To Doctor Bhupinder Kaur - about folliculitis

[helpmed2011]

Doctor,  
never had any skin issues in my life.  about 6 weeks ago, started ithcing all over the body.  there were inflammed follicule face to feet.  went to the doctor and  had punch biopsy done and doc prescribed triamcinlone.  after a week went to the doc again, the biopsy
result is:
"sections at multiple levels show a perifollicular infiltrate of lymphohistiocytes which focally extend thru the follicular epitheilum.  Focally, there is perifollicular fibrosis suggestinga late/resolving lesion.  A PAS stain was negative for fungal organisms".
told the doc the itching stopped.  

again, after about 10 days, the same symptoms started spreading, went to the doc, he prescribed doxycycline oral antibiotic and topical ketoconozole cream (30g).  i used this on my face and body.  since i was washing my face every few hours when i was using the cream didn't have whole lot of bad reaction; however started getting drying peeling skin.  so i apply only a lil bit on face, i used on my body broke out in hives on both sides of my stomach (where there were bunch of inflammed follicules) i stopped applying ketoconzole on my stomach. its only 30g so i have only lil bit left;    and the doc told me to continue another refill of doxycycline and ketoconzole if needed.  actually, want to go and see the doctor before again continue on the prescription.  don't have insurance and is expensive.  probably, i will a wait a while longer before i make my next appt.  am taking this antibiotic only for the last 6 days;  will this antibiotic and ketoconzole will clear this folliculitis.  i see hyperpigmentation (am dark color) like small dots all over the body, legs, some on face.  
qn:  1.  will this medication clear this problem
2.  will the scar clear on its own or any medication needed for that
why did it recur?
thanks in advance

[Bhupinder Kaur, MD]

Hello,
Thanks for writing back. It is good that fungal culture has been done and it has also come negative. It can be due to dermatitis caused by an allergic reaction to chemicals, wool, soaps, cosmetics and certain foods. Desonide is a low potent steroid and can be used as you have been advised by your dermatologist. The biopsy findings are suggesting a healing old lesion and not fresh skin cause. Hence it is not suggestive of a recent bacterial of fungal infection but suggest old skin cells inflammation.

I sincerely hope that helps. Take care and best wishes.

[priyagracemthomas]

What if you've had freckles on your palm for 4 years

[helpmed2011]

thank you Doctor.
this is the result of Biopsy done in end of feb/March 2011.
see this says negative for fungal organisms.
"sections at multiple levels show a perifollicular infiltrate of lymphohistiocytes which focally extend thru the follicular epitheilum.  Focally, there is perifollicular fibrosis suggesting a late/resolving lesion.  A PAS stain was negative for fungal organisms".

Is the above test different from what you're referring in your response .

Went to the doctor today and he went over the lab test report for culture test done.
3 weeks ago doctor incised a pustule and sent the sample out for culture test.
doctor said no staph, nothing to be concerned about regular flora.
I asked what type of problem bacterial, fungal or viral.
he said if it was viral there will be blisters. and fungal first biopsy test came back negative.
probably, picking up something from environment.  i asked if this is common and repeated exposure, why body doesn't fight back.    for that, doctor said, we have to find what is causing.  also, i said, the ithcing isn't intense like what it was couple of months ago, i told him my concern, i never itched as far as i can remember, i never touch my nose, face, but i have itchy feeling to do so at least about 20 times a day now.   this is bothering me much.  last time he prescribed desonide which i didn't use a whole lot afraid of using cortizone/steriod neck down.  didn't use that on face. he said use it only for couple of weeks and discontinue.
also, suggested not to use any body spray, cologne spray, after shave etc., which i have beenusing for years.  going stop using and see any improvement.  what is your opinion.

[Bhupinder Kaur, MD]

Hello,
Sometimes folliculitis is caused by fungal infection like yeast and in such cases. it is often diagnosed by fungal culture or KOH examination and is often treated with an antifungal shampoo or body wash such as ketoconazole. Resistant cases of folliculitis like yours may need treatment with isotretinoin pills for several months. Please discuss these possibilities with your doctor.

I hope it helps. Take care and regards.

[helpmed2011]

went to the doctor about 15-20 days ago. i told the doctor that i took doxycycline for 22 days as he prescribed and used ketoconazole.   and told him still have inflammed follicles.  still have itching (but has reduced considerably compared to what it was in Feb/Mar 2011).  still it itches, sometimes its only inflammed follicle, sometimes pimples, pustules near hair follicle.
Doctor admitted he couldn't figure out what type of folliculitis.  then i suggested to get culture done to findout what type of bacteria.  but the results came back negative (the lab technician informed me).  have to go to the doctor again to check with him on test results and further treatment.

what do you think.  biopsy done 2 months ago, culture done 2 weeks ago, whats next?
if you can tell me i can check with my doctor i have appt on wed.
thanks

[Bhupinder Kaur, MD]

Hello,
Doxycycline is an antibiotic but ketoconazole is an antifungal. So for folliculitis, topical and oral antifungals are needed. It is surprising that your condition of folliculitis is not responding to antibiotics. I suggest you to get a culture done and then start with specific antibiotics.

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 dermatologist. I sincerely hope that helps. Take care and please do keep me posted on how you are doing.