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Dermatology (Expert Forum)
demodex and folliculitis
Answered by
Alan Rockoff, MD - dermatology, Child Skin Problems
The Rockoff Dermatology Center
Brookline - MA
This forum is for questions regarding Dermatology issues, such as: skin rashes, acne, birthmarks, skin infections, rosacea, and general skin care.
demodex and folliculitis
by Martin2007, Mar 03, 2007 12:00AM
Dear Dr. Rockoff,
In Dec 2006, I had a skin eruption that was very itchy, especially at night. It was located on inner thighs, buttocks, and arms. I was very worried it was scabies. I saw a dermatologist who identified it as Demodex, not scabies. I had a treatment by Stomectol (with disinfection of surroudnings). 14 days later, the demodex were not gone. So I had Ascabiol for 2 nights. Demodex was gone.
Since then, I had a pruritic folliculitis that did not respond to topical Fucidin, so I had to take Oral Fucidin (1000 mg for 10 days and 500 mg for 10 days) and Diprosone for same period (degressing from twice a day to once a day). A biopsy of a new button showed lymphocities, neutrophiles and very few eosinophils. Morphologically, it was identified in the lab as Eczema. No mycites and no spores.
Once I stopped Oral Fucidin, folliculitis is reappearing, on the buttocks and inner thighs. It hurts and itches. The dermatologist wants to give me Erythromycin for 30 days. The dermtologist is also wondering if there are any physical underlying causes. I am very worried and read that folliculitis and demodex are related to immunity. I would appreciate your sincere opinion.
In Dec 2006, I had a skin eruption that was very itchy, especially at night. It was located on inner thighs, buttocks, and arms. I was very worried it was scabies. I saw a dermatologist who identified it as Demodex, not scabies. I had a treatment by Stomectol (with disinfection of surroudnings). 14 days later, the demodex were not gone. So I had Ascabiol for 2 nights. Demodex was gone.
Since then, I had a pruritic folliculitis that did not respond to topical Fucidin, so I had to take Oral Fucidin (1000 mg for 10 days and 500 mg for 10 days) and Diprosone for same period (degressing from twice a day to once a day). A biopsy of a new button showed lymphocities, neutrophiles and very few eosinophils. Morphologically, it was identified in the lab as Eczema. No mycites and no spores.
Once I stopped Oral Fucidin, folliculitis is reappearing, on the buttocks and inner thighs. It hurts and itches. The dermatologist wants to give me Erythromycin for 30 days. The dermtologist is also wondering if there are any physical underlying causes. I am very worried and read that folliculitis and demodex are related to immunity. I would appreciate your sincere opinion.
Doctor's Answer
by Alan Rockoff, MD, Mar 03, 2007 12:00AM
, Mar 03, 2007 12:00AM
It has long been controversial whether Demodex causes anything, or whether these mites are just a normal resident of follicles. It doesn't sound as though the biopsy you had showed excessive numbers of Demodex mites, so I don't see why your doctor still thinks that's the cause. I think a course of oral antibiotics may be worth considering, but I'd suggest a bacterial culture first, if possible. Other suggestions would include showering with an antiseptic cleanser and applying an antibiotic like bacitracin or neosporin in the nostrils at night to suppress colonization with staph germs. Often, folliculitis goes away by itself and isn't worth treating, except for lotions for itch, and so forth. I don't hear anything in your story that suggests immune dysfunction.
Take care.
Dr. Rockoff
Take care.
Dr. Rockoff
I saw my doc yesterday and he effectively asked for blood tests (including TSH for thyroid) and for bacterial culture before Erythromycin. Also next week will do a test for intestine. The test for thyroid came from our discussion about surprising hair loss since a couple of months as well as swelling of feet. Fingers crossed, we'll see.
There is an abstract that says skin disorder from autoimmune disease may present before labs (like TSH) go out of range. This was my big downfall...I didn't know this 15 years ago when my Hashi's presented with skin disorder. The tests you need are Thyroid Antibodies (TPO-Thyroid Peroxidase and Antithyglobulin).