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Pityrosporum Folliculitis ?

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Lion Queen and Willow,

I am a pretty new member, but have been on this site for weeks now - just absorbing all this info and both of you have some great things to share so thanks!

I am 37 and suffered with mild to mod acne since early 20's. I was thinking that I had folliculitis down on the right side of my chin since it sounded similiar to what you have described and others out there as well.

I just went to the dr and the told me I have peri-oral dermatitis and I am going to be on Metrogel and Erythromycin for 30 days to start as he says it takes for ever to go away. I don't see much on this - do you know anything about it? I am still thinking I have a fungal problelm as I was on Doxycycline and Bactroban topical a month back for what they thought was impetigo (same area on face). Will the Mandelic Acid help me somehow- I know that you mentioned before LQ , that it is an antifungal, if so which Vivant are you using, you had mentioned before there is one for oily skin I think? Also, I was really looking into Green Cream and I am wondering if I have to hold off on that...God, can't I just worry about wrinkles now instead of dealing with this other stuff too?

I am currently doing the regimen with Purpose Cleanser, Proactiv BP, spot treat with Murad Salicylic Acid, and Jojoba Oil and Cetaphil Cream mixed together for a moisturizer.

Thanks again for all your help you provide.

Hello again,

First of all, the chin seems to me like an odd place to develop folliculitis. Not that it's impossible, but I've just never run across that before.

Dermatitis is kind of a general term, isn't it? Like calling something a rash? I don't really know much about it. Anyway, your doctor seems to think it's bacterial in nature, and maybe it is. But if I were you, I'd try changing my toothpaste as well .... just in case.

Since you have this irritation going on, it's probably not a great time to start trying new products, especially active ones like mandelic acid and Green Cream. I would advise waiting to use anything new (and potentially irritating) until your skin is in more normal and healthy condition.

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I think you are right on all counts. I saw alot of info about the toothpaste, so I am definitely going to change that.

Did you still exfoliate with the toothbrush when you had PF pretty bad?

Thanks again...

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I had a lot of flakiness accompanying the PF at one point, and tried the toothbrush again .... but my skin is too sensitive for it now, probably because of the Accutane.

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Hey, I was just wondering if anyone has tried moisturizing the area with PF, accompanying normal treatment, with an oil free moisturizer of course?

I don't think I would moisturizer at the same time that you apply the treament, it may reduce the effectiveness of the treatment product, since the moisturizer may prevent the treatment from being absorbed. You might try doing it at a different time of day though. If you do, make sure you use something that is not comedogenic and not too heavy - I think heavy moisturizers can worse PF. Try for something that is water based - I use a hyaluronic acid moisturizer which seems to work ok.

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Okay, so I am not sure if this is "PF", but apparently it is some form of folliculitis. I get these tiny flat red spots & bumps on my lower calves, only where there is a hair follicle. The red spots are only noticeable close up, but it really bothers me. I've only had them for about 2.5 years. They don't feel or look "bumpy" either.

I thought at first it was shaving irritation & ingrown hairs, so I tried not shaving for awhile (it was winter, so no one had to see me hairy, haha) and using a 2% SA gel once a day on my legs. It didn't do anything. I've also tried BP; took anti-histamine cuz my regular doctor thought it could be an allergic reaction; used witch hazel; lac-hydrin five; cetaphil anti-bacterial soap...all did little or nothing to help. BP, the anti-histamine & anti-bacterial soap were especially ineffective. Some definitely helped the few obvious ingrown hair bumps, but the little red spots mostly stay. This makes me think they are not simply shaving irritation or ingrown hairs, but something else in addition to it.

I mentioned it to my derm & she looked at my legs & said it was "hair follicle irritation" and prescribed me 0.1% triamcinolone acetonide cream (apparently used to treat a variety of skin conditions). The copy of some receipt/diagnosis thing I got said it was "folliculitus".

I was told to use a thin layer twice a day for only 3 weeks, because it can't be used long term. My legs cleared up about 90%, only to slowly return to their previous state about 2 months later. So I was back where I started.

I went back to the derm & she refused to do anything more about it. She said "that's just how some people's skin looks" :evil:

I'm still not exactly sure what is causing these red spots, but could treatments for PF possibly work for me? Could it be a fungal thing? I don't understand what is causing the "irritation" of my hair follicles; that is such a vague diagnosis.

Right now I use Cetaphil gentle soap in the shower, lightly exfoliate with a loofah twice a week, Cetaphil moisturizing cream after I shave & lac-hydrin five on days I don't (it stings bad), and I apply the SA after I shave. I use an all natural shaving cream by Alba with non-comedogenic ingredients and a Gilette sensor excel razor. Again, this helps ingrowns, but not the red spots.

I have very oily skin, and this is definitely not acne.

I'm considering Mandelic Acid or a 2% Zinc Pyrithione soap.

I've seen ZNP bar, but what do you think about DermaZinc Soap? I like how it has more minimal ingredients...

Any input is appreciated, thanks :)

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Well, from my personal experience of PF, it doesnt sound like it. For me it just exploded all of a sudden, one day it wasnt there, couple weeks later it was really bad. Also the bumps arent flat, at least not from what I've seen.

I have seen a couple of people with something similar to what you describe on their arms (not sure if they have it on their legs, not seen them) and it doesnt seem to bother them.

I'd say your best bet would be to just go for it and try mandelic acid, as it is both anti bacterial and anti fungal.

Good luck

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"Folliculitis" is definitely a hazy term .... there are so many different things that can irritate the follicles!

I don't know what's going on with your legs, Siouxsie, but you might try using some of the anti-fungals. You could use Nizoral shampoo or the Vivant mandelic cleanser to shave your legs with, for example ... see if that has any effect.

If you want to use a leave-on mandelic on your legs, I'd suggest trying the Vivant 9% toner. It's a lot cheaper than the 15% serum, and I've found it to be an effective anti-fungal. It's available at betterhealthyskin, or sometimes on eBay. Or NuCelle might have a suitable product .... I think their prices are lower.

Edited by Ishayat
Edited link out - link was broken
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Mandelic acid arrived through my post box 5 minutes ago, just put some on and a little goes a long way I'm releived to find out :D

I'll keep you updated with my progress now, since I'm 90% clear at the moment, hoping to push it to 100% with Nizoral, ZNP and Mandelic ;) It's getting nuked at last :dance:

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I woke up this morning with small blisters over a certain area where I applied it (the area was already irritated from ZNP, ketoconazole etc...) but I used it on my face aswell and it was fine... just have to hope it passes.

Anyway, how long should it be before I start seeing results?

Thanks

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Have you tried Fusidic Acid ? Its an antibacterial that doesn't let the infection reproduce through protein synthesis. My derm prescribed this for me for some mild foliculitus I had, did the trick for me.

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^^^^ I've never heard of it ..... but I'm going to google!

UPDATE: Probably not the solution for most of us.

First, it's not licensed for use in the United States.

Second, while it's anti-bacterial ..... I don't see any indication that it's anti-fungal.

I'll keep reading.

this is from Wikipedia:

Fusidic acid works by interfering with bacterial protein synthesis, specifically by preventing the translocation of the elongation factor G (EF-G) from the ribosome. Fusidic acid is only effective on gram-positive bacteria such as Staphylococcus species and Corynebacterium species. Fusidic acid inhibits bacterial replication and does not kill the bacteria, and is therefore termed "bacteriostatic".

Fusidic acid is a true antibiotic, derived from the fungus Fusidium coccineum and was developed by Leo Laboratories in Ballerup, Denmark and released for clinical use in the 1960s. It has also been isolated from Mucor ramannianus and Isaria kogana. The drug is not licensed for use in the US, but, as sodium fusidate, it is approved for use under prescription in the UK, Canada, Europe, Australia and New Zealand.

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I woke up this morning with small blisters over a certain area where I applied it (the area was already irritated from ZNP, ketoconazole etc...) but I used it on my face aswell and it was fine... just have to hope it passes.

Anyway, how long should it be before I start seeing results?

Thanks

I generally see bumps drying up within a day or so .... but some are more stubborn than others. I have a few on my right cheek right now that just don't want to disappear.

I hate this stuff.

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Mandelic acid arrived through my post box 5 minutes ago, just put some on and a little goes a long way I'm releived to find out :D

I'll keep you updated with my progress now, since I'm 90% clear at the moment, hoping to push it to 100% with Nizoral, ZNP and Mandelic ;) It's getting nuked at last :dance:

what brand of mandelic acid did you get and where did you get it?

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I got Ishtar Skinlights Mandelic acid serum (15%) from ebay.co.uk (I live in U.K)

So far its workng really well, except for the irritation, but they also sent me a free mandelic acid wash and exfoliation sample, which I have been using, removes and flaky skin and also gets the mandelic acid into the pores.

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I am just curious because I haven't seen many people talk about it recently... How many of you who have Pityrosporum Folliculitis have used oral antifungal medication such as Sporanox, Nizoral, or Diflucan? (Itraconazole, Ketoconazole, or Fluconazole) And if you have used one of them how well has it worked?

I have used Ketoconazole in the past and it has completely gotten rid of my PF, but it has come back recently and now my dermatologist prescribed Itraconazole to be taken for the first week of next three months. Hopefully it will be more permanent this time.

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I used oral antifungals (ketoconazole) for a while, reduced it but never made it go away, and really messed up my liver.

I can't believe I found this group.... let me tell you my VERY long story and hope some of you can learn from my suffering.

I first notice PF when I was 18 and a freshman in college. It was incredibly bad covering my entire face, neck and chest. My doctor told me it was "hot tub folliculitis" probably contracted from my neighbor's pool. He prescribed a steroid pack which made it WAAAAY worse. (funny, he was the only one to come close to the correct diagnosis and he was just a pediatrician).

It continued to come and go for the next 13 years. Yes, years. I could go to bed with clear skin and wake up in the morning COVERED in an itchy, bumpy rash. Every dermatologist I saw (there were 5) told me I had acne and prescribed either retin A, or oral antibiotics. (Which I now know were making it worse.) They didn't believe me when I insisted it wasn't acne and said it itched. One doctor even told me I needed a psychiatrist when I refused a prescription for retin A and told him it wasn't acne. 3 rounds of Accutane cleared it while I was on the drug, only to have it return withing 1 month of stopping.

I became convinced it was some sort of allergy. I changed every soap, shampoo, makeup etc that I could think of. I was allergy tested for foods and tested postive for a few things and went years without certain foods, yet the rashes still came back. I became an expert in wearing turtlenecks and scarves to hide the bumps. Luckily, I have a very understanding husband, there were times when I just couldn't leave the house I felt so ugly.

Then, I got pregnant. The folliculitis was so bad I became depressed. It sucked all of the joy and fun out of being pregnant. Going to work was horrible, I would come home and cry in the shower, it itched so bad. I was so sick of my dermatologist telling me I had acne that I saw a new one recommended by a coworker. Well, he was a complete jerk. He basically told me I had acne, then in the same sentence said it looked follicular. He said he could do laser treatments on me once the baby was born. He also said he didn't have the time to figure out exactly what I had, and that I could go to a teaching hospital if I needed to know. I was so mad and devastated that I went home and googled "folliculitis". There was a photo that could have been me!!! Why would he say folliculitis, then try to treat me for acne!! THEY DON'T KNOW ANYTHING< THEY JUST THROW CREAMS AT YOU.

I went back to my old dermatologist and demanded that she pop one open and tell me what was in it and I showed her the article I had. Imagine my surprise when it came back as pityrosporum folliculitis.

Well I found a great derm, old school, but young enough to be knowledgable. Here is my regimine. It works well, but summer in Atlanta, or any kind of exercise will inflame it.

1. ketoconazole 2% cream twice a day to entire face, neck and chest.

2. Retin A micro once or twice a week, just to keep area dry.

3. Wipe down sweaty skin with rubbing alcohol immediately after workout or sweating. (the drier the skin the better)

4. NO ORAL CONTRACEPTIVES OR HORMONES. They inflame the condition.

5. The most important step.... once a month in the summer, less in the winter I go to the derm and he lightly sprays my face, neck, chest with liquid nitrogen. Yes, the same thing used to remove warts. Just a light spray gives you sort of a "wind burn" as if you have been skiing all day. This exfoliates the skin and kills yeast in the top follicles. It works FANTASTIC.

6. As needed selsun blue (selenium sulfide) shampoo to hair and skin. Leave on and rinse off in 5 minutes.

The ketoconazole, alcohol, nitrogen treatment and selsun blue are all safe during pregnancy. As is a weekly dose of fluconazole if you need it, but it doesn't help very much.

I hope I can help some of you out there. Imagine, I am a pharmacist and suffered for 13 years with no hope. How can any of us know what to do if a trained derm can't identify one of the most common skin afflictions on the planet?

I also am going to order a ZNP and tea tree oil. Thanks for the suggestions. PS just go into any pharmacy and they can order you a ZNP or the propylene glycol if you want.

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I went on a sugar binge last week (trapped in house with sick kids, bored and a bit depressed) ..... and two areas of my face flared up worse than usual with PF. Note to self: must stay away from the sweets.

I am also starting a course of photo-facials .... had the first one today. The treatment kills bacteria, so I'm hoping it will be anti-fungal as well. No guarantees, though. At least it should even out my skin tone, which is the main reason I'm doing it. I find that the PF spots are very hard to get rid of .... the redness lingers for a long time, and then leaves a brown spot behind. Mandelic helps get rid of those, but it's an awfully lengthy process.

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I went on a sugar binge last week (trapped in house with sick kids, bored and a bit depressed) ..... and two areas of my face flared up worse than usual with PF. Note to self: must stay away from the sweets.

I am also starting a course of photo-facials .... had the first one today. The treatment kills bacteria, so I'm hoping it will be anti-fungal as well. No guarantees, though. At least it should even out my skin tone, which is the main reason I'm doing it. I find that the PF spots are very hard to get rid of .... the redness lingers for a long time, and then leaves a brown spot behind. Mandelic helps get rid of those, but it's an awfully lengthy process.

Hey, about it taking so long to get rid of them... well I MAY have found a solution, although somewhat radical.

Over the past week I've been using Mandelic acid, with some moderate success. The real improvement came when I started to really binge on the stuff.

I started to apply it (15% serum) around 3 times a day, even when my neck (where my pf is) was red raw. At some points I was unable to rotate my head because it hurt my neck so bad. Patches of skin would just come away, it was awful, and people at my work asked me if I'd been seriously burned on my neck.

Since then, my morning regime has been to apply Mandelic acid (I now apply only when my skin is NOT raw and cracked), wait until that soaks in, then applying ketoconazole cream, which really sooths the skin and prevents a lot of flaking! Then if needed I use moisturizer aswell. So basically stacking these 3 things on top of each other.

So far it seems to be working really well, there's no marks where the pf has been, and I'm really struggling to see any pf spots at all! It's certainly a little early to be celebrating yet, but I think this could work.

I think the fact that SO MUCH skin came off has helped to basically shed anything that was there before, and now it's starting to regenerate quite nicely, mostly without pf! Fingers crossed this works, I'll keep you updated. (And I don't reccomened anyone try this until I've seen if it works, the pain is quite excrutiating ;) )

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I think the "red, raw, excruciating pain" bit might be where you lose me on that method. :lol:

However .... it makes a lot of sense, now that I think about it, to layer ketoconazole cream on top of the mandelic. Mandelic acid is an unusual AHA in that it is lipophilic; it can penetrate the sebum in the pores, much the same way that salicyclic acid does. So the mandelic will enable the ketoconazole to penetrate much more deeply into your skin than in would otherwise.

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This is so stupid.

Why do we have to modify our lifestyles so much to get rid of this shit?

Why can't derms find a solution for this?

All these regimens are great, but they stop working the minute I get off the regimens.

Why can't I just be a normal carefree person and just wash my body once a day in the shower and be done with it?

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This is so stupid.

Why do we have to modify our lifestyles so much to get rid of this shit?

Why can't derms find a solution for this?

All these regimens are great, but they stop working the minute I get off the regimens.

Why can't I just be a normal carefree person and just wash my body once a day in the shower and be done with it?

I wish I had an answer to your question. I've been showering twice a day since I was diagnosed. Plus, I don't really exercise anymore. It just makes it look so bad.

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No new PF spots since I had the photofacial three days ago.

Old spots are completely dried up and starting to flake off; redness was gone the morning after the facial.

It's way too soon to get excited, of course, but I am cautiously hopeful.

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