Staph Infection or Acne Necrotica???

Doctor,
I have been dealing with acne problems since I was 18 and am now 22.  I went on accutane when I was 20.  Before tane my acne was the comogenic/cystic variety.  Since coming off it it is papular/pustular, with no comodones and is all over my scalp now as well.  I went on accutane again but it came right back.  I went to a new dermatologist who said acne cannot occur on the scalp and suggested a biopsy/culture.  The culture didn't grow anything but the biopsy came back as "superficial staph aureus perifolliculitis".  He said the culture didn't grow anything but they could see the bacteria on the biopsy (gram stain is assume).  So he prescribed me 14 days of doxycycline as well as bacitroban ointment for the nares.  This didn't do anything so I went to another derm for a second opinion.  He said despite the biopsy results he thinks it is Acne Necrotica or propionibacterium folliculitis and prescribed long term tetricycline.  I am at a loss with what to do.  Should I continue to treat it as a staph infection or pursue acne treatments instead??? Get a third opinion maybe???  Any advice on what you think it is or which avenue to pursue would be helpful.    

[Alan Rockoff, MD]

I agree with the second dermatologist that acne doesn't affect the scalp.  The biopsy showed bacteria, but if the culture didn't show staph germs, then it most likely is caused by other bacteria or perhaps the pustules are sterile and don't have any bacteria.  This is a very hard problem.  It may take trials of several antibiotics for your doctor to help you bring this under control.  I don't think you'll get much benefit from going to different doctor.  Stick with the one you have and work  with him.  I know it's hard, but patience is ncessary.

Take care.

Dr. Rockoff