demodex and folliculitis

[Martin2007]

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.

[Alan Rockoff, MD]

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

[jibberjabber]

I have had problems with my skin since approximately 1996, when on a trip to Maine in June when the mosquitos were ferocious and I used a repellant with deet which I was apparently allergic to and broke out in hives.  Since then whenever I get poison ivy, mosquito bites or scratches on my legs and I scratch them they tak "forever" to heal.  I had also developed bumps on the top and back of my scalp which itched & I scratched and had this problem until 2006 when the scalp cleared up from using Scalpicin.  I then developed small bumps on various parts of my body and when I scratched them they stayed sore and hurt at times.  I have been treated with various creams and antibiotics & bactrim.  The bactrim & cream caused severe hives.  I am finding some relief with a regimen a dermatologist put me on of topical clindamycin and steroid.  I had excema as a child, and have been told different dxs by different docs:  folliculitis, pruitis, mersa.  When I had a biopsy Staph infection showed up, antibiotic was used and subsequent biopsy was clear.  It seems I will never get rid of this problem; however, I am doing much better.

[CindiNelson]

I read that doggies can be more susceptible to demodex if they have hypothryoidism...and since the dermopathies with thyroid disease can be itchy (mine was)...and since hypo can cause all sorts of skin disorder (including the eczema)...I'd check for Hashimoto's just to rule it out.  Sometimes the first sign of an autoimmune disease shows up in the skin.  

[Martin2007]

Thank you Dr. Rockoff for your insight and thank you all for your comments.

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.

[CindiNelson]

TSH is the standard thyroid function test for hypothyroidism, but it does NOT detect whether you have Hashimoto's (autoimmune thyroid disease).  Although hypothyroidism can cause skin changes (dry skin and myxedema eventually for example), sometimes Hashi's being autoimmune...will initially Present with skin disorder of various types..and it may be the only sign initially that you have an autoimmune disorder.  

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).  

[Martin2007]

Thanks so much for your info. I hope to get done with this, folliculitis has been ruining my life... I just pray we know the reason for it...