Update after two years.

Overall my dermatologist is pleased with the results however she can still see evidence of demodex activity on my face particularly around my nasel folds and chin and she reminds me to keep using the scabies lotion regularly as maintainence.  This is evident in the images below, as a couple of small pustules.  

My face looks a little flushed in these shots and it's due to a couple of reasons.  One reason is that we are now treating the strong veins around the nose and over the chin with a new laser called Genesis.  We are also going over the cheeks to close off the veins to remove the background redness.  

This new laser is very effective and the downtime seems to be less than the previous laser.  While it is so much more targetted, it is also very much more painful and I'm only on a moderate setting.  I haven't had to resort to a stressball until now, and behind my goggles I am weeping with pain.

Unlike recovery from the previous laser, the recovery is less like a surface burn but more of an interior swelling so my past strategies of quickly cooling the skin does not apply.  In fact, there's really nothing I can do but be gentle for a couple of days and not let my husband near me with his beard stubble which feels like a thousand daggers.  

The second reason for the flushed appearance could be due to anti aging products recommended by my dermatologist which can both cause flushing.

I'm still getting into the routine but basically it's using a Vitamin C topical serum in the morning with 50+ sunscreen over the top and at nighttime, a very low percentage Retinol topical with Hyaloronic Acid serum over the forehead and cheeks and the scabies lotion around my nasal folds and chin.  I couldn't afford the topicals sold by my dermatologist but have purchased very similar products from The Ordinary which are almost a tenth of the price.

At this point, I am very confident in my skin.  My complexion is generally clear and even.  ...and not bad for nearly 51!

PS.  At long last I got a sample tube of SooLantra and used all 10mg of it over the course of 5 nights (just around my problem areas).  It was okay.  No reaction, no nothing really.  The Cetaphil base it consists of makes it easy to apply and lightly moisturising.  My feeling is that the Quellada or Lyclear is just as good and at a fifth of the price.  I was glad for the opportunity to test it out though!

 

As you may have read in my previous posts, I used Quellada Lotion and Lyclear Cream but these are just two of the many Permethrin 5% preparations you can purchase over the counter and use off-label in your quest to eliminate the demodex mite.  

Because these two products aren't available worldwide, I thought I'd dedicate this post to brands available outside of Australia.

Manufacturer                       Brand

GlaxoSmithKline                    Kwellada-P
Actavis                                  Permethrin Cream
Perrigo                                  Permethrin Cream
Galderma                              Permite
Sandoz                                  Permethrin
Galenium                               Scabimite
Neoderm                               Lindell Lotion
Steifel                                   Nedax-5
SkinVenture                           Casthrin Lotion
Prestium Pharma                    Elimite Cream
Renaissance Pharma               Permethrin Cream
GlaxoWellcome                      Nix Dermal Cream
Amideep Pharmaceuticals       Permarin
Tomar Medicines                    Skabi-Rid
Glenmark                              Glenper Cream
PSM                                      Lyderm Cream        
             ...and many more.  

If none of the above are available in your particular country, internet search "permethrin 5% scabies" and your search engine will bring up a brand available to you locally.

Read the ingredients on the box or bottle to confirm that it contains 5% Permethrin.  The other ingredients will consist of the carrier and preservative.

Best wishes
Kate

One year on and still amazing results.

It's been a year since my last photographs and I thought it would be great to update you on my skin.

I have been less regimented with the scabies lotion (Quellada) over the last year - only using it for a couple of nights in a row when I get a breakout on my chin or in the nasal folds.

I haven't had any more laser treatment since I finished the course in early 2016.

My routine these days is very simple.  I keep my skin clean with a gentle cleanser (Cetaphil) and because I'm now 50 years old, I've been using a basic hyaluronic acid to keep the wrinkles at bay topped with Cetaphil lotion (to trap the hyaluronic acid in).

I always wear a hat when I got outside and I am mostly pretty good at remembering to apply sunscreen.

This probably really is my last post regarding my battle with rosacea.  ...maybe...

All the very best

Kate

My rosacea has been beaten so this is a final update...maybe?

I saw my dermatologist last Thursday.  She has told me that she doesn't want to see me for the next 18 months.  Hooray!  I like her a lot but the consultation fee is something I don't particularly enjoy paying.

Her advice is to continue using the Quellada Scabies Lotion just once a week as a maintenance against the demodex mites.  She said I could use the Lyclear but I reminded her that I was a bit irritated by the formaldehyde in the cream although once a week as maintenance would not be an issue for me as it was when I was using it daily.

She said that there is no need to switch to SooLantra.  It does the same job and the Quellada is 70% less expensive.

My advice to anyone who has found my page:

• Ignore my earlier posts and go straight to using a dedicated scabies treatment - either Lyclear or Quellada.  Use it every evening and eventually the demodex mites will be eradicated.

If you can afford to, use SooLantra.  I would imagine the preparation is very gentle on the skin although I have not had the opportunity to try a sample.

• Only once the mites have been eradicated will it be worth assessing the damage to your skin and determining a course of repair as in IPL (Intense Pulsed Light).

• The science is here to support it and dermatologists the world over now agree that the pimple and pustule rosacea is caused by demodex mite infestation (or over-colonization) so don't be afraid to broach this subject with a dermatologist. It is interesting to note that ophthalmologists came to this conclusion a lot earlier linking blepharitis and occular rosacea to demodex mites.

• Don't fall prey to companies (or individuals) with outlandish claims of a magic cure.  There are a lot of people making a lot of money because of rosacea.  If it sounds too good to be true, avoid it!  When I was experimenting in my earlier posts, I was enticed to try a bit of pseudo-science (apple cider vinegar, hydrogen peroxide, undiluted tea tree oil etc) and I am the first to admit that the feeling of desperation can override usually good common sense.  

Finally, be kind to yourself and be gentle on your skin.  Don't be sad about the damage, the skin has a remarkable ability to repair if you gently (and patiently) help it along.  

Right side of face. May 17, 2016

Left side of face. May 17, 2016

Best wishes

Kate

My battle against Demodex Mites has been won!

It's really nice to know that people are reading about my journey!  Here's an update...

It has been almost one year and my skin has improved significantly.

Since getting the demodex mites under control using Quellada scabies lotion on a daily basis, my dermatologist has said to use it once a week.  Sometimes I forget and use it every couple of weeks when a small pimple reminds me to apply the lotion (paying particular attention to my sebum rich areas - the creases of nose and chin).

Morning routine at this time:
Cleanse with Cetaphil.
Zinc sunscreen with a tint OR I apply a mineral foundation if I am needing a made up look.

Evening routine at this time:
Cleanse with a micellar water to remove the sunscreen or makeup.
Apply Cetaphil lotion OR Quellada (once a week - I aim for Sunday evening)

The redness which remains is veins damages from the Demodex infestation.  To minimise the flare ups, I have had 4 sessions of IPL.  Initially the settings were low and bearable but each session is now dreaded as the operator has increased the pulse and focuses on my problem areas - on and around the nose and a couple of really stubborn veins on my chin.  I take two paracetamol before I go to the appointment but I doubt they do much to counter the shock of each zap.  I describe myself as pretty tough but I cried during my last session.

On average, it takes me around 3 days to recover from a session most of which consists of tender skin, one or two little bruises and swelling beneath the eyes.

I've got a routine I follow to minimise the discomfort.  As soon as I get into the car, I apply alcohol free aloe vera gel and turn the air conditioner on for an icy blast.  As soon as I arrive home, I very gently wash the sunscreen off my face (applied by the IPL operator as a matter of course) and apply Advantan cream followed by a layer of aloe vera.  I spend the next couple of hours sitting up on the bed, fanning my face with a hand fan and gently applying cold compress to particularly hot areas.

I stopped using the Solosite burn gel but only because as soon as you touch it, it sort of flakes off in blobs and was a bit messy.  I recommend that you don't go out in public with it on.  Other than that, if you have some on hand, go for it!

Within a couple of hours, I have the redness under control.  The skin feels very tender and remains that way for a few days.

I almost forgot!  Here's some exciting news for Australian rosacea sufferers!...  My dermatologist said that SooLantra will be here within the next month or so.  She said that although the Quellada has been excellent for me, she would get me a sample of SooLantra to try.  It will be interesting to see how much the SooLantra will cost here but it won't be anywhere near as affordable as the $25 a bottle I pay for Quellada.

Still battling the demodex mites but winning!

Since my last post, I saw my dermatologist and was recommended to try IPL (Intense Pulsed Light) to reduce the redness in my cheeks, nose and chin where the veins are damaged.  

I had my first session 4 weeks ago at the dermatologist and am due for my second session tomorrow. 

The head dermatologist came to inspect my face before the session and she said that I had done a great job of reducing the mites but they were still evident around my nose creases and on my chin. I realised that I hadn't been focussing on those areas since it was the pimples and pustules on my cheeks which had been causing me the most concern.  Since then I have paid particular attention to the chin and nose creases and there has been a nice improvement. 

During the session, the zapping was uncomfortable particularly around the base of the nose and nostril flaps.  I figured that if I don't make a fuss it will be over faster so I gritted my teeth and tried to focus on my breathing.

The following four days were spent being very gentle on my skin and using a thin application of Advantan cream (daily) and regular applications of Aloe Vera gel to soothe the burning feeling.  I found some Solosite gel in the cupboard and it was nice but if it was touched after application it was a bit messy to deal with.  

After my skin felt calm again, I continued with my current demodex mite eradication.

Currently I am using Quellada lotion once a day.  The best time to apply it is in the evening just as the mites are starting to emerge.   

You may recall, I was using Lyclear with great results but after a couple of months I noticed discomfort most likely from the preservative (formaldehyde).  My dermatologist said to use whichever feels the best.  Most people wouldn't react to the amount of formaldehyde so it's a matter of trying it.  The Lyclear is certainly easier to apply.  The Quellada is wetter and therefore takes a bit longer to work into the skin.

Here are the latest images of my cheeks.

It's been a while between updates.

I met with my dermatologist in February and while she was up to date with information regarding the approval of SooLantra in the US, she was not supportive of me using Ivomec.  

"Too strong, too strong!" she said.  

I am inclined to disagree based on how my skin was responding and improving but I'm not a dermatologist. In hindsight, I think that the tea tree oil products were too strong but used less often and for particular reasons will continue to have their place in my routine.

My dermatologist started me on a Permethrin 5% scabies cream called Lyclear Dermal Cream.  

From the patient information leaflet: "Lyclear Dermal Cream contains butylated hydroxytoluene (E321) and formaldehyde which may cause local skin reactions (e.g. contact dermatitis), or irritation to the eyes and mucous membranes (lining of the nose, mouth and genital areas)."

I commenced twice daily usage (February 10th) and mostly my skin has responded very well with only two significant skin eruptions.  The skin generally appears smooth.  Flushing episodes are less common and abate sooner than in the past.  

My rosy complexion remains but that is due to the many broken capillaries across my cheeks and around my nose and will have to be addressed by future laser treatment.  I am able to disguise this by applying a mineral foundation (or a tinted sunblock) but am careful to wash it off as soon as I can.

The demodex mites continue to inhabit my pores but in fewer numbers these days.  I can feel the tingly, itchy feeling here and there on my face and in my hairline after the sun has set.  It serves to remind me to apply the Lyclear cream before I go to bed.  There have been a few occasions, that when the itching feels more aggressive than usual, I apply the Ivomec fluid and after that has dried, I apply a layer of Lyclear over the top.  

My current routine is as follows (and is dependent on how my skin is feeling at the time):

Morning (if showering).
 - Wash with TTO foaming cleanser OR with Cetaphil cleanser. 
 - Apply Lyclear Dermal Cream.

Morning (if not showering).
 - Dampen cleansing pads with micellar water (currently using Suisse Micellar Water because it was on special!). Discard and use a fresh pad to finish.
 - Apply Lyclear Dermal Cream.

I wear a hat when I go outside but if a sunblock is needed, I use a tinted 30+ by Invisible Zinc.  I don't like the shininess but the colour helps to disguise my broken capillaries.

Evening (if not showering).
 - Dampen cleansing pads with micellar water. Discard and use a fresh pad to finish.
 - Apply Lyclear Dermal Cream OR if there is obvious mite activity (bumps/itching) apply Ivomec (allow to dry) and then apply Lyclear Dermal Cream on top.

Evening (if showering).
Wash with TTO foaming cleanser OR with Cetaphil cleanser.
 - Apply Lyclear Dermal Cream OR if there is obvious mite activity (bumps/itching) apply Ivomec (allow to dry) and then apply Lyclear Dermal Cream on top.

My application of Ivomec fluid topped with the Lyclear has so far not exceeded more than once weekly.  I have used it as "booster" when I can see that there are bumps forming.  I apply it at nighttime because that is when the demodex mites are active.  

In additions, I recently started taking vitamin D3 and vitamin B but not specifically for this issue. 

The two pics below are a vast improvement on what I was dealing with late November 2014.  My right cheek (bottom image) has always been the worst effected.  It's the side I sleep on. 

My next appointment with the dermatologist is in June.

Week 5 progress pics.

Where have we come in 5 weeks of using firstly Tea Tree Oil products and Ivermectin in the form of Ivomec?

Here are the first images taken November 29, 2014 followed by the most recent images taken today January 26, 2015.

Without a doubt, there has been an improvement.

One week until I see my dermatologist.

I've focused on applying the Ivomec in the early evening (before the mites stir from their "homes") and again before I go to bed.  

The break outs are less common now.  There hasn't been a deep hot bump for a couple of weeks and the white-headed pimples are no longer a daily occurrence.  A dab of TTO comes to the rescue and quickly heals the spot.

While the skin on my cheeks still appears to be red, I'm wondering if it's a combination of vein damage and that it's just going to take a long time for my skin to heal now that I seem to have the mites under control.  I wouldn't want to address the issue of broken veins until I'm 100% confident that I can control the rosacea.

One week until I present myself to the dermatologist.

Week 3 and the demodex fight back!

My skin, which was looking less inflamed into week 2, is now a battlefield of raised red bumps and surface whiteheads.  I am being woken around 2am by a sense of the mites moving over my face and brows and have been reapplying the Ivomec.  My pores seem to have enlarged again with the increase in activity over the past three days.

I had read in the Galderma trail results that there is a surge of activity at the week three mark and I'm certainly noticing it.  The fact that I am experiencing this using the Ivomec gives me hope that it is working in the same way as the SooLantra and am looking forward to a turnaround in week 4 and continued improvements onward from that point.

I am continuing the daily cleansing of my face with the TTO foaming facewash and the nightly application of Ivomec when the mites are moving from the pores in search of a breeding partner.

Two weeks to go until I see my dermatologist.

Seeing results with Ivermectin.

After one week of using Ivomec twice daily after cleansing, I'm seeing an improvement.  I noted that Galderma's patients saw improvement by the 2 week mark with a decline in skin condition (increased pimples and pustules) around the 3rd week and then further improvement from the 4th week.  

My observations using Ivomec are that around the 3rd day I experienced a substantial breakout of surface-based whiteheads across both cheeks and lesser so on my neck, decolletage and across my upper back.  It should be noted that I was not applying the Ivomec onto my upper back.  Within 2 days, the whiteheads are clearing with only the occasional one appearing.  In the last 7 days there have not been any of the painful, deeper cystic-type swellings.

Each time I have applied the Ivomec, I have noticed a slight warming sensation of the skin.  The feeling dissipates within seconds.  There is no accompanying flushing of the skin, it's is only a sensation.  I don't know if the sensation is due to the ivermectin itself but I suspect it is more likely to be from one of the carrier ingredients (glycerol formal or propylene glycol) and I'll bet it is specifically the propylene glycol which is used in personal lubricant products because of the warming sensation it provides. 

Regarding the safety of using Ivomec to treat my rosacea, I have found the following information: 
Ivermectin works by disrupting nerve impulses in parasites. It binds to glutamate-gated chloride ion channels which occur in invertebrate nerve and muscle cells which leads to an increase in the permeability of the cell membrane, thereby paralyzing and killing the invaders.

The margin of safety for compounds of this class is attributable to the fact that mammals do not have glutamate-gated chloride channels, the macro-cyclic lactones have a low affinity for other mammalian ligandgated chloride channels and they do not readily cross the blood-brain barrier.

Source: http://dailymed.nlm.nih.gov/dailymed/archives/fdaDrugInfo.cfm?archiveid=27632

It's exactly one month until my appointment with my dermatologist.

I readily researched rosacea.

November 29, 2014

I have 8 weeks until my next appointment and I am on a mission to present myself to her with a fresh face.

Thanks to Google, these are things which I have found particularly interesting:

• Demodex mites are in proportionately greater numbers on rosacea affected skin.
• Tea Tree Oil is a highly respected antiseptic.  Demodex mites don't really like tea tree oil.
• You can ingest diluted borax which changes the preferred habitat for the demodex mite.
• Human insecticides can assist in temporary eradication.  
• Deplorable witch doctors are taking advantage of  rosacea sufferers who are at their wits end.  Human nature, I suppose.

The easiest way to start was to take a look at Tea Tree Oil (TTO).  Tea tree oil has been claimed to be useful for treating a wide variety of medical conditions...(source Wikipedia, Tea Tree Oil). It kind of sounds a bit witch doctor-ish but I've done a lot of reading and confident that what I've read so far about TTO in correlation with demodex mites and rosacea at least needs to be considered.

Chemist Warehouse has a range called Thursday Plantation and I purchased three products:

• Tea Tree Facewash for Acne 150ml
• Tea Tree Antiseptic Ointment 30g
• Tea Tree Oil Antiseptic (100% pure)

Facewash first.  I wet my face over the basin and then spread two pumps worth over my face and into my brows (avoiding the eyes) and it felt so cool I decided to leave it there for a minute before rinsing it off.  

After rinsing, I blotted my face with two sheets of paper towel.  My face felt fresh.

Next, I generously applied the Antiseptic Ointment to my face.  The coating left me glistening and felt nice.

Finally, I dotted some of my pimply bumps with the pure TTO.  Since it was on top of the ointment, the fact that it was undiluted didn't concern me.  

And I took a photograph of each cheek.

My sensitive skin.

November 2014 

After a long Melbourne winter, I came to the bleak realization that my rosacea symptoms were out of control.  Redness had increased, pimples and bumps were battled with on an almost daily basis and several spider nevi had left their jagged marks on my cheeks.  All evidence of the battle I was losing.  I was glad that my appointment with my dermatologist was approaching.  

I see a dermatologist primarily to have regular skin cancer checks.  Growing up in Queensland in the days when sun sense consisted of a smear of Pink Zinc across your nose and throwing your hat off as soon as Mum had disappeared into the house, and in my twenties having moved to Melbourne, I was using solarium regularly enough to combat the SADS.  Yes, of course there was vanity involved as well.  Tanned skin looks so healthy! Right?!  

During my first consultation with the dermatologist 2 years ago, she noted that I had rosacea.  Oh!?  I had no idea.  

I had, up until that point, concluded that I had very sensitive skin...and marketing had convinced me that it was special skin.  I spent a fortune over the years purchasing the latest products marketed at that skin type.  By thirty years of age, my bathroom cupboards were overloaded with products which I'd tried, tested and found lacking.  With no more room and even less gullibility, facials were now preceded with, "Please don't sell my anything today".  

For a while regular glycolic peels were helpful.  The burning sensation seemed to calm things down for a week or two and I found myself yearning for the burning and I was a good client.  I would pre-purchase my peels in lots of six.  I stopped yearning when the beautician put her prices up and I'd grown tired of hearing her boyfriend woes.  With her prices, she could afford to see a good psychologist instead of ear bashing a client.

Life and priorities changed when I landed a husband, got a mortgage and had a child.  I stopped worrying so much about what I looked like.  Did I let myself go?  I was too tired to consider that I might have and blamed my red cheeks and pimples on my tiredness.  In springtime, I would blame my red cheeks on hay fever coupled with tiredness.  

This winter, there was a definite shift in my psyche.  Tiredness had given way to self-consciousness. Knowing now that I had rosacea and knowing that people always attribute it to alcohol (and I'll admit, I do like a glass of wine or two), I started to hide from people - fearing they would judge me for my complexion.  I rarely left the car at school pick up and drop off times.  I made up excuses to avoid social gatherings.  If I didn't have a choice, I would take extra care in applying mineral foundation and powder to disguise my red and lumpy cheeks.  To draw questioning eyes away from my cheeks I would overemphasis my eyes and brows.  

The appointment with the dermatologist had come.  Skin check done.  Nothing to worry about.  Good.  "Your rosacea is very active", she observed.  And then she recommended trying a low dose of  roaccutane.  All I need to do is pass a liver function test and a cholesterol test and then I can get started.  She printed two pages of do's, don'ts, and side effects and said she'll see me in 8 weeks.

I'll pause for a second.  At my age, even a low dose is not something which will comfortably fit into my lifestyle.  For one, I am a mad keen gardener.  I'll potter about for hours digging, watering and planning (and wearing a hat of course) but also enjoying being outdoors.  Even low dose roaccutane makes you very sun sensitive.  

It's a commitment and I need to think about this further.