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Malassezia (Pityrosporum) Folliculitis

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Hello all.

I have been suffering from tiny red bumps that sometimes have whitehead and follow a follicular pattern (follows my hair follicles, hair usually in middle) along my neck, back, chest, and upper arms (sometimes). I also have small bumps all over my forehead and along my hairline. These (on my face) do not usually turn red, they seem to be under the skin.

I have been treated for this as acne for years. 10 years I would say. My mom even told me that I had these little bumps on my face when I was a baby! Finally realized what I was suffering from was a yeast overgrowth that looks alot like acne that alot of docs can't recognize or distinguish from acne.

Antibiotics that are normally used to treat the bacteria that cause acne only make this problem worse. Sometimes just going through a round of antibiotics for a cough is enough to set them off.

Until now, it was always something manageable that I could cover up. But after my first hot yoga class (where the room is like a sauna!) and a bit of scratching I did while studying one day, it went crazy! It is so itchy now, and that has never been a problem.

Anyways, I went to the doc and first he prescribed erythromycin. I told him I didn't think this was the problem but he insisted it was acne, and therefore bacterial. I then printed off this information about the condition and went to another doctor:



(please note the space at the beginning of the link in between the "h" and the "t". It wouldn't let me post it unless I did that, not sure why. I'm new!)

This is the most thorough, academic reviewed literature I could find on the internet. The doctor went through it and agreed that I was suffering from those symptoms. She prescribed oral Ketoconazole, 1 200mg tablet per day, until it is gone, and then I will start using topical Ketoconazole that is used in Nizoral shampoo (for dandruff) at 2% probably a few times a week tho, depending on where I'm at.

I am nervous about taking this medication because of it's known liver side effects. I was already on a high dose vitamin A treatment for my "acne" (not accutane, just drops my naturopath prescribed), which I informed her, and she told me to come off of that and take this instead.

I am going to let you all know how this goes. I am currently avoiding tight clothing, moisturizers, letting my hair touch my skin, eating foods I am sensitive to, and eating a sugar balancing diet. I am a VERY healthy person. This can happen to anyone!

My first report:

Actually looked as though it improved even the tiniest bit this morning. Not as red. Experienced an upset stomach when I woke up, but so far so good. No major changes though. Apparently, it takes about 2 weeks to work.

Staying positive and trying not to stress! :cool:

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Day # 2 :

Woke up to skin that was less inflamed than yesterday. Seems like some of the raised bumps are flat now. This may have to do with the Nizoral shampoo I used last night (let sit on my skin for 5 minutes) and the fact that I did not put moisturizer on areas where it is showing those little bumps on my face. We will see how this fluctuates during the day - the night has a way of healing the skin, and the day time is usually a source of irritation considering it is on my chest and easily rubbed even with loose clothing. I will be extra careful today, just because it looks better than yesterday. :-)


So, apparently I have dandruff now? Wtf PF!

Edited by tishi
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Day #3

Major improvement over night! The big bumps are gone, and now it seems like any new bumps are very small. The old ones seem to be drying up too. Again, I used the Nizoral shampoo on my chest, back, and neck last night, and I also purchased some Head & Shoulders shampoo, which worked like a charm for relieving my itchy scalp! Good day all n' all. I will try not to aggravate it while I go about my sunday errands today!! It is obviously still there, but there is definite improvement which I have not seen for a very long time. Yes!

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Day #4

Improvement once again! This is very exciting. They seem to become smaller and smaller as each day goes by. The big nasty ones are drying up, and leaving red marks, but they are no longer active! I am very pleased. The itch is starting to dissipate as well, which is an added bonus because scratching makes these suckers spread like wildfire. By the way, I exfoliated VERY GENTLY last night using a soft cloth, because there was a build up of dry skin. This seems to flatten some of the nasty active ones, and not aggravate them thankfully. I don't recommend any exfoliation tho (I couldnt resist) because it usually just makes it worse, I just got lucky that time!

My face is getting better too, except for the hormonal acne that has made its appearance by my chin/lips, but that just happens at this time of the month. That is why I am going for a facial today, because I don't want to make it worse than it already is! Never touch those nasty ones, only let professionals do it!

The dandruff spell has completely cleared up since using the head and shoulders (2 times!) and thank god because it was so insanely itchy.

We will see what will happen with the leftover red marks that are mini scars from the pf that ravaged my chest and neck. Hopefully they will heal quickly! Once the pf is gone I might consider getting some sort of photofacial or light therapy to clear up the scarring/ heal my skin. We shall see how long it takes to kill these mofos.

The war continues . . .


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Facial was a success! She is awesome though, and I don't think many facialists would be able to do what she did. She also gave me some Colorsense mineral makeup to cover some of the scarring. No big PFs now, little guys, but staying in check. Continuing with treatment, so far its working.

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Day #5

Improvement! One little guy on my neck, but so far everything else is calming down. This is after a very long time of suffering with this, and I can't believe it!

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Thanks for the reports.

Keep us updated on your progress, particularly AFTER you stop taking the pills.

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great i would love to read more about how everything turns up

how long do you have take the pills for? I read that the best way to treat this skin disorder is by taking a 60 day course.. one pill a day and applying the nizoral 2% shampoo

is this what was prescribed by he doctor?

are you using the topical cream also?

Edited by nenrod
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It's been almost a year since this topic was active. I'm guessing since tishi hasn't been on means she's all clear (makes sense). I'm going through what I think is the same issue as this. I'm going to the dermatologist tomorrow to confirm if I have this Malassezia Folliculitis thing. Battling skin problems for 10+ years. I have my other acne in check with diet and the right regimen. So maybe this will help me get clear once and for all!!!

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It's hard to find a doctor/derm that doesn't laugh at you when you bring up the word yeast or folliculitis.

Doc: "Just take these antibiotics and I'll see you in 6 months."

Me: "But the last ones you gave me didn't do anything but make it worse."

Doc: "I'll up the dosage, see you in 6 months"

Me: "Thanks DOC!" :naughty:

What do you have to do to get prescribed some Ketoconazole? Geeze...

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I have been struggling with these stubborn bumps, and acne like things on my neck and chest now for a couple months. It all started right after I was prescribed Bactrim. I am so thankful for finding this post because I am thoroughly convinced that I have these exact symptoms. I am also very lucky that my step-mom is a RN and I called her up and asked her to get me a prescription for Ketoconazole, and the Ketoconazole shampoo. She wrote the prescription up, had the doc sign it and its being sent to the pharmacy right now! I am going to pick it up tomorrow morning and I will report back with my findings.

I just have a couple questions, the OP said she was taking 200mg a day, as I don't have any instructions from my doctor I guess I will just take that dosage. Has anyone else taken this medication and if so could you inform me of how much you were taking? Thanks again OP for the informative post!


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I'm new to this board and have PF or MF as it is called now. I see a lot of posts but no one seems to post that they are cured? I have taken Diflucan and still have some bumps but noticeably less. I'm wondering if I should try a round of Ketoconozole pills or Itraconozole. Anyone have any experience with Diflucan - fluconozole not completely killing it and using another antifungal with success? Thanks

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Hey everyone,

I figured I would comment on this because, well, I actually diagnosed what was wrong with me by message boards like this. Here's my story:

I'm a 26 year old Italian-American with naturally oily skin. About 10 years ago in high school I went to a dermatologist for my bad acne. I was prescribed an antibiotic Doxycycline 100mg twice a day. I took if for months because, well, it cleared me up pretty damn good. I refilled the script if there was a refill available and continued to take it because as long as I was on it, I had no acne. I always had some Doxy even after I stopped taking it. If my acne got bad again, I'd take 1 pill a day until it got better.

I now know that you're not supposed to take this medication this way. It probably caused my candida (yeast) overgrowth and pityrosporum folliculitis.

Around that time, I developed a really bad rash on the back of my neck right at my hairline after I had my haircut. I get it cut short, so they always use a buzzer back there to line it up. But every time I got it cut, for 10 YEARS, it would flare up really bad and look really terrible. Even in between haircuts it was still there. Every derm and doc told me I need to grow my hair out and not get it cut short. I did that. But it was still present under my hair. I could feel it.

Fast forward about 10 years and I see another dermatologist because of this rash on the back of my neck. Again, I am failed by the professionals and given an antibiotic, Minocycline. It helps clear up any acne I have on my face (by this time at age 26, my acne is not bad at all) but does nothing for the rash on my neck. I give up hope. Again.

I researched online for hours and hours each day and finally came upon a post that made me realize what I was dealing with. A fungal overgrowth. I had many of the symptoms of Candida Overgrowth. I had PF on by back. Whatever is on my neck is either Candida of PF. I just knew it.

I went to a physician's assisnt that I used to work with and told her...this is what I have, and this is what I need. What I needed was an oral antifungal. The one I asked for was Ketoconazole because I had read that was the common treatment for this issue.

BACKGROUND: What ended up happening to me was a direct result of continued use of oral antibiotics. Using antibiotics for extended periods of time kills not only all the "bad" bacteria (stuff that causes acne) but also all the "good" bacteria in your digestive system. When this happens, it allows the "good" yeast/fungus in your digestive tract to grow and multiply and TAKE OVER YOUR LIFE. With no good bacteria to battle the yeast/fungus for a spot to live, it thrives. My poor diet didn't help. And it may have actually been caused by the candida overgrowth. I had such a sweet tooth. I would eat sweets and desserts like they were going out of style. I loved greasy food (who doesn't) and I was living on my own so ordering a pizza or calzone was so easy. Well, sugars and carbohydrates feed the yeast, and it continues to grow uncontrollably. It caused a myriad of symptoms: grumpiness, irritability, depression, heartburn, sluggishness, lack of motivation, low libido, etc. There's many more I neglect to mention. I knew I had a Candida overgrowth because I did the spit test. If you don't know what that is, Google it and try it. It may shed some light as it did for me. I knew that I had a fungal overgrowth in my gut and that the "acne" on my back and the rash on my neck was also fungal. Whether it was candida or pityrosporum or something else...I didn't know for sure. But I knew it was fungal and that an antifungal would help whatever it was.

I started a Candida diet about 2 weeks ago. It is essentially a no sugar, no carb diet. Only meat and veggies. I felt great immediately due to the diet and lost significant weight. Im down about 7 pounds in 2 weeks. I was religious with the diet for about a week. I'm talking literally NO SUGAR NO CARBS. But i broke the diet a little but in the last few days. I mean, it's summertime....

I started oral Ketoconazole about a week ago. I take one 200mg tablet 3 times a day on an empty stomach for 600mg daily. I know most people here have been taking 200 or 400mg daily, but this is what I was directed to do and I have had absolutely no problems on the medication so far. I'm also putting Nystatin antifungal cream on it at night. I can't put it on before work because it leaves my hair white and looks ridiculous. I do however use some tee tree oil before work and the smell usually subsides significantly by the time i get to work.

I am seeing results. It has only been 5 days and the back of my neck is drying up. I used to have little tiny cystic-like pustules back there and most of them are gone. Now when I say gone, the pustules and bumps are gone. However, I've had this for 10 years and have had numerous barbers' clippers go over it time and time again so there is certainly some scarring back there. So the scarring can still be seen, but the pustules are certainly subsiding. I can even feel it when I run my hands over it.

I am confident that I can beat this with continued use of the Ketoconazole, Nystatin at night, tee tree oil during the day, and a low-sugar, low-carb diet. Oh and I also take a probiotic pill once a day. This restores the good bacteria in your gut.

I must say....anyone with either of these issues (and really, anyone in general) should really consider changing your diet to a low-sugar low-carb. It has made a world of a difference for me. It's not all that fun (no soda or other flavored drinks, no breads, no fast food, no candy, no desserts, etc). My blood pressure has dropped from 135/85 to 110/70 in 2 weeks. Very significant. I also try to run a couple miles 3-4 times a week. I have lost about 7 pounds. I no longer need coffee in the morning. I am so energized compared to what I used to be. My skin is looking great. I am happier and livlier.

I will continue to post my experiences and updates if people are interested. I just thought I would give my story since I've been dealing with this issue for 10 years and only figured out what it was and how I can stop it by reading someone else's story.

Good luck and keep fighting the good fight.

Edited by nickv182
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