% cream. (As he prescribed, I’ve used the Permethrin twice from scalp to toes, one week between applications.) I was finally free of any itching last week, but 4 days ago the itching/crawling returned. I’m now using the Permethrin cream daily: sparingly around my nose and around my scalp hairline, which is where I feel most of the itching. It’s helped, but I still have some symptoms and would prefer a product for long-term use that has minimal side effects. I also doubt my dermatologist will keep renewing my Permethrin cream.

    Can someone please recommend a tea tree oil product that works well to fight Demodex mites, but also has a mild scent? I bought Vitamin Shoppe brand tea tree oil, but I returned it after using only a few drops. The strong smell was unbearable on my body (I tried only a few drops mixed with a facial wash solution on a very small area.) Also, my bathroom smelled horrible for 2 weeks afterwards from just opening the bottle (and possibly showering off the TT oil, but I cleaned the shower afterwards and the smell was still strong.) I’ve tried a few samples of various tea tree oil products at Whole Foods (sniff test or putting a drop on my arm) but they also smelled very strong. As long as the scent disappears after a short while, I can live with that, but I can’t be around other people wearing something as strong as the Vitamin Shoppe TT oil! Please be very specific if you reply with a product recommendation, and if possible, please tell me where you bought it. Thanks in advance!

  33. hopeforcure says:

    UPDATE: a major breakthrough! Yesterday, my body was itch/crawl-free, and I had minimal itchy or crawly sensations on my face or scalp! (Mite sensations occur now mostly after I apply the Permethrin on specific areas; I think it’s the mites trying to run away!) Here are the details of what’s happened:

    After my previous post 5 days ago, I had increased redness and tiny bumps around my face and mouth. I began putting my Permethrin Cream 5% on those areas in am and pm, after washing the same area with “R. Essentials Fresh and Clear Therapeutic Cleanser,” which has 5% glycolic acid and 2% salicylic acid. The problem got worse for a few days, and I almost stopped because the treated areas looked and felt very irritated from the cream and/or the wash, but then things got better. (I don’t know if the cleanser played a role in either the initial irritation or the eventual improvement, but I’ve been using a different 2% salicylic acid product on and off for two months, because I’ve read it can help get rid of mites.)

    I then added this, in both am and pm: I used a Q-Tip swab to put a small amount of my Permethrin Cream 5% INSIDE my nostrils. This is because I’ve read that Demodex mites can be found in that area. Also, since my Demodex symptoms first began, I’ve noticed that the inside my nostrils was red and that I would have some itching inside my nose. (I thought it was allergies.) I’ve done this additional step of applying the cream inside my nose twice a day for 3 days, and now my facial redness and tiny bumps are almost gone!! I have only a slight pinkness outside one nostril; it’s tiny and hardly noticeable. It will probably be gone tomorrow.

    I never tried putting Permethrin Cream 5% inside my nose until the past few days, because the instructions say don’t apply inside nose or mouth. However, I was desperate for a cure! It seemed to irritate the area for the first couple of days and made my nose “run” a little bit, but today I’m OK. Not sure if it was the mites that were causing the burning sensation or the cream, but it was apparently temporary. The skin inside my nostrils looks less red than it has for at least a year!

    I am still using Medicated Selsun Blue selenium sulfide 1% shampoo daily on my scalp and Aubrey Sea Buckthorn soap daily on my body in the shower (I also have used Aubry Sea Buckthorn Moisturizing Cream, which seemed to also help a bit with body itching, but I’m not using it now. I bought the Aubrey products at my local Vitamin Shoppe store. I’ve read many posts that recommend Sea Buckthorn products to fight the mites.)

    I stopped using all four of my prescription topical steroids weeks ago, and I’ve recently stopped using many home remedies that I’ve tried for the past 2 months: Neem oil soap, Neen oil shampoo, borax mixed with hydrogen peroxide or apple cider vinegar and water, dry mustard added to body washes and shampoos, 2% Neutrogena salicylic acid body wash (used on my face), etc. Also, on March 2 and March 30, my dermatologist injected an area on the back of my scalp where I had scales and lots of itching with steroids (which caused the mites to go crazy right afterwards – ouch! But the scales went away and have stayed gone with using only Selsun Blue shampoo.) I think all these things helped get rid of most of the mites, but the Permethrin Cream 5% applied to remaining affected areas seems to be killing off the remaining mites.

    Summary of my use of Permethrin Cream: I did a full-body overnight treatment of Permethrin Cream twice: March 3 and March 10. Each time, it helped a great deal. However, the mite symptoms returned after each treatment, but to a lesser extent. For the past 9 days, I’ve been using the Permethrin Cream applied sparingly on itchy areas of my face and head, mostly around the hairline, ears, nose, and mouth, and on my eyebrows. For the past few days, I’ve also used the Permethrin Cream inside my nose.

    Caution: package insert for Permethrin Cream 5% says do NOT put the cream inside the nose, so please make your own choice based on what you and your doctors decide. But, a tiny amount applied inside the nose (I only apply it near the opening of the nostrils, ~one centimeter inside the opening) seems to be killing kill off the last of my Demodex mites!

    Per my previous post: I’d still like to try tea tree oil products that have a mild scent. I’d like to add them to my routine for maintenance, and possibly stop my use of Permethrin Cream. Please post a reply if you have any recommendations.

  34. Caroline says:

    I’m still having good results with permethrin. I dont apply it in my nose but I do make sure to rub some on the undersides of my nostrils. Same for eyebrows. Since doing this I have not had ocular Rosacea either. I’m convinced it works for me.

  35. Scott says:

    Try two drops of pure tea tree oil in a spray bottle of water. spray it on your face (eyes closed of course) and let dry to help sterilize your skin and hair follicles. It has certainly helped my skin

  36. hopeforcure says:

    Thanks, Caroline and Scott.

    Caroline, I think your idea is a good one, since after using the permethrin daily, my nostrils got sensitive when around allergens, such as dust. I’ve stopped using permethrin since ~5/29. (All of my itching/crawling sensations had already stopped by then.) I’ve recently had success using 100% pure aloe gel (Fruit of the Earth brand) used liberally on the affected areas around my nose and mouth, two to three times a day. Because I think the mites are gone now, I may have some other problem that causes redness and bumps in this area. The aloe gel seems to calm my skin better than anything else I’ve tried, prescription or otherwise.

    Scott, can you please share the specific name of the TTO you recommend? The brand I mentioned in my previous post has too strong of a scent – it’s far worse than PineSol! I can’t even take the top off the bottle without my bathroom smelling bad for days.

    Any other reader suggestions for a mild-smelling tea tree oil brand would be appreciated.

  37. Judy says:

    has anyone seen theses mites coming out of their nose, I have a very strong mirror which I am able to see them I feel them in my ears and around my eyes.
    My doctor seems unable to find a cure
    I have tried tea tree oils also products for kills nits & head lice but that made no difference. I have used permethin 5% which did help, but unsure how often I can uses it
    Any advice welcome

  38. sharrod says:

    hi, i have been looking for a treatment for this for a about two year’s this almost brings a tear to my eye .i been to all types of doctors but only to get turned away or to get a bill,i sometimes said god couldnt be real,i hope it dont be hard getting the mediction

  39. Flash says:

    I have just ordered 4 tubes of 1.87% Ivermectin from ebay. It is for horses. I have heard great things by using this topically. I am also going to take it internally and I will let everyone know my results. I have demodex on the backs of my arms for nearly a decade! One doctor told me it was rosacea and I did some research and demodex is what I have, there is not doubt in my mind.

    I believe that rosacea is just a skin irritation that causes the mites to eat away the dead flaky skin, which then, in turn, causes a secondary bacterial or fungal infection, causing the red bumps.

    I have also been using Seabuckthorn soap, and it seems to have everything under control, but has not eradicated the problem.

  40. peggy says:

    hi .i just wanted to know how to exactly use ivermectin .
    im suffered of rosacea .:(

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