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Gram Negative Folliculitis Story With Questions And Photos

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Hello, this is my first post. Thank you for reading and for any advice.

Here are some pictures I took while composing this post. This is after a couple days of prescribed treatment and weeks of my own treatment. [Removed link]

In 2008 I was diagnosed with folliculitis. It was on my face only. My entire face was covered in acne-like whiteheads and papules. I have suffered from mild to moderate acne since puberty. I knew that this was something other than acne. I went to the dermatologist and he immediately diagnosed me with folliculitis. He gave me a fungal shampoo. That didn't work. I went back a week later and he gave me a prescription for topical Clindamycin and an oral antibiotic. He told me not to sweat (difficult since I live in Florida). It cleared up.

Unfortunately, that wasn't the end of it. Over the past four years I have suffered from folliculitis. I am now 40-years-old and I kind of just live with it. I try to treat it with stuff I have: Benzoyl Peroxide, Glycolic acid cleansers, a combo clindamycin/Retin-A drug (Ziana), salycilic acid. This stuff doesn't make much difference. I have to wait it out. It lasts for about a week or so and clears up. I didn't go back to the dermatologist because I found that no matter what I used it cleared up on its own and nothing seemed to speed recovery.

Folliculitis is very emotionally distressing. I'll have clear skin for months and suddenly notice clusters of pinpoint whiteheads and know I'm soon in for a face covered in papules and pustules. One year I probably had it six times per year. A couple years were great and I would only get a couple outbreaks. Even though my dermatologist advised me not to sweat I exercised and did hot yoga. When I was doing hot yoga I didn't have any folliculitis. I went to YMCA and did spin and aerobics and I didn't find that sweating brought on the folliculitis, if anything it seemed to be better when I was exercising. This was probably a coincidence. I realized that my folliculitis was not aggravated by sweat; it was something else that was entirely random and unpredictable. Random to me at least. I never knew what was or is causing it. I have wondered if my makeup or beauty products were contaminated. I wondered if it was my food. I wondered if it was poor hygiene.

I am now beginning to believe it is a case of gram negative folliculitis (my doctor thinks it is) and not a contaminated product or hygiene. He did tell me to throw away my makeup.

For the past 6 months, or longer, I have not had any folliculitis. In mid-November I had a UTI and was prescribed Bactrim. I had a rash on my face, neck, and chest (photosensitivity rash) and stopped the antibiotic. Soon after the rash I broke out in folliculitis. Like always I waited for the folliculitis to clear up like it usually had in the past. I still had some of the Clindamycin/Retin-A combo drug (Ziana). I put this on my face and it would look better but I couldn't get it to fully heal. Just when I thought it was clearing up, it would come back. I was never prescribed Ziana. My mother gave me a tube, to treat my regular acne, she was prescribed a few years ago. Maybe it was in 2008 when all of this started. I can't remember. I do know that I stopped using Ziana for a while because in the past, I noticed that it did nothing and was not useful in clearing folliculitis. I used it again this year because I was desperate and maybe it would help this time. It wasn't working fully (maybe it made it come back). I couldn't get rid of the folliculitis.

This week I went to the same dermatologist that I saw in 2008. He took a look at me, asked me what was happening over the last four years, and told me it was probably gram negative folliculitis. He gave me a prescription for SulfaCleanse (sulfa face wash) and told me to buy PanOxyl bar. He told me to wash with PanOxyl in morning and Sulfa wash at night. He told me to lather the PanOxyl and Sulfa and allow it to sit on the face for 10-20 minutes.

I have been doing this for the last two days. The folliculits looks a little better. My face is red and dry, and starting to scale, but that is to be expected. He told me the next step was Accutane and to come back when it was "particularly bad" so he could culture it again. In 2008 he cultured it and the results came back negative -- normal skin flora. Nothing grew in the lab.

Here is what I have and haven't done:

-I have NEVER been on long-term antibiotics. Over the last four years I have been prescribed an antibiotic four times. Levaquin for UTI, Bactrim for UTI, a sulfa for UTI, and amoxicillin for an for a run of the mill upper respiratory illness. I have photosensitivity reaction (fairly common occurrence) to most antibiotics. In my entire life I would estimate that I have only been prescribed antibiotics around ten times. I do not seek out antibiotics unless completely necessary. I have not taken long-term antibiotics for any illness, including acne.

-I have cleansed my face with a myriad of products. I will use everything from Dial antibacterial bar soap, to acne cleansers (PanOxyl, Neutrogena), to Ivory soap, to Ajax dish liquid for a quick cleanse in the kitchen sink (I know, not good). I use a glycolic acid cleanser called Wrinkle Revenge 2. Usually I cleanse my face with the soap that is in the shower and the Wrinkle Revenge a few times per month. Sometimes I use a night cream with retinoid in it by Neutrogena.

After some preliminary research it seems that I may have destroyed the normal skin flora on my face with oral and topical antibiotics, even though I have not used antibiotics on a regular basis. I have read that when retinoids and benzoyl peroxide are used along with oral and topical antibiotics, they can have a synergistic effect. I do not think I have overused antibiotics but when combined with the BP and Retin-A, they were working together to destroy my face. Maybe? This is my educated guess, I can't know for sure.

Right now, I am at a loss and pretty distressed. This last bout of folliculitis has lasted for a month. I have always been upset about going to work with folliculitis on my face (it's localized on my face only, never in my scalp, never on any other parts of my body). I thought I beat it for good when I hadn't had an outbreak in a while.

What do you think of the PanOxyl bar and Sulfa wash my doctor has prescribed? Other than sulfa wash, and I know BP kills bacteria, I am not using the other antibacterials or antibiotics I have. I am never using Clindamycin and Ziana since I think these (combined with the antibacterial soap and other stuff I have been using) may be the culprits. Again, this is a guess and I don't know. The doctor told me to stop using antibacterial soaps and liquid soaps meant for hand washing. He told me to use Dove bar for sensitive skin after the folliculitis clears. I am afraid that the folliculitis will not clear and I will have to go on Accutane and I'm not to thrilled about that.

Any advice or comments appreciated.

Edited by MadsKeystone
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Try getting opinion from another dermatologist regarding your treatment. Go for accutane if need be. Low stomach acid is the cause of most fungal infections. If you want to try the holistic route than cut down dairy and start juicing vegetables carrot, cucumber, celery, beet, wheatgrass etc. Juicing book website have many recipes. Also keep on doing yoga.

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Have you tried taking probiotics? I think he should of told you to use hibiclens wash instead of sulfur and bp face washes. Hibiclens kills both gram positive and gram negative bacteria. It also kills bacteria for up to six hours on your skin.

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Thank you for the replies. I have not taken probiotics. I will look into this. Can you recommend a certain brand or product?

My dermatologist mentioned Hibiclens. He said "they are finding bacteria in Hibiclens". I might try it anyway, especially if the Sulfa wash and BP don't work, which they don't seem to be, though I haven't been using the PanOxyl bar or Sulfa wash that long. I have read conflicting information on Hibiclens, BP, and the Sulfa. Sometimes I think I should just use nothing but Cetaphil cleanser or Dove bar for sensitive skin. I don't know what to do. I reason that the dermatologist is trying to dry everything up (and kill bacteria) with the BP and the Sulfa, just like Accutane dries everything up.

Time is the only thing that works for me but this time is taking way too long. It's especially difficult at any time of the year, though especially now with Christmas parties and events, I can't hide in my house.

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The only probiotics I've ever consumed are the kind that are in Dannon activia. Antibiotics kill both good and bad bacteria so its good to replenish your body full of good bacteria called flora. You can google "best probiotics to buy". I know that you want to buy probiotics that are refrigerated and that should be kept that way.

Finding bacteria in hibiclens?! That's news to me! Did the doctor tell you what kind of bacteria? Doctors use hibiclens on MRSA patients.

I've been using hibiclens for about 3 weeks and its been working better than bp or any sulfur product I've ever used. I'm not sure if I have acne or folliculitis but the hibiclens works! Last time I went to the doctor he prescribed tetracycline and it didn't work. The only thing that worked were antibacterial face washes.

You should give the hibiclens a try :) you should see results in two weeks if it works for you. If it doesn't work for your face it makes a good hand soap so it won't go to waste. You can find it in any drugstore in the first aid section.

Edited by a.p.
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Hello. This might be my first time posting here.  I will provide some information on medications that have worked for me. 

There is a newer cleanser/wash with mild sodium hypochlorite (bleach), and seems to be patented, as I haven't found another product like it. It is approved by the National Eczema Foundation and listed on their site. It works wonders for an OTC product and states folliculitis is one of things it works for. They have multiple versions of the product, some have salicylic acid, some don't, some have more salicylic acid, some have a little more sodium hypochlorite. The bleach in the product is not strong enough to bleach out hair or clothes though.

Another product that works really well is Sodium Sulfacetamide 10% - Sulfur 5% wash/lotion. This requires a prescription. Sulfur and Sodium Sulfacetamide both have anti-bacterial properties, sulfur less so, but sulfur also helps shed dead skin cells, allowing the chemical to get to the follicle.

Both of the products I've mentioned work without you having to worry about accidentally bleaching your clothes, hair, or eyebrows, like you would with 10% benzoyl peroxide. The products I've mentioned seem to work better than ketoconazole 2%,zinc pyrithione 2%, or chlorhexidine gluconate 4.0%. The two products might work the same as using a 10% benzoyl peroxidewash everyday, but with way less irritation. Clindamycin 1% also works well for spot treating, but can't be used all over the body, as in my situation. The bacteria build a tolerance to Clindamycin easily, according to my dermatologist. Please try these, if nothing else has worked for you.

In my case, antibiotics work as long as you are taking them, but once you stop, you will break out at some point like you have never seen before. You can take 200 billion active probiotics, immunity mushrooms, colostrum, immunity herbs, vitamins, green foods, AHCC, high PH water, etc., daily (I have tried), but nothing will destroy the more severe cases of folliculitis permanently. Staph is everywhere, and some people's skin just can't fight it off.

Edited by folliculitisking
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I am cured! Two years ago, I started having recurring infections around my mouth that would last up to 10 weeks. I also had folliculitis that spread down my neck and inhabited my torso twice for weeks.  For the last several months, I fought folliculitis that was basically all over my face.  I used every bactericidal chemical possible, plus essential oils and topical and oral antibiotics matched for my particular gram negative bacteria (and later for gram positive) to no avail. Mid-November, I discovered I've had hyperparathyroidism, which keeps vitamin D low. Prior to surgery, I was suspicious that my folliculitis could not heal due to low vitamin D (vitamin D regulates oil production and acts like macrophages to eat up bacteria), so I sat in the sun in Florida (where I had my surgery) the day before surgery for 1 1/2 hours. The day after surgery, my face was smooth! It stayed smooth for about four days, and then small pimples and blackheads quickly started to populate my entire face again! I was now back home in Colorado, and my doctor had be taking 3000 IUs of vitamin D3 along with my calcium, so I guessed that was not enough and increased my vitamin D3 to 4000 IUs, and my face cleared again and has stayed clear! Be sure to monitor your vitamin D levels for toxicity, but the Vitamin D Council's website has great info on how much we can safely take! Hope this helps you all!

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