24 replies to this topic

[Lakerfan858]

Hello everyone,

I have been searching all over the internet regarding my problem, but have not found a solution for it. I have seen numerous posts re: this problem, but have not seen any solutions yet so I am hoping someone can help me with this problem.

Let me give a brief history about my skin and other relevant information:

- I have had acne since I was 12 (I am currently 29). It used to be severe, but has gotten better w/ the exception for my mouth-area
- Over the years, I have tried most antibiotics (for ex: all the 'cyclines), most oral gels, creams, etc. You name it, I probably tried it
- Used steroid sprays for years (nasarel, flonase); haven't used for 5+ years
- Recently had bad scalp acne that I think was caused by using a face shaver to shave my head Most of it is gone w/ the use of selsun blue
- Currently, folliculitis seems to come and go in various spots on my face; especially the mouth
- I have been on and off (mostly on) cetaphil lotion for 10+ years


I am now 29 and my acne on the areas excluding my mouth are better now; although I have a lot of blackheads on my nose, but for the most part, they don't flare up and become painful whiteheads. My mouth on the other hand is a large problem. The most noticeable part about my mouth is that there seems to be a red outline around my mouth. This problem has been plaguing me for the past 5+ years. My derm thought that I may have perioral dermatitis, but let me continue. I have a lot of blackheads in this area; a lot of them turn into whiteheads that vary in size from small to extremely large and from pain-free to extremely painful to the touch. These whiteheads form in my chin area, my mustache area (underneath nose, but also spread to entire parts of mustache), on lip-line (they are painful), and I occasionally get some inside or on the corners of my nose. In addition to the blackheads, I see many fordyce spots that remain dormant, but w/o a moments notice, turn into whiteheads. I see these spots in my mustache area and all over my chin including the corners of my mouth. I also sometimes get whiteheads on other parts of my face. I also notice that the problem flares up during stressful times. I have recently passed the CPA exam (which caused me to stress a lot), but even after passing, the week after, the large whiteheads returned (see pictures attached).
PLEASE NOTE: Accutane seems to be the only effective treatment for this problem, but immediately after stopping treatment, it shortly returns with a fury! No matter what I do and how often I wash my hands; nothing seems to work.


Here is a brief list of things I have tried for this problem within the past 3-5 years (please keep in mind I have tried pretty much everything for acne during my teens including all the 'cyclines, etc.:

- Squiggle (flouride-free toothpaste)

- California Baby (calendula cream and special perioral dermatitis face wash)

- Doxy (100 mg)

- Accutane (as noted above, is the only effective treatment for the whiteheads, but shortly after treatment, the problems returns - I do not want to start accutane again as it is only effective WHILE taking the pills)

- Hibiclens

- Aveeno soap

- Cetaphil wash & soap

- Baby rash lotion (I forgot the brand name)

- I have tried some other perioral dermatitis treatments; to no avail



I am currently using:

A.M - Bactroban for nose (will stop soon as day 5 is near), dial antibacterial soap, cetaphil lotion

P.M. - Bactroban for nose, brevoxyl 4%, cetaphil lotion

Shave (every other day): electric shaver (I soak in 70% alcohol for at least 30 min. after every use)

Hand-washing: I ALWAYS WASH MY HANDS w/ antibacterial soap

NOTE: When a large whitehead is present, I "break" it with a gauze and apply neosporin on the area once the whitehead is broken. 8 out of 10 times, the whitehead does not return.

I am running out of options and my dermatologist basically is giving up as she has NO IDEA what the heck is going on. She tested me for herpes (negative), the culture of the whiteheads came back with nothing but "regular" flora. What do I do now? I recently had a bad flare-up that I was able to temporarily get rid of by breaking w/ a gauze and applying neosporin on (there was no way I was going to work with these things on my face).

If anyone has input, suggestions, feedback, stories, please let me know as I am at the point of giving up... I get extremely depressed when I get a flare-up (which happens often).

Thank you,

Extremely depressed

[daarchitect2007]

What does she mean by "normal flora"?? You should ask. Is she the one that told you to put the bactroban up the nose? Bactroban is used for staph aureus infections so maybe your culture came back positive for that bacteria.

Take care bro

[Contained]

i got the same shit. Red, irriatated skin around the mouth and lower chin. It is honestly an outline, to describe it the best. Now it spread and covers around corners of nose and spread out towards the checks under the eyes. I have tried countless chemicals...all to no avail. the worst part bout it is that wen you move your mouth (smile,eat) the skin gets irritated and it turns bright red.

I had this since I was a sophmore in high school. I am now a sophmore in college. I learned just to deal with it, but that does not mean every day I am a happy go luck guy. It really sucks and I am still a firm believer that whatever it is, it is here to stay. Only thing I have not tried is accutane. I don't get whiteheads or anything, just red skin and if you stretch it along the chin, I see tiny white clusters of bumps just staring back at me and laughing.

fuck that.

[Lakerfan858]

i got the same shit. Red, irriatated skin around the mouth and lower chin. It is honestly an outline, to describe it the best. Now it spread and covers around corners of nose and spread out towards the checks under the eyes. I have tried countless chemicals...all to no avail. the worst part bout it is that wen you move your mouth (smile,eat) the skin gets irritated and it turns bright red.

I had this since I was a sophmore in high school. I am now a sophmore in college. I learned just to deal with it, but that does not mean every day I am a happy go luck guy. It really sucks and I am still a firm believer that whatever it is, it is here to stay. Only thing I have not tried is accutane. I don't get whiteheads or anything, just red skin and if you stretch it along the chin, I see tiny white clusters of bumps just staring back at me and laughing.

fuck that.

Thanks for the reply... I am not giving up hope yet... It just sucks having this problem... I'm glad at least you don't have the whiteheads that come w/ this problem.

What does she mean by "normal flora"?? You should ask. Is she the one that told you to put the bactroban up the nose? Bactroban is used for staph aureus infections so maybe your culture came back positive for that bacteria.

Take care bro

Thanks for the reply. I forgot to mention that I am the one who brought up bactroban to the derm as she was out of options. Per the derm, I don't have a staph infection; I just read on this site that someone w/ a similar problem to mine had success w/ bactroban - me, however, no luck...

As I type this reply, more whiteheads have sprung up and I have a big painful lip pimple... my favorite.

[daarchitect2007]

Judging by the fact that you have pustules (not whiteheads) and your culture came back negative for staph aureus and instead has normal flora I would be confident in saying you have something called Propionibacterium Folliculitis. It is more or less the same thing as acne except there is no comedo formation. It is often confused with staph folliculitis and often occurs in older males (see here: http://www.ncbi.nlm.....d.section.5272). Bactroban will do no good bro. The reason the accutane works is that it interferes with the bioavailability of the P. Acne bacteria's biofilm. You have two options. I assume you are in LA considering you are a laker fan Search for something called the Kobyashi method on here. It is selective electrolysis of the sebaceous gland that results in its permanent destruction. You are an excellent candidate as you have both active lesions and a small affected area and it is in LA. Option two would be long-term low dose accutane. Sometimes that is all that will help. I have had a similar eruption for a while that has been misdiagnosed as staph until quite recently. I am on 10mg every third day and it is keeping me clear. I get my monthly bloodwork and also yearly radiographs to make sure I have no bone changes. Maybe a little extreme, but it's worth it to me because I get them all over the scalp and it drove me into depression. Lemme know if I can help anymore.

[Lakerfan858]

Judging by the fact that you have pustules (not whiteheads) and your culture came back negative for staph aureus and instead has normal flora I would be confident in saying you have something called Propionibacterium Folliculitis. It is more or less the same thing as acne except there is no comedo formation. It is often confused with staph folliculitis and often occurs in older males (see here: . Bactroban will do no good bro. The reason the accutane works is that it interferes with the bioavailability of the P. Acne bacteria's biofilm. You have two options. I assume you are in LA considering you are a laker fan Search for something called the Kobyashi method on here. It is selective electrolysis of the sebaceous gland that results in its permanent destruction. You are an excellent candidate as you have both active lesions and a small affected area and it is in LA. Option two would be long-term low dose accutane. Sometimes that is all that will help. I have had a similar eruption for a while that has been misdiagnosed as staph until quite recently. I am on 10mg every third day and it is keeping me clear. I get my monthly bloodwork and also yearly radiographs to make sure I have no bone changes. Maybe a little extreme, but it's worth it to me because I get them all over the scalp and it drove me into depression. Lemme know if I can help anymore.

Daarchitect2007,

You're close w/ your guess re: my location (I live in San Diego). As far as your suggestions, I will definitely look into it. I wouldn't mind going on a long-term low dose of accutane; I am just concerned about the long-term effects. I really appreciate your input as this problem is driving me crazy. I will definitely look into Kobyashi in this forum. Did you have a similar problem to mine or was it different?

Thanks.

[adamrodriguez]

i used to get those man, they suck, but eventually they pop themselves and go away.. maybe you are too dry in that area try some moisturizer and stop using harsh cleansers like soap and stuff with harsh acids and chemicals like BP... i dont know man, im not an expert..

i still get those things on my chin, that is my usual dry area at the moment but i havent got them on my lips for quite some time.


**OHH OHH!! try B-complex 6 pills a day for a week see if it helps**

[daarchitect2007]

Well accutane is no joke. But I have to say is that I have NO side-effects on this ultra low dose regimen. No changes in my blood work at all. According to most research the only cumulative side effect of long term retinoid treatment are bone changes, often called DISH syndrome. A yearly check-up by a rheumatologist will deduce whether this is an issue. Most research shows that long-term retinoid therapy cannot be sufficiently linked to DISH syndrome. There are also several rare side-effects of retinoid therapy that rear their heads rather soon. Since you have taken this drug before, I assume they should not be an issue. Anyhow, it is time to think of your disease not as Acne Vulgaris, but more as propionibacterium folliculitis. It is not going to go away like comedonal acne. Once I came to this conclusion I made the decision to go on the accutane. We are dealing with a CHRONIC condition. No one expects someone with psoriasis to just deal with it, so why should we? Low-dose retinoid therapy is a mainstay in the treatment of pustular psoriasis, lupus, keratosis pilaris, acne congblata, hidradentitis suppervita, and many others. It is a very personal decision whether to risk the therapy. But I weighed it out as a lesser of two evils. Depression and anxiety were ruining my young life. I was not willing to allow it to continue. I am taking a calculated risk by taking this medication. I have a wonderful dermatologist who is there with me every step of the way, I am getting all of my testing done on a regular basis, and I am living a much happier and more productive life. I have, more or less, the same condition as you. An inflammatory, pustular, dermatitis related to the overgrowth of acne bacteria. I get them where you do, as well as on the scalp. That being said, I am not a medical professional, so I cannot diagnose you. Bring up my suggestions with your dermatologist and print out the p acne folliculitis description I linked to you to show her. Anyways, good luck bro. If you end up taking the long-term accutane route I would be willing to talk to you anytime if you needed any support. Take care brother, and I hope you recover from this terribly distressing disease and its psychological side-effects.

[daarchitect2007]

BTW, you're an accountant? I have a degree in Finance, and minored in accounting. I do financial accounting for a firm here in phx. Also, I see you have had scalp acne as of late. Same thing with me. It is the same phenominon as the lip acne. Lemme know if you would like me to explain the pathogenisis of the disease. It is NOT acne vulgaris. It is different but similar. My derm and I have discussed it thoroughly.

[allblaxfan69]

I got stuff a little like that, just remember no picking.. picking will make it look like absolute shit.
anyway i suggest panoxyl bp

[Lakerfan858]

i used to get those man, they suck, but eventually they pop themselves and go away.. maybe you are too dry in that area try some moisturizer and stop using harsh cleansers like soap and stuff with harsh acids and chemicals like BP... i dont know man, im not an expert..

i still get those things on my chin, that is my usual dry area at the moment but i havent got them on my lips for quite some time.


**OHH OHH!! try B-complex 6 pills a day for a week see if it helps**

I'll try the B-Complex... thanks for the reply.

[Lakerfan858]

BTW, you're an accountant? I have a degree in Finance, and minored in accounting. I do financial accounting for a firm here in phx. Also, I see you have had scalp acne as of late. Same thing with me. It is the same phenominon as the lip acne. Lemme know if you would like me to explain the pathogenisis of the disease. It is NOT acne vulgaris. It is different but similar. My derm and I have discussed it thoroughly.

Yes... I'm a certified number cruncher (well, I am not licensed as of yet... I just passed the exam). Do you work for a CPA firm also? If you can, please explain how the scalp acne and "lip" acne are relevant. To be honest w/ you, I would trade passing the CPA exam for getting rid of this darn problem... I can not stand it... I feel the same way you do re: it and I am at the point where I can't function properly.

Anyways... thanks for your input... I really appreciate it.

[dwhaa]

http://www.acne.org/messageboard/500-IDENT...-T-t211269.html
check out this poster and his pics - like yours? He has other pics in other topics I think. I wish someone had the answer for you!

Dawn

[Lakerfan858]

http://www.acne.org/messageboard/500-IDENT...-T-t211269.html
check out this poster and his pics - like yours? He has other pics in other topics I think. I wish someone had the answer for you!

Dawn

Dawn,

Thanks for posting the link to the post. It looks very similar to mine. I will read through the topic shortly.

[ThatAznKid343]

you know, it might perioral dermatitis, cuz i have the same thing like that.
Whenever I use a certain toothpaste, i break out a lot around my mouth. But when i switch back to my old one, it goes away in a couple of days.

Ever try changing your tooth paste? Supposedly, it's the fluoride in the tooth paste that makes me break out. Currently i'm using Aim tooth paste, it also has fluoride but i guess less than other ones because it doesnt make me break out. xD

Hope that helps.

[ballyhara]

Try changing your toothpaste, shaving cream, after-shave.. any product you put in that area. If there's any improvement, one of those may be the culprit. Try re-introducing the products one at a time, if it re-appears after introducing a certain product, that might be what's causing it.

I also experienced a case of redness and drying in the perioral area, but more of an itchy rash on both corners of my lips. They felt dry and hurt when I opened my mouth wide like when yawning. My mom (both my parents are MDs) said it could be a sign of vitamin deficiency. I forget what specific vitamin she mentioned, maybe you can google? She had me take multivitamin supplements and it went away. I also applied lip balm (Nivea night care) on my lips and on the itchy areas every night and that helped.

[melissabee23]

That is a problem area for me too. Here are a couple things to note...
1. Do you use chapstick? All brands, even the types with only supposedly non-clogging oils give me whiteheads. I have to be very careful not to lick my lips so that they never get dry. (licking your lips causes dryness since the saliva "digests" your skin. ew!)
2. I have to eat oily foods and salad with olive oil really carefully so not to spread around my outer lip area.
3. Dan's regimen really cleared up the area for me! Also Tazorac makes the whiteheads shed off in one day.
I hope that helps.

[Lakerfan858]

you know, it might perioral dermatitis, cuz i have the same thing like that.
Whenever I use a certain toothpaste, i break out a lot around my mouth. But when i switch back to my old one, it goes away in a couple of days.

Ever try changing your tooth paste? Supposedly, it's the fluoride in the tooth paste that makes me break out. Currently i'm using Aim tooth paste, it also has fluoride but i guess less than other ones because it doesnt make me break out. xD

Hope that helps.

Thanks for the reply. I tried switching to a non-flouride toothpaste before (squiggle), but to no avail; the breakouts kept coming.

I actually bought another non-flouride and non-SLS toothpaste today called Salt Toothpaste sold at Whole Foods... I will let you know what happens.


Thanks.

[Lakerfan858]

Try changing your toothpaste, shaving cream, after-shave.. any product you put in that area. If there's any improvement, one of those may be the culprit. Try re-introducing the products one at a time, if it re-appears after introducing a certain product, that might be what's causing it.

I also experienced a case of redness and drying in the perioral area, but more of an itchy rash on both corners of my lips. They felt dry and hurt when I opened my mouth wide like when yawning. My mom (both my parents are MDs) said it could be a sign of vitamin deficiency. I forget what specific vitamin she mentioned, maybe you can google? She had me take multivitamin supplements and it went away. I also applied lip balm (Nivea night care) on my lips and on the itchy areas every night and that helped.

I tried changing my toothpaste to a non-flouride, non-SLS toothpaste before (squiggle), but it didn't help. I am going to try a new toothpaste by Waleda called Salt Toothpaste that is like squiggle, but different. I will let you know what happens. I use an electric razor and sterilize after every shave. Re: the vitamin deficiency theory, maybe your mom meant one of the vitamin B's (B5, B6, etc)? I have read a lot about it; how it can be great for acne overall, but some people say it can be dangerous too so I am a little skeptical.

Anyways, I don't use lip balm at all as I quit b/c I thought it was the trigger for my "lip" acne.

[Lakerfan858]

That is a problem area for me too. Here are a couple things to note...
1. Do you use chapstick? All brands, even the types with only supposedly non-clogging oils give me whiteheads. I have to be very careful not to lick my lips so that they never get dry. (licking your lips causes dryness since the saliva "digests" your skin. ew!)
2. I have to eat oily foods and salad with olive oil really carefully so not to spread around my outer lip area.
3. Dan's regimen really cleared up the area for me! Also Tazorac makes the whiteheads shed off in one day.
I hope that helps.

Thanks for the reply.

1) I don't use chapstick period as I thought any type of lip balm was the cause of my problem. I was wrong as the problem still exists.

2) Good idea.

3) Maybe I should try Dan's regimen. I wanted to try Tazorac, but my insurance didn't cover it; my derm gave me retin-A instead which I am hesitant to use b/c I tried it before and it was unsuccessful.