oral ivermectin - demodex

[josepht3]

Has anyone here been diagnosed with demodex blepharitis and taken oral ivermectin? Could you post your story? I have tried tea tree but it's too harsh for my lids. I maintain lid hygiene but clearly this won't kill the mites. Any input is welcome

[ehsan372]

hi .i am today sarting.i hope this help me

[mbperso]

Hi ehsan372
I have MGD and just been diagnosed with demodex.
Doctor give me ivermectin for one shot and a TTO gel to put on the lids for one minute.
I add TTO 50% to put on eyelash every evening.
Can you please explain exactly your routine and preparation of TTO (quantity, frequency..)
Thanks

[MGD1701]

..........

[mbperso]

Hi MGD1701


Thanks for your advices.
I visited a new specialist and I learnt new things.
Now I do confirm that a good doctor is able to see demodex at the slit lamp: he turned around one upper lash for 2 minutes and then he saw lot of demodex.
He said everybody has demodex but some have a lot.
I had eyelashes analysis and only one eye showed demodex, while the Dr saw them. Conclusion it is better to find a good Dr than doing analysis !


Based on my research:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1772908/
Weekly lid scrub with 50% TTO and daily lid scrub with tea tree shampoo is effective in 4 weeks.
Study in vitro: TTO 100% kill in 4mn, 50% in 15mn, 10% in 150mn.
Demodex carry bacteria.

my new routine :
- Evening 2x/week for 1 month: put TTO 50% on eyelashes with a tip, for 2 minutes or more because it stings
- twice a day for 1 month: shampoo with TTO (or ointment) for 5mn on eyelashes then clean eyelid
- shampoo TTO 5% for hair eyebrow and face
- I add HOCL every day to kill bacteria

After a few days itching went away

[Italyboy]

Hey mbperso what is the exam to know if you had demodex ? I saw lot of doctor but for me it looks like they don’t know a lot about it ( demodex mites )

so so I would like to know is there is an exam or something to atleast know if you had it , because doctors said that everyone have bacteria on eyelids but it’s generic.

also you don’t have started oral ivermectin ? You are just doing manial cleansing with TTO right ? Thankyou.

[mbperso]

Hi @Italyboy,
Analysis for staph is : bacteriology (tear removal, its hurts a bit. Result was ok)
Analysis for Demodex is : parasitology of eyelashes (remove 8 lashes on each eye, found 5 demodex only on one eye)

Yes everyone has demodex and bacteria but it should be limited. Some bacteria are carried by demodex, and when demodex dies after 3 weeks, they let bacteria.
Based on my research it seems that only about 30% of young people don't have demodex (or very little).

Ivermectin:
Dr prescribed me : Stromectol 4 pills in one shot (12mg of Ivermectin) , eventually repeat it after 2 months.
But based on my research it should be repeated after 1 month

[MGD1701]

Hi, maybe someone would find this article interesting.

''Confocal microscopy assists Demodex management
June 12, 2018

Laser in vivo confocal microscopy monitors treatment of Demodex blepharitis by observing mites in all phases of the lifecycle and helps guide clinical decision making, according to researchers at the Association for Research in Vision and Ophthalmology meeting. The retrospective chart review followed 11 patients from a population who were previously treated for Demodexfolliculorum that received an in vivo confocal microscopy exam (IVCM) and then returned for follow-up IVCM testing.

The IVCM exams consisted of serial imaging of the eyelid margin and around the lash follicle.

Researchers selected quantified images from IVCM exams performed before and after treatment with topical 4-Terpineol (T40) wipes or a combination of T40 wipes and oral ivermectin.

There was an average of 177 days between imaging sessions.
At baseline, a mean mite density per follicle of 4.42 was found, with an egg per follicle density of 1.93.

After treatment, mite density was 2.42 mites per follicle, and egg density was 3.12 per follicle.

Compared to baseline, researchers noted a significant decrease in the density of D. folliculorum mites after treatment.
Researchers wrote that, surprisingly, there was a significant increase in the eggs of D. folliculorumafter treatment.

Typically, as lash collarettes and detectable mites become less frequent, treatment is tapered, researchers wrote.
“
Our findings provide alternative and potentially more effective treatment schedules,” researcher Nicolas Pondelis told Primary Care Optometry News.

“The fact that eggs survive treatment may mean that topical wipes do not effectively treat the mites while still inside the egg.

The lifecycle of the mite is 12 to 14 days, and, as such, a staggered treatment with topical wipes (1 week on 1 week off, 1 week on, etc...) may be more effective than 2 weeks of treatment alone.
“
Essentially, the use of tea tree oil wipes may effectively treat adult and larval mites only, and other therapeutic options (whether timing of treatment or new drug targets) should be investigated to make sure the entire population of mites is being effectively treated,” he continued.
IVCM imaging provides real-time feedback on patient response to treatment, Pondelis added.
“
Results from these studies have shown that topical wipes may not be effective in treating all stages of the mite life cycle,” he concluded. – by Abigail Sutton

Reference:
Pondelis N, et al. Detection and assessment of treatment efficacy of Demodex blepharitis by in vivo confocal microscopy. Presented at: Association for Research in Vision and Ophthalmology; Honolulu; April 29-May 3, 2018.

Disclosures: Pondelis reported no financial disclosures. Please see the full study for all remaining authors’ financial disclosures.''

quoted from the 'Healio' website.
I found the info though Prof./Dr. Alice Epitropoulos Twitter.

I add tea tree oil product to clean lids/lashes, but now only 2-3 times/week as prevention,
although I do not have red, itchy eyes in the morning. Not all have symptoms anyway, what I have read.

[mbperso]

MGD1701 ,

Thanks for sharing this recent and interesting article.
I have some interrogations and conclusions

-Cleaning lids and lashes with 3% TTO gel/foam is good for hygiene (I'm doing twice a day).
But it won't kill the mites, since in vitro TTO 50% is needed to kills mites in 15mn, and lid hygiene lasts only 2mn. Moreover, in vivo it is more difficult.

-Life cycle is 18 days max, so treatment is needed for 36 days (two cycles)
-Best treatment is 50% TTO and let it for 15 mn at least. And before bed put TTO on lashes to avoid mating during the night.
I got used to put 50%TTO every night on lashes before bed. It doesn't sting anymore, with closed eyes.

[Spanishteach01]

My first symptom was a horrible, tormenting itching sensation along my lower lid margins. It would keep me up at night and persisted during the day as well. I was constantly told it was allergic, despite having extensive allergy testing and eliminating and avoiding my supposed allergens. The itching would run in cycles and felt so deep (Such an odd sensation to try to describe). I was given every allergy drop to no avail and was even given a course of oral steroids, which had no effect and I think actually made it worse. I mentioned Demodex to every eye doctor I saw. Some completely denied that it would cause my symptoms, some prescribed Avenova, Cliradex, Sterilid, etc. All of these products did not work and caused my eyelids to become extremely sensitive to any chemicals, even now. Every time I asked them about oral ivermectin, they either told me it wouldn’t help or had no idea what I was talking about. I have seen some big name eye doctors in the NY area and was very surprised that they were not willing to discuss or consider this. They told me I was over exaggerating my symptoms and that the itching couldn’t possibly be that bad. I do not like to take conventional medications but I was so desperate that I was willing to try anything to get some relief

After a year of this, I met with a dermatologist for a separate issue in NYC who said that he thought I may have an overpopulation of either type of Demodex ( Brevis or Follicularium) when I mentioned this in passing. His theory was two fold: 1) Certain people are genetically more sensitive to the byproducts of the mites( He went into a very lengthy discussion that was kind of over my head). 2) Because I have seborrhea, the excess oil/yeast is allowing the mites to proliferate too much. I also have rosacea and seborrheic dermatitis on my face. He also said that if it didn’t help that there wouldn’t be any adverse effects from taking oral ivermectin. He was shocked that the eye doctors I had seen weren’t even willing to try it to see if it gave me any relief.

He gave me two doses of Oral ivermectin. It really did decrease the itching significantly. Three months later he gave me another two doses. I am not sure how he will proceed in the future; if this is the type of thing where I will need periodic maintenance doses. He also told me to wash my blankets, sheets, pillows, etc a few times during the treatments, as well as to change pillowcases frequently.

I am not sure why eye doctors are not well informed or unwilling to try oral ivermectin. It is inexpensive and without many side effects or drug interactions. I feel there is a big disconnect between dermatology and opthamalogy and that the two are very interconnected.

If you truly feel that Demodex may be an issue, I would suggest that you find a dermatologist who may have more knowledge or be more open minded. While I have many other symptoms, for now (Knock on wood) the itching has subsided a great deal.

[MGD1701]

Thanks for sharing so much info. Great you have now got it under control.

Did dr recommend future regimen you should do at home as maintance/prevention?
Maybe tea tree oil product?

[Spanishteach01]

The dermatologist I saw is actually very leery of tea tree oil products. He says that many people have bad reactions to them or eventually develop sensitivities. I am in the latter group. I used tea tree oil products for many months without any real effect and now can no longer tolerate them around the eyes. My eyelids swell and itch and become discolored if I use tea tree around my eyes. I can use it elsewhere without issue for the time being.

He is starting to recommend Avenova, he says it can kill the nymph form. He also said we can redose in the future if necessary. It was very refreshing to talk to a medical profesional who acknowledges that Demodex is a real issue and can cause real symptoms. He also has me on Soolantra at night for the face to keep the overall count down. I also have a mixture of mild rosacea and horrific Seborrheix dermatitis at the moment so the Soolantra should help with the rosacea.

[MGD1701]

Thank you so much for sharing.
Indeed demodex is very common but most doctors do not tackle it.
I add tea tree oil as preventative regimen (although I dont have red, itchy eyes in the morning - not all have symptoms anyway) and no problem with it - tried many and most are not good.

[Fisher]

Hi everybody, I wanted to comment on some of the things you have mentioned and ask some questions.

Spanishteach01 I relate so much to your case (I'm Spanish, by the way). I also have seborrheic dermatitis, and apparently rosacea as well (I was told that at the beginning of this summer - I'm guessing I have a mild case of it though, because for the moment I don't have any pimples). I have the usual facial redness and flakes that come with SD so I guess the symptoms somewhat overlap. I also have blepharitis; it started about one year and a half ago. I have itchiness, dryness, mucus discharge and rheum in the morning.

This summer I decided to try and find a solution for these two disorders (the doctor recommendations, warm compresses and wipes for Blepharitis, topical steroids for SD, weren't really solving anything, and as we all know steroids aren't good in the long run), and started to google intensively for alternative methods. Regarding the SD, right now I'm bascially relying on a healthy diet (lots of fruits and vegetables, no added sugars, no processed foods, no dairy, no chocolate, no gluten) and a product called BIOM8 created by a Canadian guy who has an amazing web site on SD, SkinDrone, chock-full of information. I must say particularly the diet has helped a lot, and my skin looks healthier. Flakiness is basically gone, sadly some redness remains.

Blepharitis, as we all know here, is a bit more complex to tacke. My eye doctor isn't very informative (says there are many more products to deal with it in the USA, but they aren't available in Spain, also he can't confirm if it's specifically demodex what I have). Long story short, this is the routine I'm following after my internet research:
1. I swipe my eyelids with HOCL (Natrasan) sprayed 3x on cotton pads. I wait for 20 minutes.
2. I swipe them again with Cliradex.

While buying Cliradex, I found this interesting comment (it's the top rated comment) which claims it has a DEFINITE cure for blepharitis:

https://www.amazon.com/gp/customer-r...SIN=B00HBISPME

The comment is itself followed by another person who also recommends HOCL and offers more info. Ever since I started using HOCL my eyes improved a lot, but I was still having some terrible days where all the symptoms come back as strog as before, so that's why I decided to also give Cliradex a try as well. I still get some rheum in the morning, but much less itchiness, redness and mucus discharge. Still, I would like to try for the definite cure, and that's why I'm thinking of adding oral Ivermectin to the mix.

I have so many questions about it. I read it's a one dose only thing: so you just take it ONCE in your lifetime and that's all? Shouldn't you repeat after a few days, or even a few more days so it killls every new generation of the demodex as they are born, after the last one is erradicated? How do you get it? Do yo need a doctor's prescription for it or is possible to just buy it OTC? (this might be different in Spain actually).

I also found another article (in Spanish) about a guy claiming he managed to cure Blepharitis for good by using Permethrin, a topical cream normally used for scabies which seems to have some similarities with Ivermectin. The guy seeems very thorough and trustworthy, here's the link to the whole article he wrote (I'm sorry it's not in english, if someone wants it I can maybe write a basic summary / translation):

http://www.islabahia.com/artritisreu...sporacaros.asp

Apparently both Ivermectin and Permethrin are both very effective against mites, with some studies showing Permethrin is a bit more so, but it being being topical seems to me to make it less safe for use around eyes (the guy who wrote the article comments on this and suggests using it at night because your eyes will be closed then, and it needs to be on for 12 hours).

Thank you and sorry for the long post!