Problems include Pitryrosporum folliculitis, rosacea, etc.

[johnnypsd]

Have multiple skin problems.  Hoping for help.  I'm a 38 y.o active, light-skinned male living in So. CA, good health other than skin stuff.--Current problems are: 1) Facial flushing, heat, 2) Pityrosporum folliculitis on trunk; 3) Bizarre occasional outbreak of pustules on face following heat/sweat, excercise.  History: Developed pustules on back/shoulders.  Went to dermatolgist. Oral Keflex and Mupricin in nose resolved it briefly, but it came right back.  Told MD about my other 2 problems (above)--was experiencing(and still am)ever-increasing flushing, redness, heat in face, sometimes extending into neck and upper chest.  Had always been an easy blusher, but it used to resolve w/in 2-10 mins.  Now I'm a fairly constant base red/hot (all over face-all the time) becoming fire red in blushing scenarios.  Symp. nerv. system seems very involved. Also, coming in from wind or cold results in many hours of incredible redness.  This was never a problem b/f, but has become one in past 2-3 years.  Redness negatively impacts my work (public speaking.) MD said I have some Rosacea symptoms and a little seb. dermatitis on face, but no papules or pustules.  25 mg of Atenolol started about 6 mo's ago helped a little w/ flushing at first, but not much help these days.  I recently had 1 session w/ Gemini laser on whole face w/out much help.  Hands and palms are now red, but not hot.  7 mo's ago, MD gave doxycycline for 7 weeks-no help w/ rosacea symptoms, but the apparent bacterial folliculitis of shoulders resolved--UNFORTUNATELY, IN ITS PLACE I NOW HAVE A NEW CREATURE on my entire trunk--pityrosporum folliculitis.  Thought is that antibiotics killed bacteria, leaving the yeast to take over as main skin flora, invading follicles.  I'm quite self-conscious about it.  10 days oral Lamisil did nothing.  Have used Nizoral shampoo every 3rd-4th day (leave on 10 mins and rinse) and Zinc soap on other days.  That helps some. Some days are OK (I can feel the lesions with my hands but they are not very visible.  Other days my trunk looks broken out in red bumps, scales, and a few pustules.) 3 days of oral Ketaconazole helped, but it came back again.---Overlapping all this is my final bizarre thing--following exposure to high heat (golfing in desert) my face consistently breaks out in hundreds of small, superficial pustules.  This sometimes happens (sometimes not) in lesser heat/exposure times such as after 45 mins basketball or summer softball or just moving furniture for a few hours. Pustules appear follicularly centered, fairly uniform pattern, cheeks & forehead mainly, but entire face involved too-appears w/in 12-20 hours of exposure and resolves on their own w/in 2-3 days.  Some redness, but no itching.  Culture says "Mod-Staph, coagulase neg. B lactamase negative (Oxacillin and Penicillin suscep.);" and "Few-Staph, coagulase neg. strain II B lactamase pos.(Oxacillin-suscep, Penicil-Resist.)"
Any thoughts about anything that can be done about these things?  Thx. JP

[Alan Rockoff, MD]

Unfortunately, there's nothing I know of that helps flushing other than avoiding the things that trigger it, to the extent possible.  Most men don't wear makeup, of course, but for your speaking engagements you might want to get a makeup person (at a department store counter) to show you how to apply green-tinted foundation--green cancels out red.

If your doctor is sure that the folliculitis is Pityprosporum, other therapies that might help atr applications overnight of Selsun shampoo or a course of oral itraconazole.

The facial rash may be heat-related with blocked sweat glands.  Possibly, a topical cortisone cream could help.  Those bacteria are not relevant--they live on the kin normally.

Take care.

Dr. Rockoff