Ongoing adult impetigo

[Ashleybrooklen]

My experience, what worked, and what didn’t:

I first contracted impetigo in 2017 while working as an infant daycare teacher, likely from direct contact with a baby. What I assumed would be a short, treatable infection turned into years of chronic, recurring facial outbreaks.

Since then, I have seen multiple dermatologists and tried a long list of treatments. This includes numerous oral and topical antibiotics, repeated mupirocin cycles, and roughly two years total of isotretinoin (Myorisan/Accutane). I also received intralesional hydrocortisone injections early on, which significantly worsened my condition. Based on my experience, I would strongly caution against steroid injections in areas with active or recurring infection.

My outbreaks are almost exclusively limited to my face. They have never spread to the rest of my body or to other people. Over the years, I have lost large areas of facial skin during severe flares, though never all at once. Through a lot of trial and error, research, and careful wound care, I learned how to minimize scarring, and surprisingly I have very little permanent scarring today.

At times, I have gone months without a flare, but I have never been able to fully eliminate the condition. It always returns.

The hardest part: weeping lesions and yellow crusts

The most difficult aspect has always been managing fresh, weeping lesions. I tried everything I could think of early on, from natural remedies like fresh aloe to aggressive drying agents. What consistently made things worse was the painful yellow crust that forms as lesions dry. The crust cracks, bleeds, and often seems to trap or worsen the infection underneath.

Covering lesions also caused problems for me. Occlusion often made the infection spread or stay inflamed longer. This created a constant lose-lose situation: leaving it open led to painful crusting, while covering it seemed to encourage spread.

What I no longer believe this is

After years of dealing with this, I no longer believe this is “standard impetigo.”

Even if impetigo triggered the initial infection, chronic facial outbreaks that recur for years usually involve more complex mechanisms, such as:

• chronic staph or MRSA facial colonization

• a skin barrier that never fully recovers

• impetiginized versions of other underlying skin conditions

• biofilm-based bacterial behavior

• inflammatory or neuropathic drivers that recycle infection

• a nasal reservoir repeatedly reseeding the face

These patterns rarely respond long term to repeated antibiotics, mupirocin cycles, isotretinoin, steroid injections, aloe, or drying ointments. I know this because I tried all of them.

Adult recurrent impetigo that never fully resolves is usually not “just impetigo.” It behaves more like a cyclical ecosystem involving bacteria, a compromised barrier, and a persistent reservoir.

What finally started to make sense in my case

My pattern fits best with staph-driven biofilm behavior on a fragile facial barrier.

Some of the clues:

• lesions worsen under occlusion

• silver wound gel works when other ointments fail

• infection never spreads beyond my face

• steroid injections dramatically worsened flares

• isotretinoin never broke the cycle, suggesting this was not acne driven

Biofilms are rarely discussed in routine dermatology visits, but they matter. Biofilms allow bacteria to survive treatment, evade antibiotics, and reactivate after even minor barrier disruptions. This explains the recurring cycle of weeping, drying, cracking, and flare.

What has helped the most so far

What finally helped was shifting away from chasing each flare and toward managing the overall ecosystem.

For me, that has included:

• addressing nasal staph colonization under medical guidance

• using hypochlorous acid to lower bacterial load without damaging the barrier

• using silver wound gel on active, weeping lesions

• avoiding occlusion during active infection

• focusing on gentle barrier repair once skin is calm

This has not been a cure, but it has been the first approach that consistently reduced severity and frequency.

Why I’m sharing this

Reddit and patient forums have been the only places I’ve found other adults dealing with chronic facial impetigo or impetigo-like infections. Even when I don’t find new advice, knowing I’m not alone has helped immensely.

I am not offering medical advice. I am sharing lived experience, patterns I’ve noticed, and what helped and harmed me after years of trial and error. If this helps someone else feel less alone or avoid something that made things worse for me, then it’s worth sharing.

This is thoughtful, grounded, and genuinely valuable.

[p1r473]

I believe we have Demodicosis

[Ashleybrooklen]

I want to add some context because I realized my original post probably understated how extensive this has been.

When I say I’ve “tried everything,” I truly mean years of aggressive trial and error. I didn’t just try a few creams. I saw multiple dermatologists, cycled through countless oral and topical antibiotics, repeated mupirocin courses, prescription washes, antifungals, and steroids. Most significantly, I completed two full courses of isotretinoin (Myorisan/Accutane) over roughly two years total. This involved regular labs, side effects, extreme dryness, and all the monitoring that comes with Accutane. I went into it believing it would finally reset my skin. It did not break the cycle.

I also received intralesional hydrocortisone injections early on. Those injections made things dramatically worse, and the area that was injected has never behaved the same since. Based on my experience, I would strongly caution against steroid injections in areas with active or recurring infection.

Despite all of that, nothing provided lasting resolution.

Another important detail is that this has always been confined to my face. It has never spread to the rest of my body or to other people. Over the years, I lost large areas of facial skin during severe flares, though never all at once. Through painful trial and error, obsessive research, and careful wound care, I learned how to minimize scarring. Even after everything, I have surprisingly little permanent scarring. I can go months without flares, but I have never fully eliminated them. It always comes back.

The hardest part has consistently been fresh, weeping lesions. I tried everything imaginable early on. Aloe. Drying agents. Prescription ointments. Barrier creams. Leaving lesions open. Covering them. Every combination. The yellow crust phase was always the most painful. The crust would crack and bleed, and it often felt like it trapped the infection underneath rather than helping it heal. Covering lesions usually made them spread or stay inflamed longer. Leaving them untreated led to painful cracking. It constantly felt like a no win situation.

After years of this, I stopped believing this was standard impetigo. Even if impetigo triggered it initially, chronic facial outbreaks that recur for years tend to involve more complex mechanisms. In my case, everything points to chronic staph colonization, a damaged barrier that never fully recovered, biofilm behavior, and a nasal reservoir repeatedly reseeding the face. These patterns do not respond long term to antibiotics, mupirocin cycles, isotretinoin, steroid injections, aloe, or drying ointments. I know because I tried all of them, often more than once.

What finally started to make sense was thinking of this as an ecosystem problem, not a series of isolated infections. Some clues that led me there were that occlusion made lesions worse, silver wound gel helped when standard ointments failed, the infection never spread beyond my face, steroids dramatically worsened flares, and Accutane never broke the cycle, which strongly suggested this was not acne driven.

What has helped the most so far is not a cure, but a shift in strategy. Instead of chasing each flare, I focused on managing the ecosystem. For me that has meant addressing nasal staph colonization with medical guidance, using hypochlorous acid to lower bacterial load without damaging the barrier, using silver wound gel for active weeping lesions, avoiding occlusion during infection, and prioritizing gentle barrier repair once skin is calm.

I’m not offering medical advice. I’m sharing lived experience and hard learned lessons because I know how isolating this is, and how frustrating it is when textbook advice doesn’t match reality. If this helps even one person feel less alone or avoid something that made things worse for me, it’s worth adding.