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Recurring Folliculitis -- Bacteria or Fungus?
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Recurring Folliculitis -- Bacteria or Fungus?

Background:

I've never had a skin condition like this ever, and certainly not one that returns. I traveled to Brazil in late August 2012, while I was there my skin become extremely inflamed--a systemic itch and redness--everywhere. I returned and was treated for atopic dermatitis with the usual treatment: mometasone furoate for my body and Protopic ointment for my face. However, this did little in the way of providing relief and within a month I had developed several pustules in my mustache area. I saw a dermatologist who put me on Bactrim DS for a week. Almost instantaneously my issues resolved--no more itching, the pustules disappeared, and I could shave and conduct business normally again. After the regimen was complete, the symptoms returned. A culture was taken: it came back negative for MRSA. I was subsequently put on Bactrim DS again for 2 weeks. Immediate relief ensued but, again, the symptoms recurred after the antibiotic course was completed.

This is my third cycle in this pattern, and to no avail.

Aside: My doctor (2nd opinion) does not want to put me on an antibiotic regiment until he sees signs of infection (i.e., pustules), but I have a job that requires interaction with others on a daily basis--I do not have time to develop signs and then run to his office in the middle of a work week. I also feel like I'm being treated for my symptoms, not the underlying condition.

Symptoms:

Constant itching/skin inflammation on face, forearms, upper arms, upper back, upper chest, lower legs. Pustules, evidence of folliculitis on the upper lip (where I shave) and (to a lesser extent) in areas noted above. Inflammation seems to be eczema, likely exacerbated by whatever is causing the infection.

Chronic tiredness

Skin burns when using relatively innocuous soaps (e.g., face burns washing with CeraVe).

Medical history:

23 y/o male, no chronic disease. Mild allergic rhinitis/seasonal allergies. Has had isolated, very mild cases of atopic dermatitis in the past in all the usual places (behind knee, skin fold above eyelidsm, and in the crook of the elbow). Very clean diet, non-smoker, rarely consumes alcohol. Diet is extremely clean and the patient exercises regularly (i.e., the patient is an athlete).

Questions:

I do not think this is a chronic issue I'm left to deal with because contraction was so acute in nature--I remember distinctly the week all this started.

Could this be pityrosporum folliculitis? My theory is that this is fungal in nature and the antibiotics killed the naturally occurring bacterial fauna on the skin that would normally compete with the fungus. This would explain the recurrence.

Something is causing the systemic eczema. The folliculitis might be (1) a manifestation of the cause or (2) a by product of staph on the skin infecting an open wound (from shaving) with the cause being something else. I think it is a FUNGAL cause, but the infected follicles are bacterial infections (which is why the antibiotic treatment works).

Your thoughts? Any help would be most welcome.
563773_tn?1374250139
Hello,
For these symptoms sweat dermatitis can be one of the possibilities. You may try calamine lotion. You should also maintain hygiene and try to keep the area clean and dry, wear loose-fitting cotton clothing. Also use an antibacterial soap or mild soap like dove. Avoid deodorant / cosmetics. You can also take oral antihistaminics for itching but they may cause drowsiness.
If the symptoms persist then it will be best to get it evaluated from a dermatologist.

It is very difficult to precisely confirm a diagnosis without examination and investigations and the answer is based on the medical information provided. For exact diagnosis, you are requested to consult your doctor. I sincerely hope that helps. Take care and please do keep me posted on how you are doing.

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