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.

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!

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.

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.

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.

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 ...

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 ...

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!!

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.

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 My whole face, except for my forehead, is super clear.

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 ...

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.

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 . . .

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!

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.

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

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

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.

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.

Hi, Just got on this forum. I've had pf for over a year now, but just self diagnosed in the last month. My experiences are exactly like everyone else pertaining to the Derms. It's amazing how they misdiagnose this so frequently and to a great extent many of them don't have a clue how to treat it. I basically TOLD the Derm I have now what I had, and that I didnt want antibiotics and to prescribe me diflucan. I used the Diflucan for 20 days at 150mg per day, I also used Keto cream and 2% shampoo. It started to clear up after about three days then by the 11th day it just flared up. I kept taking the diflucan and doubled up on the keto cream and shampoo to twice daily. Now, I have about 7 active postules on the chest, back, head, and shoulders, none on the face really. My regiment now is keto shampoo and cream twice daily, zinc pyrithione body wash (dial makes one now), 100% tea tree oil, probiotics, vitamin c, and garlic capsules. I no longer have the itch so I take that as a sign that it is improving(I hope). To my knowledge Pityrosporum or Malessazia is not contagious as it is a fungas that we all have on our bodies. I was wondering out of all the people who are on this post how many are healthy with healthy immune systems? I was also wondering how many of you are intense exercisers? (crossfitters,weightlifters,triathletes).. I have noticed that the PF is worse when I exercise and it helps to immediately shower when I am finished and begin my regiment. I've neen healthy all my life and I rarely ever get sick, I havent had a cold since 2007. Anyone have a clue as to how long this thing usually lasts, or does it never go away? Also, I just turned 40 and have read that it effects men in their 4th decade more than any other population. I'm thinking it may be a hormaonal imbalance of some kind as my testosterone levels are abnormally and naturally high.

From what I read about fungus, they grow immune to certain things that try to kill them. So I've heard of people rotating different anti fungal treatments so the fungus can't adapt. The melassazia fungus especially is also lipophillic meaning it feeds on fats and oils. That's why they cause flaky scalp and dry skin on the face and body. I also read that the fungus will persist if you use emollients (moisturizers). Fugus like dampness. Another thing is that fungus like sugar, so I believe having a no sugar/no carb diet will help get rid of it. I don't really exercise so I can't say mine is related to what you are saying. I shower daily and wash my face and neck 2 times a day with mild/natural products.

For me, I'm just going to take my antibiotic for 3 weeks up to when I go back to the derm. It'll be funny if I'm still in the same condition and she'll say, "OK let's start you on some treatments for fungus!" Of course by then I should have the results back from the cultures they are supposed to do.

Pityrosporum folliculitis.

Topical or oral antifungals are the most effective treatments for this type of folliculitis. Because the condition often returns once you've finished the course of oral medication, your doctor may recommend using topical ointments indefinitely. Antibiotics aren't helpful in treating pityrosporum folliculitis and may make the infection worse by upsetting the normal balance of bacteria on your skin.

I guess if I get worse from the antibiotic, I'll know this is true and the answer will be clear.

Source:

http://www.mayoclinic.com/health/folliculi...ments-and-drugs

Beachcat,

Yes, I have all of those. What made me think it was for sure PF was the sandpaper feeling. I could also take my nails and kinda scratch and it was like a hard piece came out, almost like a blackhead, but not. I went back to the derm a couple days ago and she said that they ran tests and it showed no fungus, yeast or bacteria. All it showed was inflammatory. She put me on an oral steroid, prednisone. I took ketocanozle for a week and used the nizoral shampoo before that and it looked as though it was starting to clear. Started to smooth out and not have that sandpaper feeling. Of course the derm had no answers to why that would help it if it wasn't fungal!! The prednisone is just making me itch in places that I wasn't before!! I'm beginning to think I need to find another derm to go to. It's upsetting when you go to a specialist and they don't know what the hell they're doing!! I'm still not convinced that it isn't PF. Looks just like it, in the same places and everything. I'll finish the steroid and when I go back in 2wks if no results then I'm finding another derm and she will know that she sucks!! lol Thanks again for listening to me vent. I will keep checking back in and let you know how its going!!

From what I read about fungus, they grow immune to certain things that try to kill them. So I've heard of people rotating different anti fungal treatments so the fungus can't adapt. The melassazia fungus especially is also lipophillic meaning it feeds on fats and oils. That's why they cause flaky scalp and dry skin on the face and body. I also read that the fungus will persist if you use emollients (moisturizers). Fugus like dampness. Another thing is that fungus like sugar, so I believe having a no sugar/no carb diet will help get rid of it. I don't really exercise so I can't say mine is related to what you are saying. I shower daily and wash my face and neck 2 times a day with mild/natural products.

 

For me, I'm just going to take my antibiotic for 3 weeks up to when I go back to the derm. It'll be funny if I'm still in the same condition and she'll say, "OK let's start you on some treatments for fungus!" Of course by then I should have the results back from the cultures they are supposed to do.

For some reason most Derms don't have a clue about pityrosporum. Its not as common as the bacterial type and mostly exists in tropical climates. Its fairly common with athletes and also recurring. I would say one of the major indicators that it is fungal is the itching, especially when you perspire or become hot. It also burns when you begin to sweat. Hope it works out. Please let me know.