Update 20 June 2019: This topic is outdated, instead read:
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In this topic, I want to document/focus on the current best treatment, so that users don’t have a read through multiple topics.
Most users have reported success stories with using Soolantra (a topical form of Ivermectin) as only treatment. Some users have complemented it with oral medication metronidazole or with oral ivermectin. Because these oral treatments where combined with Soolantra, it’s unclear whether these oral treatment have any effect at all, although some studies with people with strange/unclear skin problems did show effect, but that could easily be a different disease.
Apart from Soolantra, users that tried Sudocrem (topical zinc oxide) report a high success rate, like Soolantra:
Because it’s cheap and available without prescription, it may be worth trying it before Soolantra. But note that there aren’t as much reports about it on this forum than Soolantra.
Keeping the skin healthy by hydrating it, may also be something worth trying. Although not much users have reported focussing on it.
Soolantra (topical ivermectin + moisturizer)
Soolantra (1% ivermectin) is an easy to use topical and usually doesn’t have much side effects. Some people may experience reddening and irritation of the skin.
The leaflet says that if you don’t have improvements after 3 months, you should quit using it.
Soolantra can be applied on the face, in the area’s where the lesions occur.
The positive effects of Soolantra may in some cases be noticeable within just a few days. Although it’s unclear whether this can be contributed to its ability to kill demodex or its anti inflammatory effects.
Oral metronidazole (brand name Flagyl)
Metronidazole is an antibiotic and an antiprotozoal, that can be used against demodex. Different diseases require different metronidazole doses.
In ref1 they used 250 mg oral metronidazole, three times per day for 2 weeks, for the treatment against demodex. (Note that they also used oral Ivermectin).
Oral metronidazole is probably more efficient against demodex than oral ivermectin (note that this may be the opposite when compared topically), but oral metronidazole is may have serious side effects, possibly permanent.
Oral ivermectin (brand name Stromectol)
Ivermectin is a broad-spectrum antiparasitic drug that can be used against for example mites, scabies, bedbugs, lice and demodex.
The dose is disease specific and also depend on the body weight. In ref1 they used two doses of 200 μg per kg body weight, 1 week apart. So if your body weight is 70kg (~154 lbs), you should take = 70 kg * 200 μg/kg = 14000 μg = 14 mg on day 1. (So if a tablet is 3mg, then you should take between 5 and 6 tablets on day one.) Then, at day 8, you should take the same amount again.
Oral ivermectin may cause side effects, although compared with the leaflet of oral metronidazole, oral metronidazole seems a lot more serious.
References
- http://www.ijidonline.com/article/S1201-9712(12)01315-X/fulltext
- http://www.medscape.com/viewarticle/843159
- Demodex unresponsive to oral ivermectin and topical permethrin - The Rosacea Forum
- http://archderm.jamanetwork.com/article.aspx?articleid=1784334
Users
- Firstman: Soolantra + (probably oral) metronidazole. Status: reported clear in 2015-05.
- Anymnoo: Soolantra + oral ivermectin + oral metronidazole. Status: reported clear in 2015-08.
- Tso: Soolantra. Status: on treatment.
- RecoverE: Soolantra + oral metronidazole. Status: “GREAT” improvement after metro, but not 100% clear, continues using Soolantra.
- Raju: Soolantra + oral ivermectin (probably 5*3mg at once, second dose 1 week later) + oral metronidazole (2g per day for 1 week). Status: on treatment.
- pcal1: Starting with Soolantra + oral metronidazole (2x 400mg daily, 2-6 weeks). Status: on treatment.
- misfit108: Started with Soolantra. Status: on treatment