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ActiveBrake

What is this? Persistent acne under corners of mouth on 31yo male

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Posted (edited)

I've been a very long time lurker on this site and only now built up the courage to write something. I'm a 31 year old guy who has had ongoing acne/skin issues since I was around 14.

I've attached a few photos of this latest flare-up. I just have no idea what is happening - can anyone provide some advice? I get these small lesions almost exclusively under the corners on my mouth. They usually bunch up with 3 or more in an area the size of your fingernail but they don't have puss in them, they are just red and inflamed. It usually starts with one and then it's like that sets off a little cluster. I try not to pick at them but as they sometimes get flaky I need to do some level of picking.

I'm healthy, I eat well, I exercise, I'm positive and motivated and have a regular schedule so it's not like I'm lacking sleep or switching up my life too often. But literally every few weeks I have this fresh hell on my face that takes at least 3 weeks to heal. The lesions in the photos are all 3.5 weeks old and just won't heal, and they are constantly replaced by new ones if they do.

My acne is pretty mild, and I know so many other people have it way worse off that me, but my it doesn't respond to anything. I've had literally dozens of courses of antibiotics (erythromycin, mino, doxy, azithromycin, cephalexin, amoxicillin, metronidazole, bactrim), used a million types of creams/gels/washes (BP, hydrogen peroxide, duac, adapalene, azelaic acid, antifungals, zinc, chlorhexidine 4%, triclosan, nizoral, witchhazel), gone batshit with quack/holistic medicine (yoghurt mask, salt water rinse, honey mask, vit d mega-dose, omega 3 mega-dose, vit a meda-dose, psyllium husk, H2 antihistamine mega-dose, H1 antihistamine mega-dose, more sun, less sun, caveman regimen, non fluoride/SLS toothpaste, plant-based hormone pills, sugar free), I've had 1.5 rounds of accutane (on my second round now, 10mg/day and just bumped up to 20mg a day). Nothing works!

At this point I don't even know if what I have is acne. I've been variously diagnosed with regular acne, perioral dermatitis, contact dermatitis, and fungal acne.

The mental scarring this has caused is mind-boggling. I can't look people in the eye, I walk with my head completely down, I turn down social events, if I do go out I feel so self-conscious that it's all I think about, my days/nights are spent secretly keeping all this baggage out of my girlfriends life so I don't burden her, I read into comments too deeply (my grandmother once said I looked really healthy once when I miraculously had clear skin for a few days and I went into a deep depression because it must mean that I don't look healthy when I have bad skin and that must be all she sees). The worst part is knowing that all these issues are entirely connected to bad skin. The few days/weeks I've had clear skin (directly after accutane for example) I have enjoyed the most wonderful life, completely carefree and happy. I wish I could have that all the time.

Sorry for the long rant, this is the most cathartic thing I've done in years. It's incredible listing all the things I've tried. I would have spent well over $2k on this over the years.

Anyway, if you have a similar story please share and if you have advice then I will buy you a beer as soon as I feel confident enough to go to social engagements.

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Edited by ActiveBrake

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You most likely have fungal acne caused by taking antibiotics. Which antifungals have you tried  ? - topically and orally ?

Fungal acne is caused by taking antibiotics, steroids, and some other meds, possibly including accutane (works short term and then makes the problem worse). People can start with ordinary acne, which then becomes fungal acne, as the antibiotics they take for ordinary acne reduce the ability of their immune system to fight the fungus. The "acne" would have got worse and worse as you took antibiotics.

You have to apply the specific antifungal cream that targets the particular fungus that you have.

If you get back to me with answers to the following questions, I can provide information about which topical antifungal cream to apply to control the fungus that is causing your fungal acne.

Do you have one or more of the following - dandruff, seborhheic dermatitis, itchy skin, red rashes, toenail fungus, sinus problems, gut problems, a white coating on your tongue, unexplained tiredness or headaches or "brain fog".

The treatment for fungal acne is safe and cheap - applying topical antifungal creams (which are totally safe), using anti-dandruff shampoo, and keeping the areas with acne very dry - no organic oils or moisturisers (fungus loves moisture and one type of fungus that causes fungal acne feeds on organic oils).

I am happy to hear back from you, so I can provide more targeted information for your situation.

 

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Hi Aussie Scientist, thanks for the reply. I'm also an Australian! I haven't taken oral antifungals before but I have occasionally applied canistan as I have thought it could be fungal in the past. But as I didn't see any difference (and it seems to say it's an instant change) I stopped and moved on.

I have chronic tinea (literally for the last 5+ years, can't seem to shake it) and at least one toenail completely gone with fungus. No dandruff or red rashes though my face does get itchy sometimes. No sinus problems though I generally wake up to a white coating on my tongue and I get randomly sleepy during the day but no headaches or brain fog.

I would love this to be fungal, but that seems like it's a whole new path to go down and one I have not really been looking at for most of my treatments.

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Active Break (fellow Aussie)

My suspicion is that your acne problem is fungal, because you have some of the other symptoms of a fungal outbreak.

I would buy and apply Mycostsatin topical antifungal cream (you can get it in Australia without a prescription from the shelves in the main part of pharmacies, although not every pharmacy stocks it), possibly together with Canesten cream. Antifungal creams can take a few weeks to control fungal acne (as distinct from controlling fungal rashes, which antifungal creams sometimes can control quite quickly).

Also wash your hair in an antidandruff shampoo, and keep the area with acne very dry (apart from applying the antifungal cream) - do not apply moisturisers or organic oils to the areas with acne.

You can buy oral Nilstat without a prescription in Australia (you have to ask the pharmacist for it - it is behind the counter), so you can take that to control your mouth thrush (white tongue) Alternatively, use mouthwash without alcohol or hydrogen peroxide - buy 3% peroxide from the supermarket and dilute down to 1-1.5% with water.

You swallow the Nilstat, but don't swallow the mouthwash or the peroxide (obviously!)

Vicks Vapour rub will usually get rid of toenail fungus - it takes a while. Alternatively, you can soak your toes in mouthwash and/or 3% peroxide - these treatments should help get rid of tinea also. Tinea is a different type of fungus from the fungus that causes acne and the fungus that causes some toenail fungus.

Having said that, it might be worthwhile apply some mycostatin cream to the area with tinea (be careful to avoid any cross infection, ie, wash your hands before and after touching the acne areas and the tinea areas )

I will be keen to hear how things go with the above treatments.

 

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36 minutes ago, Aussie Scientist said:

Also wash your hair in an antidandruff shampoo, and keep the area with acne very dry (apart from applying the antifungal cream) - do not apply moisturisers or organic oils to the areas with acne.

Thanks for the advice! Is there a antidandruff shampoo you would recommend? I don’t have dandruff at all but I’m willing to try anything. I’ll go get those antifungals today and see how we go. How long would it usually take to see results? I ask because it’s getting pretty cold and I can’t really handle not putting on moisturiser during the winter months. Cheers!!

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Active Brake

Antidandruff shampoo is antifungal, so it is worth using anti-dandruff shampoo, even if you don't have dandruff. From your symptoms, you have candida ace etc. not malasezzia acne etc. Candida causes a white tongue, red rashes, toenail fungus (which can also be caused by other fungi) and tiredness, whereas malasezzia causes dandruff and seborrheic dermatitis.

Swallowing the oral Nilstat (which you are supposed to do) should get rid of your tiredness. The tiredness in (most likely) caused by overgrowth of candida in your gut - candida males aldehydes which cause tiredness (and headaches in some people) - aldehydes are  are the same chemical that causes hangovers !

You can try using the 1% Nizoral shampoo (the blue one, not the red one). Unfortunately, most antidandruff  shampoos, including Nizoral, have sodium laurel sulphate in them, so they can be irritating. Mustela Foam Shampoo for Newborns (which you can get at Priceline Chemists) is not irritating - you can wash your face (and hair) in it. Mustela Shampoo is great for controlling malasezzia, and not so effective for controlling candida, but it might be worth using... especially if you have sensitive skin.

Given I am fairly certain that you have candida acne, not malasezzia acne, you can probably use a moisturiser with low or no organic oils - use with care, though - maybe use the moisturiser on one side of your face only and see if any ill effects of using the moisturiser ? What moisturiser do you use ?

You certainly don't want your skin to crack from dryness.

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Ok, I got all the gear you recommended. Nizoral 1%, nilstat drops, mycostatin cream. I also have canesten at home. I currently use Hamilton Skin Care nourishing cream.

I'll keep this thread updated and see how we go. Right now I have maybe 3 ongoing lesions, but only one of them seems to be truly fucked (the others are either on their way to healing or are in that dormant phase where it could go either way lol). I took 2 drops of nilstat this afternoon and this evening and I've applied the mycostatin once (it's twice a day but I got it in the late afternoon).

Does candida also cause bad breath? I've noticed in the last few years that I have developed terrible breath. I brush religiously now but unfortunately that doesn't seem to help (my teeth are fricken pristine tho haha). Also chewing gum seems to cause more acne for some reason. Like I chew gum one time and 2 days later I have an enormous breakout.

Ok, wish me luck with this new treatment!

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Active Break

I look forward to hearing how you go with the treatment.

Yes, candida can cause bad breath. Do you floss your teeth ? Use mouthwash ??

The chewing gum might exacerbate the candida because of preservatives ? or sugar ? in it.... What is in the chewing gun that you use ?

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Ok, Day 1 nearly done. I noticed my active acne was a little less inflamed this morning and has actually healed over enough that it was no longer an open sore. The skin around this area has become very dry, with tiny flakes covering the area. The whole thing seems to be on the way to healing and I'm now in what I call the 'clean up phase', where the lesion is effectively healed but I still have a scab, dry skin, or red marks to contend with.

I can't say for sure this was entirely because of the anti-fungals, it will probably need a few more days of improvements to confirm but it's a very good sign. The images I first posted seemed like I had at least another week before I got to this stage.

After taking the drops twice yesterday and twice so far today my breath is almost completely back to normal. This is definitely due to the anti-fungals, no doubt about it. For that alone, thank you so much Aussie Scientist!!

I usually just chew wrigley's spearmint which contains: Sorbitol, Gum Base, Humectant (422). Mannitol Flavour, Sweetener (951), Emulsifier (322, From Soy) Antioxidant (321) Colours (133, 160A). Not sure if that means anything to you. Geting a breakout after chewing gum could just be a coincidence because I usually chew gum to relieve bad breath or if I'm out on a big night - one seems to mean I have more fungal issues in my mouth and the other means I'm drinking a lot and eating crap.

 

IMG_9155.jpg

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Good news, Active Break - Thanks. I am pleased that things are working to improve the situation....

The emulsifier and artificial colours in the gum could exacerbate candida by causing histamine release, but as l you say, the effects of the gum and of other things cannot be separated.

See if you can find a more natural chewing gum, ie, without any artificial colours or flavours

Sorbitol (NO PROBS), Gum Base (PROBABLY OK), Humectant (422) (NOT SURE). Mannitol Flavour (MAYBE OK), Sweetener (951) (AVOID) , Emulsifier (322, From Soy - AVOID) Antioxidant (321) (AVOID) Colours (133, 160A) (AVOID).

I am happy to receive updates...

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Ok, Day 3 today. While my lesions have all closed up and are no longer infected I am dealing with a lot of dry and irregular skin that is very red/tender.

I think the anti-fungal has worked but I’m an incessant picker and I think I’ve done about as much damage as the anti-fungals did good. I reckon I have another week before this is all healed up.

I have no new lesions and the rest of my skin is actually looking really good.

Aussie Scientist, how long should I continue the treatments?

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Active Break

It is hard to estimate the length of time you will need to apply the antifungal creams for. You might need to always apply them, say once a week, because the fungus can/will attack again due to your immune system having been compromised by antibiotics... 

That reminds me - I suggest that you start taking PRObiotics which will partially restore the good bacteria in your gut and thereby partly restore the ability of your immune system to fight fungus.  I should have mentioned taking probiotics earlier.

If you were in America, I would now recommend that you apply some cream with polymixin in it - polymixin is an antibiotic, but it is a "special type of" antibiotic because it is anti candida and it is also anti gram negative bacteria. Gram negative bacteria cause acne like symptoms, and they often occur in conjunction with candida and cause tender skin (although the candida can do that also).  Gram negative acne is also caused by taking antibiotics, as fungal acne is.

But we cannot buy topical creams with polymixin in them in Australia without a prescription, which is annoying. However, we CAN legally buy (just) one topical antibiotic in Australia without a prescription - Chlorsig ointment. Chlorsig is sold to treat minor eye infections. It has some activity against gram negative bacteria and possibly a little activity against fungus (it is not an antifungal, though). You have to ask the pharmacist for chlorsig (like Nilstat), unless you buy it online from some chemist sites (in Australia).

I suggest you go to a pharmacist and ask for a tube of chlorsig (for your eyes), OR you can buy chlorsig ointment online from an Australian chemist at this site (where you can possibly buy oral Nilstat also?).

ttps://www.yourdiscountchemist.com.au/chlorsig-eye-ointment-1-4g.html?ff=1&fp=12581&catargetid=120289700000020731&cadevice=c&gclid=EAIaIQobChMI07Wg7-vq4gIVEg4rCh2dPA_mEAYYAiABEgLLn_D_BwE

Put a little bit of chlorsig ointment on any areas that are tender/inflame (along with the antifungal cream/s) as such areas might have  bacterial infection in them as well as fungal infection.

Instead of buying and using chlorsig ointment, you could instead buy some lidocaine/lignocaine cream off the shelf at the chemist (you don't have to ask for it) and apply that to the inflamed/tender spots. Lignocaine/lidocaine cream is sold to treat insect stings etc. - it is a mild anaesthetic, but it is also mildly anti fungal and somewhat anti gram negative bacteria.

Don't use linocaine/lidocaine cream on large areas of skin or for more than a few days at a time. It is fine to use it on small areas of skin for a few days.

I appeciate your keeping me posted

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Hi Aussie Scientist, thanks for the feedback. I think I might just hold off trying those additional creams. I'm pretty confident my lesions are healed but I just need to be better with treating my skin with care. Also, I'm actually on a very low-dose isotretinoin, which can slow down the healing process and also makes skin quite fragile.

I'll keep the treatment going until these lesions are all healed and the bottle of Nilstat drops is all used up (should be another few days). Then I will move to a maintenance program of once a week.

What are your recommendations for probiotics? I've never taken one before, and to be honest I'm not sure how rigorous the industry is in making sure there are actual live cultures in the product. I'm happy to try it out though.

You mentioned only 'partially' restoring the good bacteria in my gut - is there a way to completely restore it?

Cheers mate!

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Thanks Active Break

I would buy an probiotic from the frig in a chemist's shop. Those should be OK.

The reason that probiotics only partly fix he problem is that probiotics ONLY contain aerobic bacteria and antibiotics destroy BOTH aerobic and anaerobic bacteria in one's gut.

Anaerobic bacteria cannot live in air and also they are dangerous outside one's gut.

The only way to restore anaerobic bacteria to one's gut is with a faecal transfer. Until a few minutes ago, I thought this onlymeant what one imagines that it means - BUT there is thread on this site which has been reactivated today, in which people write about encapsulating faecal matter from a donor who has healthy gut biota.

I am not sure whether people are taking the encapsulated faecal matter by mouth (!) or inserting it like an enema. I will find this out. 

I have thought of having a faecal transfer but.....  mmm...   Faecal transers can/do do fix acne problems caused by messed up immune systems from taking antibiotics.

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Yeah, I’ve heard of FMT before too. Sounds like a lot of work, the least of which is finding a healthy donor that isn’t super weirded out by me eating/inserting their poop. But I’ve heard great things and also that it can help other issues like mental health, bowel issues, weight problems, and even stuff like autism.

I’ll go pick a probiotic up today and see how we go. I might also check out that reactivated thread on FMT. 

Cheers!

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Day 6 just about over. I’ve finished the nystatin drops and moved down to putting the mycostatin cream on every second day. 

My lesions are still healing, taking forever in this cold dry weather. I haven’t really had any other breakouts, though I’ve had one pimple (I think this one is normal acne) appear in a spot that always seems to get them every few months but it’s pretty small and not an issue. Definitely not badly infected like the others were.

I have this small area under my nose that is slightly flaring up, looks like eczema. I also have cravings for sweet things but I’m usually pretty good and can hold back.

I still reckon I need to give this treatment some time before I can truly say that fungal overgrowth is the cause. I’ll keep going for another few weeks and see how we go.

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Thanks for the Update, Active Break. Fungal skin conditions do often look like eczema.

Try applying terbenafine antifungal cream (Lamisil or a similar generic) - no prescription needed, just buy off the shelf at chemists in Aust - together with the mycostatin cream.

That might clear the area under your nose. You can add clotrimazole cream to the mix also, if you wish.

I look forward to your next update.

 

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