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

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.

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.

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.

Itchy but not bumpy!

So itchy!  Aaaagh!

I'm feeling like I'm being eaten alive.  Mostly it's my body and scalp - in small patches on my face or throat.  I wonder if the TTO routine and pryrethrin is doing little more than just annoy the mites.  I'll take an anti-histermine and consider another course of action.

Regardless of the lack of calmness in my complexion today, my face hasn't developed any new bumps or pimples so I am going to view this as another positive advancement.  ...You can cover up redness with makeup but you can't disguise lumpy skin.

I was reading today about Ivermecton and also found some information regarding sulphur cream.  It might be time to have a chat with my GP to see if she has any thought regarding mite eradication.  Failing that, I'll go and see a vet!  

Another route I have considered as a "value add" is traditional Chinese medicine.  If the imbalances I am having are due to a lowered immune system, and my current diet (which isn't all that bad) can't rectify the situation, then perhaps some acupuncture can assist. 

Feeling optimistic!

December 1, 2014

A confidence boost for me! So far, I have had calm mornings in a row.

Usually I wake up with quite inflamed looking cheeks. This tends to dissipate a little over the next hour or two. I tend to avoid looking in the mirror but today I had to keep checking to see if I was imagining an improvement.

White skin seems to be appearing within the red areas.

I continued my routine in the morning and again in the evening with the three products from Thursday Plantation and photographed my cheeks after the evening routing.

• 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 left it a minute or two before rinsing it off.

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

Generously applied the Antiseptic Ointment to my face.

Finally, I dotted some of my pimply bumps with the pure TTO.

Greeting the day calmly.

November 30, 2014

I woke this morning to relatively calm skin.  No new bumps had appeared overnight. 

I washed my face over the basin using the Tea Tree Oil cleanser (leaving it on for approximately 2 minutes before rinsing off under the tap) and blotting gently with paper towel to avoid cross-contamination.  Following this, I applied the TTO ointment and dabbed on the pure TTO on old bumps.

The calmness in my complexion remained until the heat of the day caused me to flush however, it was not as bad a reaction to the heat as I have previously experienced.

Periodically, I observed that while my face was no longer feeling itchy, my hairline was itching.  Am I imagining this?

The images below were taken that evening.

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.