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I am a 40-year-old male and I've decided to register here and share my experience because I think I might have finally found a solution to the bad skin I've had since my teenage years. Just a warning that this is a long story (27 years' worth) but if I can help even one person then it'll be worth it. I never thought I'd reach this age and still have hang-ups about my skin. You get told "it's okay, it'll clear up naturally as you age". Well mine didn't. 

My problem started back in the late 1980s. Suddenly I developed acne-like bumps on my shoulder blade area. Over the course of a few years these bumps spread and would cover my back, down onto my buttocks and thighs, and sometimes extending to my chest, tummy and neck. I have been fortunate throughout my life to have avoided facial acne and have always had fairly clear skin on my face, except for the odd zit or little patches of dermatitis which would come and go. The bacne, though, was awful. I was ashamed to get changed before and after sports lessons, and my worst nightmare was being made to play on the "skins" team in basketball, when this horrible rash would be exposed for all to see. The rash was always there to some extent, although it could be more or less inflamed at different times.

Bear in mind that back then the internet didn't exist, so there was nowhere to get information other than from the doctor. I eventually plucked up the courage to go and see my GP, knowing that it would involve showing another person my awful rash. The knowledge about various skin conditions was lacking in those days, and the treatment options were more limited. I was diagnosed with acne and put on a course of oxytetracycline. It didn't work at all.

Once I started having a sex life, things got awkward. Going to bed with someone meant exposing my body and rashes are a turn-off, right? I tried not to get into situations where my partner would see my back (e.g. I'd let them get out of bed first for shower or tea-making, and by the time they got back I'd be half-dressed - I got good at that stuff!) I even started using foundation mousse on the affected areas ("this is for my wife - I hope I got her the right brand!") If I was going through a phase where the spots were fading then this would work quite well, but if I had a new, angry red breakout, the concealer didn't work and I'd have to make excuses not to go on dates (I've had "flu" more often than any other human being!) I think I tried another course of tetracycline at some point but to no avail. Recently I learnt that they don't even prescribe that these days and tried better antibiotics that were effective to some extent, at least until I broke out again :-(

Over two decades passed like this. I tried exfoliation which would bring me out in an angry red rash but then help to clear me up for a while until the next uncontrollable breakout. When I was 23 I got put on a course of doxycycline for malaria prevention for going overseas, and this coupled with lots of sunshine on the beach cleared me completely for the first time since my early teens. I was tanned, lean and hot as! I experienced for the first time what it must be like for people with clear skin who can go to the beach and not have to feel ashamed. For a few weeks when I got back home I stayed clear, but then gradually the spots came back. I was mortified and really depressed.

My depression got worse until it actually became full-on anxiety and panic attacks in my late 30s. I got put on anti-depressants. I know my depression was related to my skin for the most part - not just stress at work etc. Then I did some reading about malassezia folliculitis and tried Nizoral shampoo. This cleared my skin quite quickly and I got excited, thinking I'd found the answer. But like many people have found, it stopped being effective after a few weeks. I then tried Benzoyl Peroxide wash. Exactly the same thing happened.

I booked an appointment with a dermatologist, who diagnosed me with malassezia folliculitis and told me to use Nizoral shampoo. I told her I was already using it and she explained that I wasn't leaving it on for long enough: at least 20 minutes, she said, not 5. I asked her why BP had worked for a while if the problem was not bacterial and she said it was because of its exfoliating and deep-pore oxidising qualities which would help stop plugs from forming. I tried leaving the washes on for longer and that may have worked for a while but then I went on holiday overseas in 48-49C heat and sweated a lot. My rash came back angrier than ever and Nizoral and BP were now totally ineffective.

This problem is coming from the inside, I thought. Is it stress? Probably to an extent, but I was now keeping a diary and I seemed to get breakouts even at times when I was on holiday and relatively reponsibility-free. Is it diet? No, I told myself, because I was always reading that skin conditions aren't related to diet. Anyway, there were people who lived on fast food and fizzy drinks and they had clear skin, so it couldn't be that, right?

Wrong. I hadn't taken into account that we're all different. Our genes predispose us to problems and some of us need to work harder to maintain decent skin. 

My breakthrough came after recovering from a really bad bout of flu (actual flu this time). The virus totally ravaged me and left me weak and feeling totally depleted. I craved vegetables and fruit, and started wanting oranges (I don't usually). I did some research on the net and it was when I came across this article https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4371663/ that I had my "aha" moment. I had been looking into nutrition and what exactly all the vitamins and minerals do in terms of function, and this was telling me that certain deficiencies could cause skin issues. I looked through the list and recognised problems I've had to deal with on and off over the years: the folliculitis, keratosis pilaris (tiny bumps at the top of my arms), cheilitis (dry lips and cracking at the corners of the mouth), eczema, mouth ulcers, bleeding gums, seborroeic dermatitis... they were all there. Maybe I have malabsorption issues, I told myself. Or maybe I'm just not putting enough of the good stuff into my body.

I immediately changed my eating habits. The only meal I changed was lunch. Lunch is now a salami, ham, sardine or cheese sandwich stuffed with as many vegetables I can lay my hands on. I have a big tray full of veg which I bring out of the fridge and treat like a sort of "Subway with all the salad". Onto my meat/fish sandwich go olives, cucumber, spinach, herbs like basil and parsley, red onion, grated carrot, sliced radish, red pepper, sometimes avocado, spring onions, tomatoes, gherkins or raw mushrooms - basically anything I can lay my hands on. If there's part of a carrot left or a stick of celery, I'll have that on the plate separate from the sandwich. I have a piece of fruit with every meal - usually a banana, orange and apple in that order. I've also started taking multi-vitamin tablets once a day. I bought an anti-inflammatory turmeric and ginger liquid and take a swig of that with my vitamin pill. 

Since I started this new diet, I haven't had a single new spot. My skin has smoothed out and feels invincible. Even when it gets sweaty, greasy or dry depending on my activities or changes in the weather, my skin just deals with it. I don't know exactly what mechanism underlies this or what out of the fruit/veg/pills/liquid is most responsible for the effect, but whatever I'm putting in my body must be doing stuff involving enzymes, receptors, inhibitors, immune system and absorption boosters... whatever, I don't know. Anyway, it's working, and that's the important thing. There's no way I'm changing my new routine!

I used to think I had an ok diet, but it seems my body needs a bit of TLC when it comes to nutrition. The 5 serves of veg a day just won't cut it, perhaps because my gut is dysfunctional. If I bombard my body with more fruit and veg than you would think it needs so that it can absorb its daily requirements, I am rewarded with clear skin. I'm so happy right now after 27 years of anguish! Even though I've only been clear a short while, I know deep down that I won't relapse like I did after a few weeks of topical remedies, which were only addressing the surface symptoms and not the underlying cause.

And the sandwiches are delicious :-)

Edited by Alias Mazes
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Update: I realised that my new diet was helping me indirectly, not directly. My nutritious diet was helping me feel better about myself and aiding my digestion. Because of that I was able to sleep easier, and it was the decent rest that was improving my skin, not the diet itself. In other words, my MF directly correlates with early/late nights. Whenever I have a run of late nights (going to bed after midnight), I get inflamed and come out in huge red spots. Most are just clogged pores but some turn into whiteheads and eventually die. Sometimes they appear as huge cysts which hurt and take ages to go away. If I keep on getting late nights, the red spots just stay there and come up and down and up and down. If I force myself to go to bed around 10 or 10.30pm and get my 8 hours' sleep for a few nights, after as little as a week, all the spots fade and no new ones appear. Circulation increases and my skin texture changes. Apparently this is because, if you don't get the right sleep at the right time, stress hormones are released, the immune system is compromised and you can't deal with the existing natural flora of MF on your skin. Also, your insulin resistance is affected and skin cell turnover rate gets messed up. Your skin is left sticky and the pores are wide open, so any dead skin just sits there and clogs the pores. It's a horrible vicious circle. I find if I keep on a cycle of late nights and sleep deprivation, I'll get spots and keep them no matter what else I do, but if I get into a nice sleep cycle then my skin improves and can cope with one-off late nights as it becomes robust and tight.

If you have the same problems as me, make lifestyle changes. Since I was a kid I've been addicted to the weird adrenaline rushy feeling of having to go to school or work tired after a late night. I've survived from day to day in a sleep-deprived state, kidding myself that I could cope with it. On most levels I can cope with it, but it causes my anxiety/panic and the stress seems to be causing outbreaks of MF, SD and possibly acne as well. 

Finally, after turning 40, I am able to admit to myself that I've been bringing this problem on myself for my whole life. I feel like such an idiot! 

Edited by Alias Mazes
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It's been almost a year since I posted here and I want to post in the same place so that anyone who finds my original story will see how I've updated it as I've learnt more about how my body works. I have come to realise that a poor diet and lack of good rest are in fact indirect causes of my pimples because they both lead to dry, dead skin on my torso. Layers of this dead skin build up very quickly and cause my pores to clog with grease and sweat. Bacteria or yeast can then have a field day underneath the protective layer of gunk (although my dermatologist diagnosed me with malassezia folliculitis, I'm now unsure if it's actually just bacterial folliculitis or just plain acne). The layer of dead skin is the direct cause of my pimples, and any profuse sweating or change in weather results in an uncontrollable breakout.

I have found that I can exfoliate this dead skin layer manually. It can simply be scratched off with the fingernails in the shower. It helps if I do it under running water so that when the skin is dislodged, it's immediately washed away from the body. Rolls of greyish waxy stuff come off and it's pretty gross! I have to be patient and work each affected area, making sure I don't miss bits. I know when I'm done because when I rinse off, my skin doesn't feel slippery with rough bits and instead my fingertips 'squeak' against the skin on my torso. I end up with long, red claw marks from the scratching, which stay for a few minutes after showering. My skin cells must shed faster than normal because the layer is back again very quickly and it all has to be done again when I shower the next day. I've been doing this for 2 months now and the results have been amazing. I've been clear for a longer period than ever before. Here is what my back looked like before (yuck!):

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And this is what it looks like now, after several weeks of daily manual exfoliation only (no other treatment at all):

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This has been life changing for me. I have been able to go swimming and go to the beach without feeling horribly self-conscious. It's a bit of a pain to have to exfoliate all the time as it means showers take about 10 minutes longer and I waste a lot of water, but it's worth the effort for clear, smooth skin that's nice to touch. I still have a few faint red marks from old pimples and occasionally I'll get a new pimple, presumably when I miss a patch of skin when I'm exfoliating, but on the whole my skin has lost the dull look and spongey feel it had before. It looks well-balanced and healthy. I hope this lasts! 

Edited by Alias Mazes
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Wow, Alias Mazes - what a 'breakthrough' in my discovery of your three posts on this 'folliculitis' matter - thank-you, thrice! Love your style of writing - quite moving actually, given my situation. I'm a 57 year young-minded/looking Somerset-based female, described as bubbly, confident, vivacious by those who see me 'on the outside' as it were, in other words - dressed! Yet, when it comes to going swimming, changing in an open-plan changing room (not many of those anymore, fortunately) and worse of all (when it just be best of all) getting undressed for the pleasure of sex, I simply 'don't go there'. Like you, I've not been troubled with acne as such. I certainly had a 'T-zone' of oil and a spotty chin/chest in my teens and twenties, this improving to the occasional break-out of facial spots in my 30's, 40's - putting that down to 'me 'ormones' - the timing matched up! But, for as long as I can remember - I've had a spotty bot in the form of red, raised bumps which appear at the lower end of my bum cheeks (where follicles/hairs are evident), and pretty much all the blessed time, accompanied by tiny white-heads/pimples, which come as quick as they 'go', but by the time they've gone, more have appeared - a pretty unpleasant sight at the best of times - no, all the time! Looking forward to a hot date in a few weeks time; we certainly won't be going swimming, or the like!!!!!! In the meantime, I'm going to re-read your posts, review my already healthy, full of veggies diet (aside from the cheddar cheese and real ales - can't help myself!) and look at my pretty shoddy sleep regime. Whilst not one for computers, I honestly don't think they help - all this sitting down on my derriere! Also going to look into topical skin washes. Fingers crossed  - after 37 years of wishing for a clear rear! Thanks again Alias Mazes, for your interesting, informative posts - and good luck going forward, with your personal matter.  (22.10.18)        

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