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Pityrosporum Folliculitis

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#1 niehaoma

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Posted 09 March 2011 - 10:15 PM

I wanted to start a new thread on Pityrosporum Folliculitis (PF). The other threads seem dead. I am not going to copy what PF is from Wiki. I assume either you can Google it, or you are reading this thread because you are like me, you have PF and you are trying to find a "fix" (notice I didnt say cure smile.gif It would be nice to keep this thread clean, with just useful information from individuals that have, or have had, PF, and how they eventually resolved it (including what they used).

I started having PF after finishing Accutane. It has been almost 2 years. In the last months, it has been pretty bad, localized to my forehead and scalp. I used 1% and 2% Nizoral Shampoo a while back, but eventually it lost its efficacy. Now, I have been using Oral Ketoconazole, Diflucan (Fluconazole), and topical Loprox. It took 7 days for the PF to completely disappear on Oral Ketoconazole, but only < 14 days for it to completely come back. Repeated the same thing with Diflucan, but it came back. Now I bumped up Diflucan from 150mg to 200mg. I am only on day 2 (after starting again). I am using Loprox a few times a week. Too early to tell yet what will happen.

I also just started today taking Oil of Oregano (OoO), as well as Pau D'arco (both are liquid tinctures). I took GSE and Garlic a while back, but it didnt seem to resolve anything.

As a note, I even took Ivermectin and Permethrin on the premise it could be from Demodex (note that Demodex mites can cause Pityriasis Folliculitis), but didnt notice any positive results.

My latest exploit is to explore Candida. I took a blood test today for Candida, to determine if there is possibly a link to the PF. Will update when results come in.

By the way, I have been my own doctor. Numerous Derms have misdiagnosed it (acne, bacterial, etc). I was the one that experimented and determined it was PF. In other words, just because your Derm is a Derm, doesnt necessarily mean they know what they are doing.

#2 niehaoma

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Posted 10 March 2011 - 10:33 PM

I wonder how many people think they have acne, but really have some form of folliculitis (PF, demodicosis). A tell-tale sign is if you have developed a very fine "sand-paper" texture to your skin, specifically on the nose, and in the nasolabial folds (laugh lines). So, no one on here has anything to share? Come on, don't be shy.

I got Extina Rx (2% Ketoconazole foam) today. Hope it helps. It is a leave on foam, so perhaps the efficacy is better than Nizoral shampoo.

#3 niehaoma

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Posted 11 March 2011 - 07:00 PM

Used the Extina foam last night. A little sticky (it is like mousse). Didnt notice a positive or negative change by morning, which is somewhat of a good thing, as my face reacts to everything.

Ordered some Caproyl (liquid Caprylic acid). I have read some reports that state it has a greater efficacy than Nystatin or Diflucan. We'll see.

So currently then, my daily regimen is:
200mg Diflucan
Oil of Oregano (30 drops - tincture)
Pau D'Arco (30 drops - tincture)
Alternate shampoo (also used on face) Loprox, Selsun, H&S, Nizoral
Extina 2% Ketoconazole foam
Anti-candida - paleo-ish diet.

Currently on day 4!

Edited by niehaoma, 12 March 2011 - 12:29 PM.


#4 niehaoma

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Posted 12 March 2011 - 12:27 PM

My derm gave me some samples of "PromiSeb". It is a Rx, but has no primary active ingredient. It is not a steroid, which is good. It supposedly has the ability to significantly reduce Malassezia (the yeast that causes Seb Derm, PF, dandruff, etc). I am trying it out on a little section. It supposedly has better efficacy than Desonide. Interesting. Noticeable results take about 14-28 days.

Status update:
Forehead is drying out along the hairline. This is generally a good thing, meaning the PF is dying, and the small bumps fading. The primary concentration and last area to go is the center of the forehead (not sure why).

An interesting factoid: People may have heard that natural flora of the skin is in direct competition with each other. In this instance, I am referring to bacteria and yeast. When the balance is upset, generally adverse symptoms appear. This is one reason why there is bacterial-based folliculitis, and also yeast/fungus-based folliculitis(PF). An interesting aspect to Malassezia yeast, is it produces "Azelaic acid' as a byproduct. If you are familiar with Azelaic acid (think Finacea, etc), it is a common Rx for anti-bacterial applications. This is how the yeast attempts to compete with bacteria. Just thought that was interesting, and also might explain why a year ago applying Finacea to my forehead had bad results. I was just adding to the already existing problem. Food for thought. To avoid confusion, Pityrosporum is also [more currently] known as Malassezia, of which there are different types, with M. Furfur and M. Globosa being the most suspect in Seb Derm, PF, etc.

#5 niehaoma

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Posted 13 March 2011 - 11:53 PM

Update:
Stopped using the Extina foam. It seemed a little harsh (stung on application, seemed to irritate my skin).

Still taking 200mg Fluconazole per day, OoO, Garlic, Pau D'Arco. Forehead seemed like it was getting better, but it was short lived. Currently on day 6.

Read an interesting post that I had read before, using raw honey. I know there are numerous reviews here about it. It is also specifically used to treat Seb Derm, which has commonality with PF. I tried the raw honey tonight. We will see if it has an effect after a few weeks.

I am amazed, there does not seem to be many forums for Pityrosporum [Malassezia] Folliculitis. If anyone knows of any, feel free to share.

#6 niehaoma

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Posted 14 March 2011 - 03:47 PM

Used the raw honey on 1/2 my forehead. Left it on for about 1 hour. Washed it off in the shower. Didnt notice a difference one way or the other come morning. I will stick with it to see if it has an effect, using it on just one side, using the other as a control.

I might have the derm switch me from 200mg Fluconazole to 200mg Ketoconazole. I think the Keto worked better in the past, at least quicker. I am also exploring Biotin. I had a Vitamin test (Spectrox) about 1 year ago, and my Biotin level wasnt considered deficient, but wasnt spectacular either (it was 40, and < 34 is deficient). In addition, it may not be the amount of Biotin I had, but rather my bodies ability to utilize it. In any case, researching these links is exhausting, and loosely-coupled at best.

#7 niehaoma

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Posted 15 March 2011 - 12:30 PM

Made two new appts with two new derms, earliest one being next week. I am not impressed with current derm. I have repeatedly asked for KOH, biopsy, or culture, but have been refused. I will update on what new the derm says next week (i researched these two, and they have been around a long time and have very high rankings on medical review sites). I feel like guessing in the dark is absurd, and I have read so many case studies that state a simple scrape and subsequent KOH (Potassium Hydroxide slide preparation) examination or stain can be used for diagnosis. The only counter argument I can see is the fact that Malassezia is considered a normal skin inhabitant, so positive results may not be conclusive. But to that I say, well, if it is NOT present, then perhaps it is something else. In addition, maybe not just the presence, but population, can provide insight as to the etiology. The quest continues ...

#8 niehaoma

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Posted 17 March 2011 - 02:04 PM

Finished my second 3-hour raw honey mask yesterday. Seeing some slight improvement. Still very dry, slightly scaly, and slightly irritated. I have also been surfing the last couple days, so maybe the salt water has been helping ...

#9 Beachcats

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Posted 20 March 2011 - 02:52 AM

Hello:

I am glad you started a new thread for Pityrosporum Folliculitis. I too diagnosed myself. MDs will not do a KOH scraping. I did push my BF to get a biopsy. It was positive. I am certain he gave this to me. My weak immune system played into it. I believe it is contagious to someone vulnerable.

I started with Ketoconazole 200 mg for 3 days. I had a reaction (allergic) with a rash and could not breathe. I am now on Fluconazole 150 mg 1X per week for 4-8 weeks. Jury is still out but tolerating the drug. I have dry mouth on both.

I am doing apple cider vinegar astring 50/50 with distilled water. This smooths out the sandpaper feel. I am using the Noble Soap with zinc pyrthione available at Dr. Cynthia Baileys website. I started RX topical Sulfacetamide/Sulphur (5%). Noticing big difference with all three combined.

I wash my hair with RX 2% Ketoconazole. Too harsh wash my face with so stopped that. Vinegar rinse after. Who cares if smell like an italian salad!!

Still exploring if Demodex too. I had KP (keratosis pilaris) crop at exact same time as scalp and chest. Extreme stress in my life so face PF evolved a few months ago. Need check thyroid!!! Think maybe low!!

#10 Beachcats

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Posted 28 March 2011 - 01:24 AM

Hi Nieheoma:

I forgot to ask you about Accutane. You said your PF started after taking it? I have read several places it cured folks when they took Accutane?! I was going to try it next. I had an itchy pimple rash on my chest and back and took Accutane and it cured me within days and it never came back. No more cysts either. Basically I have great skin except for that one time with the back and now! This itime started scalp and the forehead and nose bridge. I look sunburned too!

I do not think my Diflucan (150 mg/week) is high enough or frequent enough dose. First few days very clear and then I get worse several days til next dose. Derm hard to get appt to see. How did it go with your new derm?

Same regimin except using OTB Skin Medicated Cleanser #2 froom Dr. Baileys skincare line on hair instead of the Ketoconazole 2% RX. Zinc Pyrithione main ingredient. You are doing all things I do. I bought Oil of Oregon but it scares me because acid reflux. Want to see a Naturopath. Strict yeast free diet. Helps I think. 1 1/2 months now. I always eat great. Major stress in my life triggered. No doubt about that.

I plan to battle this PF to the death! I am very withdrawn and uncomfortable with it on every level. You sound alot like me with your approach.

Edited by Beachcats, 28 March 2011 - 01:29 AM.


#11 niehaoma

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Posted 28 March 2011 - 08:37 PM

Just went to the new derm. Disappointed. Either I just refuse to believe what they have to say, or what they are saying is crap. Derm said my redness/irritation/bumps on my forehead is Rosacea-dermatitis. That was a new one for me. He wanted to prescribe antibiotics, prednisone, and topical steroids. Three tell-tale flags he doesn't have an f-ing clue. He told me to deal with it, it wont get "cured", and to "Stop chasing my own tail." So much for bedside manner these days.

I am still trying to narrow in on naturopathic/homeopathic remedies. All my blood work says I am completely healthy, so it has to be some hidden food intolerance, or some problem with my body's natural detox functionality. At least, that is my opinion wink.gif My whole face, except for my forehead, is super clear.

#12 niehaoma

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Posted 14 April 2011 - 10:40 PM

Still battling the forehead issue. My derm put me on a quick course (10 days @ 30mg per day) of Prednisone, to get over a bad hump. It was AWESOME!!! 2 days, skin was absolutely flawless. it hadnt looked that good in so long. Sad part is, you cant keep taking it (without adverse effects). In a nutshell however, if you stop the inflammation internally, everything disappears. Oh well, it was good while it lasted. Only took a few days for it all to start returning once I finished the Prednisone. I asked the Derm to give me Plexion to try. Figured it is one thing I havent used yet. I have used Plexion for about 4 days. I dont particularly notice any positive results. Still searching for the cure ...

#13 radikal

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Posted 17 April 2011 - 10:02 AM

Guys you crack me up with your terse writing style, beachcats especially. That's not why I interjected, I have something to contribute wrt Accutane and PF.
I've been on some number of courses, five or six or whatever. Even before putting it down I noticed inflammation and fossilization of my facial hair, which much later I self-diagnosed as PF.

To my mind there is clear causation (one of the long term side effects of isotretinoin, I have others I'm also stuck with). I am aware one of the "treatment" avenues for PF is isotretinoin (Accutane). Talk about irony, the circle completes. I had no PF many years ago, before starting Accutane.
I would not recommend isotretinon to contain PF, even if it's effective. Long term you're worse off than when you started.

#14 Beachcats

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Posted 17 April 2011 - 07:29 PM

Nieheoma:

Topical sulfa has worked great for me. Alas, not a cure. Apple cider vinegar is a daily must. Sensitive to Mandelic Acid so I did not get far there. Try Noble soap! Simple and mild. Each morning I have more papules and pustules except for the first 2 days of Diflucan I take weekly. I want to try a 2 week daily course. My forehead is the war zone too! Low carb/no sugar yeast free diet still. Lots vegies, brown rice, fish, turkey.

Accutane seems to be a cure for some. Mixed results? Thanks for warning though radikal !! My stress is still high in life. Lower stress is very key to keeping this under control. My stress is somewhat hard to avoid but I meditate, walk, stay positive. No cure for this yet? You are kidding right modern science?!?

See derm in two weeks. She is actually very good. I hate the way they say it looks good when you have a sandpaper forehead with red spots everywhere. Hate to see what bad is . . .

#15 summerraine2

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Posted 18 April 2011 - 01:33 PM

Hey guys,
I'm new to this, but have been reading so many of these threads and everything there is to know on PF. I've suffered from acne since I was 12 yrs old, now 29, yes that's a long time! A few months ago I started getting these pimple like bumps on my chest, back, and shoulders. They itch, burn and sting at times. I knew it was more then acne, just didn't know what!
I went to the derm about 2 wks ago. She initially thought it looked like folliculitis, but of what kind she didn't say. She then treats me with cephalexin and some hormone pill. I called them a few days later and told them that the itching and burning were insane and that I couldn't wait a month for results or a biopsy. They got me in the next day. In the meantime I started using the otc Nizoral shampoo. A little bit of a difference, but not much.
So, I went back to the derm and they did a biopsy and she prescribed me oral Ketoconazole. It's been 5 days and I'm starting to clear up some, but still itch like crazy. Got a call from the lab today saying that my biopsy showed inflammatory. That's it? I thought if it was PF it would at least show some sort of fungus or yeast. She said they may prescribe me an oral steroid, which will make PF worse! I go back Wed. to have my stitches removed and talk with the derm. Not sure what to do anymore. Listen to the derm or diagnose myself? Tired of seeing Dr's that seem they know nothing about nothing.
Sorry this was so long, just venting to people who know what its like with this! I'll write back after my trip to the derm wed!

#16 LuN3yDaV3

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Posted 20 April 2011 - 10:43 PM

I'm going through this same issue. I've been dealing with skin issues for 10+ years. I was able to control my other breakouts, but always had this redness and dry skin that just hung around. I have dandruff and bumps on the back of my head that are like acne pustules that will eventually scab. I also have had issues with red spots on my chest and back. I cut dairy out and it helped quite a bit overall with acne but not completely.

I do have one thing to point out. Since learning about Candida/yeast, I went to the doc and have been diagnosed with Oral Thrush (yeast overgrowth on tongue). He took one look and said it looks like I do have it. Like someone said, you can't really culture for it. So he put me on an oral suspension of Nystatin 3x a day. I then figured well maybe this persistent skin issue I've been having is related to Candidiasis or PF. I have an appt tomorrow with my dermatologist. I've written some notes from reading this thread so hopefully it goes well tomorrow. I'm going to see if they can put me on the Ketoconazole pills and maybe some kind of topical. I've also been on a strict diet to try and kill any fungus in the body. I also went to an herbal store and they recommended Burdock Root extract so I'm drinking that 3x a day as well. I want to get this handled quickly! I'll update after my appt.

#17 LuN3yDaV3

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Posted 20 April 2011 - 10:53 PM

Also one other thing, Pityrosporum is the old name. It's now called Malassezia

Edited by LuN3yDaV3, 20 April 2011 - 10:53 PM.


#18 Beachcats

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Posted 21 April 2011 - 01:01 AM

Hello:

My doctors are calling it Pityrosporum Folliculitis. Old school?

Summerain have you had a KOH scraping to look for spaghetti and meatballs as they nicknamed it for how it looks? Access to a microscope. Less invasive. Biopsy can miss. How annoying for you! Do you have papules and pustules? Look like pictures of PF? Kind of like acne but uniform and stinging and itching? Rough skin??

I know mine is fungal because great response to oral and topical antifungals. PLUS I am sure my bf gave it to me. Made him biopsy his "acne" and positive!! Told him for years smelled wierd. Grrrrhh

#19 TexMurphy01

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Posted 21 April 2011 - 03:13 AM

Hmm, alright guys, I do get spots with cary. Not cystic, and often lots of little ones around the temples, and just below the lower lip. Sometimes there are bigger ones. It seems a strict diet has reduced all these things. At the minute it itches just between my lower lip and chin (quite frequent) and it usually itches just at the sides of my nose.

So to you I ask - firstly, is this likely to be this condition? Secondly, is there some soap or something I can order that might work? I heard of something called a ZNP bar, but trying to get that in the UK seems to be hard work. If possible I'd prefer a non-prescription topical.

Edited by TexMurphy01, 21 April 2011 - 03:25 AM.


#20 LuN3yDaV3

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Posted 21 April 2011 - 07:29 PM

Well I went to the dermatologist today and voiced my opinion about believing my condition was fungal. She (derm) said that it does not look like a fungal infection and that the redness, inflammation and pustules is just a bad case of acne. So I was written an Rx for Doxycycline 100mg capsules and Desonide cream for the rashy red spots on my neck. She said the antibiotic will clear the red bumps on my chest, back and head too. They did take a sample from one of the pustules and a scraping from my neck to check for both bacteria and fungus. It will take 1 week for bacteria results and 2 weeks for fungal. Ugh! Too long. She also told me to quit any other regimen and just use my Purpose moisturizer. I forgot to ask her, but I wonder what I'm supposed to use as a cleanser? Just water?

I have to go back in 3 weeks to see how the antibiotic is working. I was just hoping that I would be treated for fungal first and if that didn't work , then perhaps an antibiotic as last resort. It just surprises me that she didn't see the connection between my oral thush which is fungal and dandruff (fungal again). I've been reading too many bad things about antibiotics lately and I'm just paranoid now. I guess I just suck it up and do it.




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