Hi Doctor Fisher:

I believe I have a persistent case of some sort of mites in and around my nasal area....face and hairline.  I started to have the symptoms (below) around November, 2013.  I was hiking around a tick infested area (no noticeable ticks on me) and the people I stayed with had a dog (2 ticks) that seemed to be scratching itself all the time.

I don't want to "lead" you but that's what I think.   Some of the conditions I've noticed are:
1.  Darkened pores on nose (never had this problem before)
2.  Worse after eating oily or fatty foods
3.  A irritation tingling or itchy.  Similar to prickly heat mainly nose, cheeks, forehead, temples
4.  Worse at night or overcast
5.  Better in full direct sunlight
6.  Worse in higher humidity
7.  Using lotions, soap or shampoos with moisturizers or oils
8.  Seems to be cyclic, ie., 1 to 2 days no or less symptoms, then 2 to 3 days symptoms.  Some days absolutely none of the above symptoms
9.  Tickling in nostrils from time to time
10.  No apparent rashes, pustules, sores or rosescea
11.  Very few (seldom) thin 2-4mm red lines nasal area that come and go.  Sometimes with a slight curve

Self Treatments that lessen the symptoms

1.  Using a drying agent, such as alcohol (the dryer the skin the better)
2.  Washing/Scrubbing with plain water
3.  Some of the anti-acne facial washes
4.  Bathing using anti-dandruff soaps that leave no oil (temporary)


1.  Ivermectin (oral) 2 weeks, one dose every 7 days (some relief, but temporary)
2.  Premethrin (topical) same as above (concurrent with Ivermectin)

Personally, I feel that the Premethrin was only temporary and (in the case of mites) doesn't get absorbed deep enough and last long enough to kill through a life cycle.   I don't know how Ivermectic works but I think it doesn't get into the top layers of skin and the half life isn't long enough.

Anyway, any ideas on this ?

Totally off label use, but I wonder if topically applied Ivermectin in a paste form would work better ?  Or, in conjunction with oral Ivermectin ?

BTW, my Dermatologist basically told me that he's not a "bug" man and my Primary doctor, is an internist.

I have considered that I may have some sort of delusional illness, however that would be countered with the fact that it comes and goes (food, sweating, cycles...), and on those days I'm loving life

Age is 55-65

I appreciate any help or thoughts.

There are no bugs that do what you describe. Scabies do not live on the face in adults only young kids. You have been adequately treated for scabies so if you had scabies they are gone. If you still think you have bugs, you have a condition called delusions of parasitosis. The treatment for that condition is Orap. Before you go down that road have your provider write you for Cloderm Cream and apply this twice a day for two weeks on your face.


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Michael S. Fisher, <B>Ph.D., M.D.</B>


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