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j. j. 2

Gram-Negative Folliculitis

Back in the fall-winter of 2010, after years of clear skin, my complexion underwent some inexplicable--and distressing--changes. I began breaking out on my chin, though at first the blemishes were for the most part insignificant. I had grown a substantial beard just prior to the development of this problem, but decided to trim it down, fearing that my long whiskers were somehow to blame for my chin acne.

Not only did this fail to yield the results I had hoped for, matters actually got worse. Following a couple months of persistent, if minor, problems with my chin, my skin took a nasty turn -- at one point, my chin broke out in large, itchy pustules. They were much larger than anything I had experienced previously and very, very fragile. I kept on washing my face with Neutrogena Oil-Free Acne Wash, which I had been using for years, and more or less left my skin alone, believing that my problem would work itself out.

Well, it did...sorta. The awful breakout gave way to lesser problems. At that point I began washing my face once daily with the the Neutrogena Fragrance-Free face wash bar. I started applying their On-the-Spot treatment (2.5% BP) as well. Additionally, I altered my shaving regime -- I opted for a routine that had me wet shaving (Gillette Fusion Pro Glide razor with Barbasol sensitive skin shave lotion) every two or three days. This new way of doing things proved extremely successful.

Although my chin had cleared up completely, I chose to continue my skin care regimen. Every night I'd wash my face in the shower and then apply benzoyl peroxide to my chin--and only my chin--afterward. I was satisfied. The only problem I encountered in this time was nose, and not chin, related. Whenever I'd trim or pluck my nose hairs, I'd get large, sore bumps on the inside of my nose. They'd be very painful, and in many cases they would turn the outside of my nose red. Looking back on it, those were probably signs that my nose had been colonized by staph bacteria.

Then, late last summer and into the fall, I began to experience problems with my chin. Nothing too serious, but bothersome enough to stress me out. Nothing seemed to work -- not the BP, not sun exposure...nothing.

After several months of dealing with occasional breakouts, I broke out badly on my chin in late March or early April of this year. Like the 2010 episode, this one featured large, fragile pustules and rash-like symptoms limited to my chin. Things cleared up after 10 or 11 days, though, and I moved on.

I suffered a few minor breakouts during the first couple months of this summer, but none were bad enough to warrant serious concern. It was in this period that I ceased using face wash and discontinued use of the BP. My skin appeared to improve. It wasn't until late July that everything began going wrong in a major way.

I decided to get some sun on a Wednesday afternoon, so I headed outside with a book and sat around for a couple hours. Well, I ended up pretty sunburned. Shortly after coming back inside, I shaved. Almost immediately my chin began to break out, especially on its sides. I decided to leave it alone. Roughly 10 days later, whatever it was had run its course. I allowed a day or two to pass before I shaved again. Like before, I broke out almost immediately. This time I resolved to see a doctor.

The physician I saw determined that I was suffering from a case of bacterial folliculitis and prescribed a 14-day course of Doxycycline. She explained that my skin's defenses had likely been weakened by the sunburn, and that shaving immediately after being out in the sun was probably to blame for the infection. Anywho, all visible symptoms disappeared by day four or five. Now, this clearing of my chin may have been the result of the antibiotics doing what they do, or it may have been a coincidence (day four or five of the antibiotics corresponded with the tenth or eleventh day of the infection.)

By this point, I had done my homework on folliculitis. I knew, for instance, that trimming my facial hair would probably minimize the risk of experiencing another infection. So I bought a beard trimmer and clipped my beard to a medium stubble-length. It didn't work -- shortly thereafter, my chin began to breakout. Annoyed, I used some BP on the infected areas after applying some Neutrogena astringent with a cotton ball. Things looked good for a couple days. Unfortunately, the good times wouldn't last.

On Tuesday of this week, my chin broke out in huge pustules and rash-like, irritated symptoms. My upper lip too developed a few large pustules. So, I headed back to the doctor. This time I saw a different physician who seemed to think that rather than bacterial folliculitis, pseudofolliculitis was my problem. When I explained that I had forgone my usual wet shave for a trim with a new beard clipper, she made it clear that even trimming one's beard can lead to inflamed, infected follicles. I tried to tell her that I feel my nose may be colonized by staph bacteria, but she dismissed my concerns. It was her view that were my nose colonized, my upper lip would be impacted, not my chin. She prescribed Clindamycin gel and hydrocortisone cream and sent me on my way.

The more I read about all of this, the more convinced I become that I am suffering from gram-negative folliculitis. Although I did take tetracycline for a brief time back in 2003, I have little history with oral antibiotics. I suspect that the three or so years worth of BP on my blemish-less chin is to blame. Perhaps I upset some balance by continuing to use the BP as a preventative measure even though my chin was clear. It's the only explanation I can think of (Well, I did recently discontinue use of the B5 supplements--Vitacure B5 for acne--that I had been taking for none or so years. I doubt that that has anything to do with my chin problems, though.) Seriously, I've spent the past month researching this stuff for hours and hours and hours. Unfortunately, the physicians at my university's clinic are reluctant to provide me with a referral to see a specialist in the dermatology department. I'm absolutely at my wit's end and feel as though I have been misdiagnosed by physicians who, while good, are not specialists.

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Edited by j. j. 2

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My diet? Honestly, it's all over the place. During the week I eat a lot of bananas and apples, baby carrots, plain Greek yogurt, black bean burgers, protein shakes, oatmeal with almond milk, and a few other things. I drink quite a bit of water as well. I should definitely eat better and take in more calories -- on average, I consume between 1000 and 1400 calories a day (I'm 6'2", 210lbs.)

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I don't know what black bean burgers are. Ditch the yogurt and all forms of dairy along with the protein shakes and protein in general - protein is hard on the kidneys, especially protein shakes. Protein in all forms: eggs, nuts, beans, meats, dairy (milk is liquid protein and protein is the number one inhibitor for calcium absorption).

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Sorry to hear you're suffering from this. Pustules are a nasty business indeed.

Do you ever get the multi-headed ones? I'm interested because I started getting that kind of acne on my chin after taking antibiotics for 8 months. Mine looks like a nasty rash as well (photos on my blog if you'd like to check 'em out!). Because I'm a female the first culprit is usually hormones, but it is particularly gruesome.

I hate how finding the root cause is like a needle in a haystack. I wouldn't get my hopes up with dermatologists either; I went to mine with this kind of acne and she didn't say it was anything unusual even though I pressed. My experience is that they give you the same types of prescriptions regular physicians can. The dermatologists I've seen seem like they know and care more about the serious skin disorders.

Just wondering, have you ever looked into treating it naturally? Eg. I read that certain oils can help if it's folliculitis. Also, do you notice whether it gets better or worse depending on your sugar intake? If you're worried about BP disrupting the natural barrier of your skin, perhaps you could try acv toner if you haven't already? Lots of people say it helps balance pH and feed your skin with nutrients, which is also what my doctor said!

Edited by SquirrelMonkey

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Protein is not the problem. http://examine.com/faq/how-much-protein-do-i-need-every-day.html

I've dealt with pustules for at least the last 10 years. Do you get nose sores? Do you get ear infections? Staph make their home in the nose and ear in about 25% of the healthy public.

I've dealt with frequent nose sores and the pustules you describe. I know I was a heavy carrier of S. aureus in both my nasal passages. I found this publication http://www.ncbi.nlm.nih.gov/pubmed/23377521 and did the experiment myself. The Staph is completely gone as are my pustules and nose sores.

I did this 3 months ago and my face is clearer than ever and I haven't had a nose sore despite picking my nose (usually how I got them before). I typed up a post about this but since I'm new it needs to be approved. The Staph that is causing your folliculitis may be in your nose or ears. No type of facial treatment would take care of them there.

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Oops I skipped over a critical part of your post. It definitely looks like it's from the Staph in your nose. Try Triple Antibiotic Ointment in your nasal passages. It worked WONDERS for me. Follow the procedure in the publication I linked. That's essentially what I did to get my results.

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Screw the physicians!!! They are not out to help you, they are out to make a quick buck...there is no money in the cure! This is coming from an expert on Folliculitis, and the quacks would never give up this valuable advice I am going to give you! I just posted my current shaving regimen to The Ultimate Shaving Thread in the Shaving Forum. No dermatologist/quack has ever mentioned using Betadine to "disinfect" your skin, before, and after shaving. Think of shaving as a surgical procedure, and requires a sterile environment to do so. This info would put the "village idiot know-it-all's" out of business! Try it out, and GOOD LUCK!!!

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