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Recurring Folliculitis and Systemic Dermatitis
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Recurring Folliculitis and Systemic Dermatitis

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.

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. Very clean diet, non-smoker, rarely consumes alcohol. Diet is extremely clean and the patient exercises regularly (i.e., the patient is an athlete).

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.
4610897_tn?1393869202
Hello. Thank you for your question.

Pityrosporum folliculitis is caused by the yeast Pityrosporum orbiculare. This organism causes an infection of the hair follicle. It commonly affects young people and is described as either asymptomatic or slightly itchy papules (bumps) and pustules on the upper back, chest, upper arms, and neck. It can be misdiagnosed as acne. Diabetes can be a predisposing factor. But so can administration of corticosteroids or as in your case, broad-spectrum antibiotics. The organism is very common in tropical regions and the face is often affected, as in your case. In males, the face is the most common site.

The key to diagnosis is a skin scraping using potassium hydroxide. Microscopic examination should reveal round, budding yeast cells, and sometimes hyphae. If the diagnosis is made, the treatment is a combination of ketoconazole shampoo and oral ketoconazole (200 mg every day for 4 weeks). This regimen produces clearance of the lesions in 100% of patients. Using the pills alone only produces a 75% clearance rate. Another effective agent is salicylic acid wash.

You should ask your dermatologist to perform a potassium hydroxide examination to further evaluate this condition.

To prevent this condition, when in hot and humid climates, wear light, loose-fitting clothing, and avoid occlusive sunscreens and body lotions. After diving, remove wet suits promptly, dry skin thoroughly, and stay cool and dry.

V/R,
Dr. S
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