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.

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.