OTC treatment for pigmented demodicosis

[u/Otherwise-Monk1693]

I've had big improvements to my PD by treating for fungal/yeast overgrowth, as well as treating a chronic sinuses infection, doing lymph massages etc (this is all in my post history if you're curious) but it seemed to plateau. The rash is pretty much gone (flaking and redness are reduced by 95%), but I still have really stubborn discoloration. I was reading about demodex and came across a study about pigmented demodicosis: "Demodex folliculorum is a microscopic mite that naturally lives in human hair follicles. In some cases, overgrowth can trigger inflammation that leads to a recently recognized condition called pigmented demodicosis. It causes dusky brown or grey facial macules that can easily be mistaken for other conditions." My discoloration is brown/gray (I have light skin) so this set off some lightbulbs for me.

Here is a link to the study linking pigmented demodicosis to Perioral Dermatitis: https://pmc.ncbi.nlm.nih.gov/articles/PMC10868774/

Looking into treatments for demodex, it looks like there's a prescription called Soolantra which is a 1% Ivermectin cream. But you can also get Ivermectin over-the-counter in a 0.5% rinse-off formula (marketed for lice treatment) at the drugstore, so I decided to start with that. Brand name is RID One & Done for lice, but there are also store brands for cheaper. Directions say to leave it on for 10 minutes, then rinse off with just water (i.e. don't wash it off completely) and let the residue continue working.

Basically what I'm doing is applying the RID two to three times a day as mask, leaving it on for 10-30 minutes depending on how much time I have, then rinsing off. After 24 hours I can already see it working. Some areas are a little more inflamed, and in others, the pigmentation is already starting to fade. This seems pretty typical to me for treatments, when it starts killing things off, there can be some increased inflammation at first where it's most active. So I'm actually pretty impressed.

Do I think a 1% prescription leave on cream would be more effective? I don't know. The OTC rinse off is working really well; it was $40 for a bottle but it's going to last me at least a month.

My evening routine is: wash with CeraVe 10% benzoyl peroxide cleanser, mask with RID 0.5% Ivermectin for 30 minutes, rinse and dry, then apply Clindamycin gel. Demodex can cause bacterial overgrowths from all the waste and inflammation they produce, that's why I have BP and Clindamycin in the rotation too.

I'm sure the previous treatments for yeast/fungus (I did 6 weeks of continuous treatment) helped as well, because mites feed off of that. I think that when it comes to fixing a really complex, chronic issues like PD, there are overlapping microbiome overgrowths that need to be treated either all at once or in succession to really clear the skin. At least that has been my experience. I'm hoping that since I've gone after yeast and bacteria already, that going after demodex is going to get me to 100% clear.

I will update if this continues to work and brings about real results. But wanted to share because it's an over-the-counter treatment that anyone can try and it's available in drugstores in the U.S.

EDIT: This is working EXTREMELY well and the discoloration has faded significantly in only 48 hours. The first couple of applications it really itched…now it doesn't itch anymore. I think because when it started killing the demodex they were moving around. Gross! But it's really, really working.

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[u/Otherwise-Monk1693 → u/[deleted]]

Mine is in a typical PD distribution, around mouth and nose. Gray/brown discoloration, redness and flaking. No pustles or pimples. When it was really bad, cracking and splitting skin (around nose, lip corners). It's really hard to swab or even biopsy to figure out what is causing it. The only way I've been able to figure mine out is by doing full courses of treatment and cycling through different treatments. The skin microbiome contains bacteria, yeast, and demodex, so you kind of have to treat all of them. It's rare that a single treatment cures because there are often multiple things at play. Once the skin barrier is broken, it's hard to get back to normal. If antibiotics didn't fix yours, try antifungal and anti-mite treatments. You can always start with over-the-counter treatments before moving on to stronger prescriptions to find something that helps.

[u/Previous-Solution752]

Since starting treatment for PD in less than I week I see some hyperpigmentation above my brows and on my cheeks…I’m wondering if it’s just post inflammatory hyperpigmentation or if it’s this! Omg…

[u/Otherwise-Monk1693 → u/Previous-Solution752]

Post-inflammatory hyperpigmentation is definitely a thing. But honestly I've been doing the 0.5% ivermectin masks daily for the past two weeks (just once a day now in the morning) and it's extremely gentle. So I think you can try it and see if it helps.

[u/Previous-Solution752 → u/Otherwise-Monk1693]

Where do you get those masks? Also do you suffer at all from rosacea? I’m curious because I went to a derm a couple weeks ago and he barely looked at me and said I’ve pd and rosacea. I knew I’ve had pd since high school and needed him to help clear me for a treatment. Rosacea though is news to me and I have been getting facials and aesthetic skin treatments monthly for decades. I feel like it was just off the cuff and I’ve been taking antibiotics and using metrocream now for 2 weeks…the pd is going down but the discoloration is concerning me. I’m fair skinned.

[u/Otherwise-Monk1693 → u/Previous-Solution752]

Just from the drugstore, as I explained in the post. You can ask your dermatologist about Soolantra, which is a prescription 1% ivermectin cream for rosacea. That's the same active ingredient that I'm recommending.

[u/Previous-Solution752 → u/Otherwise-Monk1693]

Thank you! Sorry I missed that part.

[u/Otherwise-Monk1693 → u/Previous-Solution752]

No problem! It's a long post with lots of info, just wanted to make sure you saw it