M, 22

Background of acne as a teenager. Went on doxycycline aged 19. Stayed on it for about 2 years, then it stopped working and my acne was getting a bit worse. Went on accutane, and the accutane was working really well. I got clear of acne by 5-6 months on it, but my derm wanted me to continue for another 2-3 to ensure reducing relapse.

When I had about 2 months of accutane left, my face very suddenly erupted in awful pustules/red sores and papules. It came on very quickly (ie. my face went from being totally clear to ridden with pustules within 7 days). It was so bad I couldn't leave the house. I went running back to the derm, thinking it was an acne flare up. He said no way, it looks like a staph infection, and gave me 10 days of cotrimoxazole and took swabs of the lesions and nose/groin/axilla to check if I was a carrier.

The cotrimoxazole cleared me up amazingly, and my skin was flawless again within the 10 days. The swabs came back positive for staph (not MRSA) in the pustule and in the nose. I was advised to take the nasal Fusidic Acid for 5 days too to decolonise, which I did.

Anyway, my round of cotrimoxazole finished, my skin was clear again, I went on with my life.

2-3 weeks later, the EXACT SAME folliculitis happened, all over my face, focusing in the chin/beard area. Did cotrimoxazole again, this time for 14 days, and also did a more intense decolonisation (chlorhexidine washes and nasal ointment again).

Cleared me up again. But AGAIN after 2 weeks the staph came back! Every time I just go running back to the derm and get another round of cotrimoxazole to clear it up. This cycle has gone on for 5 rounds of cotrimoxazole over the space of 6-7 months. I am begining to worry about resistance.

In between the rounds of cotrimoxazole, we have tried the following general measures, to no avail 1) Minocycline (staph infection still came back within a few weeks) 2) Benzoyl peroxide (staph came back anyway, and it dried my skin) 3) Fash wash with chlorhexidine (staph still came back) 4) Clindamycin topical (worked for a while, staph still came back, with a repeated culture now showing that the staph was resistant to clindamycin) Do note that my nasal swabs have been NEGATIVE since that very first time, so it seems that the nasal ointment did it's work, but the problem is far from gone, clearly... It KEEPS ON COMING BACK, irrespective of what I am doing. The only thing that kills it is the cotrimoxazole.

Has anyone gone through something like this in the past? A seemingly invincible recurrent staph infection localised to the face? I am beginning to worry that this is some form of innate, chronic folliculitis which can't be treated...