Hi everyone,

I'm a 40-year-old man looking for some advice regarding a chronic skin problem I've had for more than 20 years.

It started around the age of 18, when I began growing more facial hair. Initially it was relatively mild — occasional small white/pus-filled spots, mainly around my nose, mouth, moustache and chin, seemingly originating from hair follicles. Over the years it gradually became more persistent and severe. I was initially treated with topical medications, including topical antibiotics, and eventually progressed to oral antibiotics. Doxycycline or Tetracyckline has helped significantly in the past, but the problem keeps coming back after stopping.

In recent years, I've also developed similar lesions on my chest and my scalp/head. The affected skin is usually red, dry and sometimes flaky, with small white pustules around the hair follicles.

I've noticed some fairly consistent triggers:

* hot weather and sweating
* direct sun exposure
* periods of significant stress

Interestingly, the condition can fluctuate between different areas — for example, my face can be quite bad while my chest is completely clear, and at other times it's the opposite.

I recently had microbiological testing performed on samples from my facial skin lesions. The results were:

* **Staphylococcus aureus, methicillin-sensitive (MSSA)** — moderate growth; **possible carrier/colonization**.
* **Malassezia furfur** — abundant growth.
* **Candida parapsilosis** — moderate-to-abundant growth.

The bacterial culture was from a swab of the facial skin lesions, while the fungal testing was performed on skin scrapings from the face.

I've been using ketoconazole (Nizoral) occasionally but it makes noh difference.

Two dermatologists have also suggested different approaches that I'm unsure about:

**Isotretinoin (Accutane/Roaccutane)** — one dermatologist suggested trying it. I I'm wondering whether isotretinoin could make sense in a case like this.

**Autovaccine (autogenous vaccine)** — another dermatologist suggested this based on the recurrent bacterial component.

I'd be especially interested in hearing from anyone who has had a similar long-term problem and eventually found a diagnosis or treatment that worked. Would you consider isotretinoin or an autovaccine in a case like this? What was your experience?



Chronic folliculitis for 20+ years – looking for ideas