Jump to content

Photo

Pustuals on scalp-Foliculitis


This topic has been archived. This means that you cannot reply to this topic.
12 replies to this topic

#1 kerrylee

kerrylee

    Member

  • Veteran Members
  • Posts & Likes
    Posts: 171
    Likes: 0
About Me
  • Joined: 15-February 08

Posted 09 September 2009 - 02:36 PM

Hi there!

My son has been off accutane for about 1 year now. So far so good! He was on it 8 months total.
About five months ago he started getting pustuals all over his scalp. They look just like a pimple. You can pop them. They gather at first on his lower neck in his hair and spread all over.
He has been on medication five times. They clear up but the minute he stops the medicine, they return and double!
I have been to the derm over and over. The last time I went she took a biopsy and sent it off and found out they contained yeast! Like a yeast insfection. Turns out I looked it up and it's called Pityrosporum Foliculitis.
Come to find out, Foliculitis can be caused by long term acne treatment!

Has anyone had this? Is there a cure?
Thanks, Kerry





#2 nikkia

nikkia

    Nikki

  • Veteran Members
  • Posts & Likes
    Posts: 525
    Blog Entries: 140
    Likes: 0
About Me
  • Joined: 09-May 09

Posted 09 September 2009 - 08:11 PM

I believe one of the mods is currently treating foliculitis with a low-dose accutane regimen.

#3 Max-

Max-

    Veteran Member

  • Veteran Members
  • Posts & Likes
    Posts: 1,078
    Likes: 4
About Me
  • Joined: 11-October 07

Achievements

     

Posted 10 September 2009 - 03:30 AM

Long term used of Oral Antibiotic to treat acne can cause persistant scalp folliculitis but what most people doesn't know is, Accutane can cause such problem as well. No doubt Accutane and Antibiotic can also suppress the scalp folliculitis if your boy decides to go back on to one of those drug. But the folliculitis will almost certainly returns (albeit even worst) once he stop taking the medication.

The best way to suppress scalp folliculitis is by using Topical products that contain Salicylic acid, Tea tree oil, Aloe vera, Hydrocostisone, Betamethasone etc.

Don't "pop" at the scalp folliculitis as it can cause scarring, spreading of the infection and hair loss.

#4 kerrylee

kerrylee

    Member

  • Veteran Members
  • Posts & Likes
    Posts: 171
    Likes: 0
About Me
  • Joined: 15-February 08

Posted 15 September 2009 - 09:51 PM

Thank you for replying!

This truely SUCKS for him! He is only 16. Can he really losehis hair!! I am freakin out.
Accutane cleared him completly...NOW THIS.

Why treat it if it's going to come back? I'm so confussed. It's spread a lot. He did Nizoral oral tablets and shampoo. It went awaybut then just came back.

Please tell me it's not life long?

Kerry-SAD

#5 Max-

Max-

    Veteran Member

  • Veteran Members
  • Posts & Likes
    Posts: 1,078
    Likes: 4
About Me
  • Joined: 11-October 07

Achievements

     

Posted 16 September 2009 - 12:28 AM

Read it if you are free.


I. What is Fungal Folliculitis?

Folliculitis is inflammation or infection of one or more hair follicles. It is sometimes caused by a fungal or yeast infection. Symptoms are small, generally uniform-sized, pus-filled pimples . The lesions sometimes contain blood. Folliculitis is often misdiagnosed as being acne. People who have acne may also be prone to developing folliculitis . One study found that follicular occlusion, and not just yeast overgrowth, was necessary for the development of fungal folliculitis . Follicular occlusion also plays a role in the development of acne lesions, therefore it is not surprising that people may be susceptible to both of these skin conditions. There are also forms of folliculitis that are bacterial – the treatments discussed in the current article may not help much with bacterial forms. If you are uncertain as to whether the problem is fungal or bacterial, you can ask your doctor to test the lesions to see if they are fungus (or yeast) or bacteria caused. Some people also come to the conclusion that they may have the fungal form of folliculitis when acne treatments have not cleared the folliculitis or have made the problem worse.

II. Background Information

From what I have read, and also from my own and others’ personal experiences, fungal or yeast-caused folliculitis is very stubborn and tends to flare up repeatedly, even after a medication or over-the-counter product seems to successfully clear the problem. The fungus may remain dormant in the skin for long periods of time, and may flare up with triggers such as humid weather, excessive sweating, etc.

Causal or Aggravating Factors:

1. Extended antibiotic use. Antibiotics may cause a fungal infection due to the fact that the antibiotics can wipe out much of the beneficial bacteria in the body, which allows the yeast or fungus to overgrow. Normally, the bacteria and fungus that exists naturally on the skin are in balance with each other. Destroying the bacteria can cause the fungus to grow unchecked. This is particularly problematic for those who have taken antibiotics for acne, as these medications tend to be taken for long periods of time, often for years. One study found that many people who had folliculitis had been misdiagnosed as having acne. A high percentage of those who were misdiagnosed had been prescribed oral and topical antibiotics and other acne medications, which were ineffective treatments in all cases.

2. Use of steroids . Long term use of steroids can also kill off bacteria, which allows the fungus to overgrow. One study found that for patients who presented with steroid-induced acne eruptions, most showed evidence of having fungus present on the skin. In this same group of patients, treatment using an antifungal regimen produced significantly better clearing of the lesions than did an anti-acne regimen.

3. Oily skin6. Fungus feeds off the oil on the skin. Oily skin may predispose a person to both acne and fungal skin infections.

4. Living in a humid environment can exacerbate the problem.

5. For body folliculitis, wearing occlusive clothing that does not allow the skin to breathe can cause the fungus to grow (as fungus likes damp, poorly ventilated environments).

6. Moisturizers, lotions.7 8 Anything that keeps the area too moist can lead to a flare up of folliculitis, this includes moisturizers, sunscreens and other creams.

7. Dietary factors may also be involved, (although there is little medical research available on the specific connection between diet and fungal skin infections). This diet-fungal connection is described most often by naturopathic and similar other types of “holistic” websites, many of which sell products and supplements intended to treat systemic fungal problems such as candida. The theory presented by proponents of the diet-fungus/diet-yeast connection is that diets high in sugar, yeast (including alcohol), and processed foods may help to feed the fungus and cause it to grow. However, these diet approaches for treating fungal infections are not without merit - antifungal supplements that are recommended by those who support the diet-fungus connection ARE well documented by the medical literature as having antifungal properties. These antifungal supplements are described in the next section.

8. Use of hottubs or spas. The heat and humidity generated by hot, steamy water can lead to flare-ups of fungal skin infections.

III. Treatment of Folliculitis

I thought an overview of OTC options might be helpful for anyone who does not want to go on prescription antifungals, or anyone who has had limited success with prescription treatments. These also may be used as a supplement or a follow-up to prescription medications for maintenance purposes. These recommendations come from a combination of sources, including medical research, natural/holistic articles and websites, and anecdotal experiences of myself and others who have tried to treat themselves for this condition.

I would also make several general recommendations for dealing with this problem:

1. Kill the fungus topically AND systemically by using:

• Antifungal cleansers
• Leave-on antifungal treatments
• Oral antifungal supplements
• Dietary changes
• Products that exfoliate the skin

2. Important: Use multiple antifungal treatments at the same time (either topical or oral supplements, or both), and rotate them on a regular basis (e.g., every few weeks) . Do NOT use the antifungal to the point where it stops working. From what I have read and through my and others’ experiences, once a product stops working, then it doesn’t work well again in the future.

3. Keep the affected area as dry as possible. Minimize use of moisturizers, creams, etc. For folliculitis on the body, applying Gold Bond Powder may help keep area drier – this may be particularly good for those living in humid climates.

4. If possible, stop using certain acne medications such as oral and topical antibiotics or topical antibacterial treatments like benzoyl peroxide. Other acne products such as retinoids may not help very much, as there is no clogged pore involved with folliculitis breakouts. If there is a combination of acne and folliculitis, it is probably okay to keep using retinoids, and other products such as salicylic or glycolic acid to treat the acne.

5. Foods to avoid : sugar and yeast containing products (bread, alcohol, etc,), processed/frozen foods, sandwich meat and other processed meats, dairy. Reducing dietary sugar may be very important, as fungus and yeast feed on sugars. According to those who support dietary methods of controlling fungal infections, omitting sugars and yeast helps to starve and kill off the fungus.

6. Also consider adding a probiotic to the diet, especially for those who have taken long courses of antibiotics for acne or other bacterial infections.

7. For body folliculitis, avoid clothing that is rough or that irritates the skin. Cotton clothing and cotton sheets are the best bet.

8. Don’t use fabric softener or harsh detergents on clothing or bedding.

9. Avoid sitting in hottubs/spas or taking really hot baths or showers.

III. Treatment Products

The following products have either worked for me, other people on acne.org or have some literature that supports their effectiveness in treating fungal and yeast forms of folliculitis.

If you are dealing with a particularly stubborn or widespread case of folliculitis, try attacking the problem with multiple products at once (cleanser, topical leave-on treatments, oral antifungal supplements) and rotating the products on a regular basis. Continue with this method for 4-6 months, even if the problem clears up. After that, you may be able to cut back to doing an antifungal maintenance regimen every few months.

If you choose to add oral antifungal supplements to your diet, it would be probably be a good idea to seek the advice of a qualified dietician for assistance. Also see any product warnings for possible side effects or drug interactions. Be sure to consult your doctor if you have any concerns with adding any supplements to your diet.

A. Topical Treatments - Cleansers

Select one or two cleansers at a time and rotate every few weeks to prevent the fungus from adapting to the treatment ingredients.

1. Nizoral Shampoo

Description: Active ingredient for the over the counter version is 1% Ketoconazole, which has been shown to be an effective antifungal treatment . There is also a prescription strength version that is 2% Ketoconazole. However, I believe that the 2% strength can be ordered on the Nizoral website .

Use: For the first few weeks, wash with shampoo once a day. Leave on for a few minutes and then rinse off. If the shampoo is helping, reduce use to once or twice a week for maintenance. Do not use this as a leave on treatment – it may cause irritation.

2. Vivant Mandelic Cleanser (or mandelic scrub)

Description: Mandelic is both antibacterial and antifungal , so it may be a good option for those who have both acne and fungal folliculitis.

Vivant Pharmaceuticals markets their mandelic cleanser as a good treatment option for killing pityrosporum fungus. Mandelic acid also helps exfoliate the skin, which helps peels off the fungus on the surface of the skin. The scrub adds a bit of extra exfoliation.

Use: Similar to above. Wash daily, leave on for several minutes and then rinse off. My experience was that compared to other cleansers and treatments, mandelic worked for a longer period of time before the fungus adapted to it.

3. Salicylic Cleanser or scrub

Description: Salicylic has fairly mild antifungal effects , but may effective for some people for folliculitis. It also may help antifungal topical treatments absorb better. Since it also helps with acne breakouts, it may be good for those who have acne and folliculitis.

Use: Wash once or twice a day with a salicylic cleanser or scrub. Leave on for a few minutes and rinse off.

4. ZNP Bar

Description: ZNP bar contains zinc pyrithione . It is often used for fungal infections such as tinea versicolor and seborrheic dermatitis . Some people find it effective for fungal folliculitis as well. It also helps by drying out the skin; drier skin can help reduce fungal overgrowth.

Use: Wash once a day, leave on for a few minutes and rinse.

5. Other antidandruff shampoos – Selsun Blue, Head and Shoulders

These also contain some of the helpful antifungal ingredients. Selsun Blue contains zinc pyrithione and selenium sulfide , which is also used to treat fungal skin infections. Head and Shoulders contains zinc pyrithione as well. I haven’t used these myself, but they do seem to work for some people. And they are also a much cheaper alternative to some of the other antifungal cleansers.


B. Topical Treatments – leave-on products and spot treatments

Select one or two topical treatments at a time and rotate every few weeks to prevent the fungus from adapting to the treatment ingredients.

1. Mandelic Acid Serum

Description: As described previously, mandelic is both antibacterial and antifungal , so it may be a good option for those who have both acne and fungal folliculitis. Mandelic acid also helps exfoliate the skin, which helps peels off the fungus on the surface of the skin. Although mandelic products are not widely available in stores, several skin care companies (e.g., Vivant, NuCelle) make mandelic serums and toners which can be ordered from the product websites.

Use: Apply serum to affected area once a day. If excessive drying or peeling occurs, reduce application to every other day.

2. Propylene Glycol

Description: Propylene glycol has been found to be a successful treatment method for fungal folliculitis. Propylene glycol can be obtained through a doctor’s prescription or be ordered online. It may be a little bit hard to find, one place to order it is from cigar companies (they use propylene glycol for cigar humidors).

Use: It is generally mixed in a 50% solution with water. Spray the mixture on the affected area once or twice a day.

3. Salicylic Acid

Description: Salicylic has fairly mild antifungal effects , but may effective for some people for folliculitis. It also may help antifungal topical treatments absorb better. Since it also helps with acne breakouts, it may be good for those who have acne and folliculitis.

Use: Apply salicylic acid topical (serum, gel, toner, etc.) once or twice daily to affected area.


4. Tea Tree Oil

Description: Tea tree oil is recommended as a useful antiseptic for treating folliculitis . Research has shown tea tree oil to exhibit antifungal activity towards several fungal species that cause fungal infections.

Use: Can be used as an overall treatment or as a spot treatment for individual lesions. For application to large area of skin or to the face, it is probably best to dilute 100% tea tree oil to avoid excess irritation. Spray or apply the solution with a cotton pad on the affected area once per day. A stronger concentration can be used for spot treating individual lesions (but taking into account an individual’s skin sensitivity).

5. Oil of Oregano

Description: There is considerable evidence in the medical literature that oil of oregano possesses both antifungal and antibacterial properties. The vast majority of this research has been on fungal infections of plants and a few studies on its use with animals; however, there have been very few human studies, and none on the use of oil of oregano for treating fungal folliculitis. Its effectiveness for treating human fungal infections is mostly cited on anti-fungal diet websites and by those who support alternative, natural forms of treating fungal problems. Interestingly, oil of oregano is also used as an antibacterial ingredient in a few acne product lines, including ZenMed acne treatment products.

Use: You do NOT want to apply 100% oil of oregano directly on the skin, as it may burn. Be sure oil is diluted in a carrier oil (many products come already diluted in carrier oils, but check your product to make sure). It may be used as a spot treatment on individual lesions, or as an all over treatment for the entire affected area. For all-over treatment, it is probably best to further dilute the oil in water and spray the mixture on the affected area one to two times a day. Information on the comdeogenicity of oil of oregano does not seem to be available, so this may be a concern with topical use of the oil for those who are acne prone. Also, oregano is often mixed with a carrier oil – sometimes olive or jojoba oils. Olive oil is rated as being slightly comdeogenic (rated a “2” on a 0 to 5 scale). The comedogenic rating of jojoba ranges from 0 to 2; however, anecdotal evidence indicates that some people may have adverse reactions to jojoba oil (but others seem to have no problems with it). Those considerations should be taken into account when deciding what formulation of oregano to use, and the method of application (e.g., it might be better used on body folliculitis rather than facial, or it may be better to use as a spot treatment only).

6. Apple Cider Vinegar

Description: While apple cider vinegar does have antimicrobial properties, its effectiveness for treating fungal skin infections is not clear, and has not been well-researched in the medical literature. The use of ACV for treating fungal infections is mostly cited by natural-product based treatment proponents. I have included it here because it may be worth trying if other antifungal treatments have been unsuccessful. Anecdotal reports of the effectiveness of ACV are mixed; some users do claim to benefit from topical ACV use for various forms of fungal infections. As discussed in the next section on antifungal supplements, ACV may also be taken orally – either in a diluted liquid or pill form.

Use: Dilute with water and apply to affected area once a day.



C. Antifungal Supplements

For many of the supplements listed below, there is evidence of their antifungal properties (see references below). However, for some of these supplements there is minimal research on its use for treating human fungal infections. Their use for the treatment of fungal infections is often cited on anti-fungal diet websites and by those who support alternative, natural forms of treating fungal problems.

If you choose to add oral antifungal supplements to your diet, I encourage you to seek the advice of a qualified dietician for assistance. Also see any product warnings for possible side effects or drug interactions. Be sure to consult your doctor if you have any concerns with adding any supplements to your diet.

For those interested in adding one or more antifungal supplements to their diet, this list may be of assistance. As with antifungal cleansers and topical treatments, it is probably important to rotate your antifungal supplements to maximize their effectiveness and to reduce the likelihood that the fungus will adapt to the product.

1. Oil of Oregano

2. Coconut Oil (or caprylic acid)

3. Undecylenic Acid

4. Olive Leaf

5. Garlic

6. Berberine

7. Apple Cider Vinegar

8. Neem


#6 Max-

Max-

    Veteran Member

  • Veteran Members
  • Posts & Likes
    Posts: 1,078
    Likes: 4
About Me
  • Joined: 11-October 07

Achievements

     

Posted 16 September 2009 - 12:34 AM

Try to find out with the doctor what kind of folliculitis exactly is your son suffering from. It could be due to fungal but it can also be due to Staphylococcal (bacteria) infections.


http://www.squidoo.com/folliculitis

http://www.ecureme.c...olliculitis.asp

#7 nikkia

nikkia

    Nikki

  • Veteran Members
  • Posts & Likes
    Posts: 525
    Blog Entries: 140
    Likes: 0
About Me
  • Joined: 09-May 09

Posted 16 September 2009 - 07:14 AM

If accutane at a low dose can work, why worry about taking it for the rest of his life? A lot of people will be on medication for the rest of their lives, or their conditions will return. If my dad doesn't take his blood pressure meds, his high bp will return. If a person doesn't take their anti-depressants, it will alter chemical function in their brain and their depression will return.

Btw, when I say the person on these boards treated with a low dose, I'm talking about 10 mg once a week. That's extremely low.

Anyway, best of luck.

#8 kerrylee

kerrylee

    Member

  • Veteran Members
  • Posts & Likes
    Posts: 171
    Likes: 0
About Me
  • Joined: 15-February 08

Posted 16 September 2009 - 12:42 PM

Thank you max for all that! They did do a biopsy and it was the Pityrosporum folliculitis. I was up all night with no sleep reading about it. I have to say I am so sad for my son. I called the dermatologist back. I dont think she is being straight about this. She called me today and said his blood work was ok and she had another treatment she wanted to talk to me about. He goes in Tuesday. Also, I made an appointment with Infectious Disease for him today. I wanted a second opinion. I know I sound crazy, but I am so tired and angry. We fought acne for 8 months and won. Now this is what happened because of accutane and Predisone and Minocycline. Its a no win situation. I am scared to death he will lose his hair! OMG...he would die! I cant even think about that. Have you heard of that? Also it is just all over his scalp. I read 22 pages on here and no one mentioned it on their scalp, just body. It has moved to his forhead a little. Can this go all over his face? and never go away?

Thanks Nikkia...I understand the whole long-term thing. I guess my thinking is, if accutane caused this...wouldnt that make it worse? Not sure????

#9 Priestess

Priestess

    Member

  • Veteran Members
  • Posts & Likes
    Posts: 111
    Likes: 0
About Me
  • Joined: 29-December 05

Posted 16 September 2009 - 01:13 PM

Well I wouldn't recommend using Nizoral Shampoo for Pityrosporum Foliculitis, I tried that shampoo under docs recommendation and it makes your hair so dry and damaged(plus it smells horrible). Plus if you use conditioner it will probably aggravatate your son's scalp condition even more.Maybe try Johnsons baby shampoo, it won't leave any oils or silicones on his scalp.

#10 Max-

Max-

    Veteran Member

  • Veteran Members
  • Posts & Likes
    Posts: 1,078
    Likes: 4
About Me
  • Joined: 11-October 07

Achievements

     

Posted 17 September 2009 - 12:28 AM

The thing about Pityrosporum folliculitis is that the folliculitis will almost certainly returns once the patient stop all treatments. I will suggest using shampoo that contains Mandelic acid shampoo twice a week and see how thing goes from there.

#11 kerrylee

kerrylee

    Member

  • Veteran Members
  • Posts & Likes
    Posts: 171
    Likes: 0
About Me
  • Joined: 15-February 08

Posted 17 September 2009 - 02:54 PM

I didn't get that last message until after Iwentt to thhe store. I bought Head and shoulders with Selinium. Thanks for the recommendation.

My biggest fear and question for everyone is: Will his hair fall out with PF. Pleease tell me no.....

#12 Max-

Max-

    Veteran Member

  • Veteran Members
  • Posts & Likes
    Posts: 1,078
    Likes: 4
About Me
  • Joined: 11-October 07

Achievements

     

Posted 18 September 2009 - 01:16 AM

I do believe that even if there is some hair loss, it will regrow within months. Anyway, I have just send you pm regarding H&S.

#13 bigwillmanc

bigwillmanc

    New Member

  • Members
  • Posts & Likes
    Posts: 6
    Likes: 0
About Me
  • Joined: 02-March 10

Posted 02 March 2010 - 02:21 PM

hello, i have just joined this web site today and im reading because im really fed up with the acne and foliculitis i have had for some time now, over 18months now coming upto 2 years. Im 29 and im a month into a 4 month course of roaccutane, im just praying that it helps as i have some large bald patches on my scalp which if anything seem to be getting wider = more hair loss and more new bumps and patches. The dermatologist said that he doubts very much that my hair will grow back because its now scarr tissue. I dont suit a bald head and i feel ugly a lot of the time because of this nasy virus. My dermatologist believes that i have a follicular occlusive disease such as acne conglobata/hidradenitis suppurativa.