Die you Demodex, die!

...I'm obviously not a Buddhist!

I had little sleep last night as I was very conscious of the mites moving upon my face.  It had me wondering if the Ivomec was not working for some reason.  I remembered that I'd left it out of the cupboard for a week in filtered sunlight while I was interstate for a holiday.  Could that amount of sunlight reduce the potency of the ivermectin in the solution?

I telephoned Merial and without giving too much away, I asked them if that amount of sunlight could effect the active ingredient.  After consulting with their resident vet, they assured me that it would be fine to "administer to my cattle".  I'm relieved to know that because I am only halfway through the 200ml bottle.

However, it does confirm that the mites are still not being effectively eradicated.

More research led me to a very interesting document: http://www.google.com/patents/US5952372 
Entitled: Oral administration or topically applying ivermectin in a dosage to eliminate demodex folliculorum mites from hair follicles in affected skin.

In short, William Robert McDaniel states that treating rosacea "with oral ivermectin in a regimen of 200 micrograms per kilogram body weight per dose for 2 or 3 consecutive doses at least 3 and not more than 7 days apart as the preferred regimen or, alternatively, topical ivermectin compounded to a 2% concentration by weight in a cream, lotion, or gel carrier vehicle is administered as an effective treatment for all clinical stages and signs of rosacea in affected persons."

My GP wrote me a script for Stromectol 3mg in December - based on my body weight I was to take 5 tablets.  Because of a miscommunication with the Pharmacist I took an incorrect dose of 4 tablets December 19th, 6 tablets January 17th and today I took the correct dose of 5 tablets.

Based on McDaniel's findings, I need to take my next dose in 4, 5 or 6 days time and could take my remaining dose again at 4, 5 or 6 days after that.  A detailed description is in the article (link above) but here's the reason why:  It "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."

Today's dose was 2pm February 2nd.
My next dose should be 7th February.
My final dose should be 13th February.

...and then I'll need to assess the outcome.  

Today's pics show the evidence of mite's at work during the night.  Several red dots on my right cheek and a couple on my left.  Over the course of the day my cheeks became more inflamed looking.   It's a step backwards but it prompted me to do more research and thereby finding this wonderful document.  ...so I'm going to say it's really a step forward!

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.

SooLantra has been approved by the FDA.

Reading that the FDA has approved an Ivermectin based cream to treat rosacea was like getting a Christmas gift from Galderma!

From what I have read, Ivermectin (the active ingredient in Soolantra Cream), has been reported to have both anti-inflammatory and antiparasitic activity.  Soolantra® (ivermectin) Cream 1% is found to be well tolerated with powerful results seen as early as two weeks with continuous improvement in patients with inflammatory lesions of rosacea.

Here is the Press Release from Galderma USA.

I can't imagine Soolantra will be available in Australia for some time but I had read in an initial report that the  new cream contists of ivermectin combined with Cetaphil cream (another Galderma product).  Having both a bottle of injectable (livestock) Ivomec (10mg/ml) and Cetaphil cream on hand, I mixed up a small batch to see what would happen.

I added 2 squirts of Cetaphil cream and 16 drops of Ivomec to a small stainless steel bowl and mixed them with a small metal spatula.  The two ingredients combined easily with no distinct separation.  I applied the mixture to my face, neck and decolletage.

Observations after 24 hours (3 applications):

• Face feels calm - not inflamed.
• Itching has diminished on face, neck and decolletage but seems more pronounced in my scalp.
• Small red dots have appeared across cheeks.  Particularly on the right cheek which is the side I sleep on.

My new routine will be as follows:
Twice daily TTO foaming face wash followed by hydrogen peroxide (3%) washed over any newly formed pustules (rinse with water after a few minutes) and then application of the home brew mixture of Cetaphil and Ivomec.

I'm lucky to have an open-minded GP.

My research of late has made me want to try oral Ivermectin (Stomectol) as a way of eradicating the demodex mites, or at least to rule it out.  Ivermectin is usually prescribed as a one-off treatment to cure scabies however demodex mites have a difficult life cycle to crack with eggs hatching within three days of being laid.  My thoughts are that more than one dose of it will be required.  

I made the appointment with my GP solely to discuss this issue.  It was interesting to note that she hadn't heard of demodex mites until now but was open-minded regarding what I was hoping to achieve and asked me how many courses did I think I would need to break the cycle.  I was unsure and hesitant to name a figure but she asked me if I thought 4 doses would be enough?  At this point in time, I'll take whatever I can get!  Since this is entirely experimental, I have no idea how often I should take doses for maximum effect.  I'm suspecting I should do it weekly and if I am getting good results, ask for another prescription.

I took my first dose yesterday but the pharmacist got the dosage wrong and only gave me 4 tables instead of the 5 tablets my GP worked out based on my body weight.  Eager to start, I took the dose during a meal and waited for any side effects but didn't experience anything - no nausea, no dizzyness etc.  I'll make sure I get the proper dosage next time.  It's not going to be a cheap exercise at $28 for 4 tablets.

I slept incredibly well last night and quite possibly it was the best sleep I've had in a long time.  It makes me wonder if my sleep disturbances are due to the nocturnal wanderings of the mite.  Perhaps I am having some success in diminishing their numbers?

Looking at the images, on my right cheek there is a large welt as a result of a deep and very painful infection.  It took 4 days to surface and looking at it, I think it will take several more to heal.  I'm not feeling defeated because this is the first pustular sore I have had since I started my routine in early December.  There have been other tiny infections which are closer to the surface resembling a whitehead but they heal quickly.  I'm assuming that over the next few days, if the Ivermectin is a success, I will end up with quite a lumpy sore face as a result of mass die-off - the infection will be due to the bacterium the mites leave in each pore as they decompose.

My left cheek, aside from having three tiny surface infections, is looking very good.  It gives me hope that by persisting with my TTO routine and in addition to regular washings alternating pyrethrin, permethin and benzyl benzoate should being results.