Tso's story

As a teenager I had acne problems, which went about completely gone at an age of about 25. I also do have hair thinning problems on the top of the scalp. I would describe my general health as healthy: no overweight, good physical condition, no medication only some topical lotion against hair thinning, and sometimes some anti-histamine pills against grass pollen allergy or dust mites allergy.

The first time that I consciously noticed the skin problem was about beginning of 2012, at an age of beginning 30s. The problem was a small yellow crust, usually on the upper lip or chin, that oozed a bit. I thought it was some form of acne, and didn’t paid much attention to it, because it wasn’t often (maybe 1 time per month) and it was small.

Also during that time, I often had eyelid problems: swollen bumps on the eye lids. Often it looked like some small bite mark was near it. (I think this wasn’t really a bite mark, but a small skin lesion that caused the skin around it to be swollen.)

Also a bit later during that time, I got a sore throat with white patches in the throat. On the Internet I found out that this should be strep throat. (A streptococcal bacterial infection in the throat. Note that streptococcal are able to cause impetigo, although impetigo is usually caused by staph bacteria.) The problem disappeared in about 1 month.

During 2012, a number of different environment factors changed for me. One example is that instead of using the bike, I used the car more often. I don’t know whether this played a role. Also, I moved out to a different city.

At the end of 2012, I though it was herpes/cold sores, something that isn’t really curable.

During all this time, the oozing yellow crusts problem was small, and not often. But beginning of 2013 is slowly got worse: more often, more severe. This didn’t really fit the profile of cold sores, which in normal people only happens about twice per year, while I got it on daily basis.
On the Internet, I found that impetigo would be the most likely cause, although normally, it usually only affects young children and cures by itself in about 2 to 3 weeks. But just by looking at the visual symptoms, impetigo is the best match for the problem.

So I went to the doctor (for the first time for this problem) and said I think I have impetigo. He looked at my pictures and said: but he thought it was something else and directed me to a dermatologist. At the dermatologist I said the same thing: I think I have impetigo. At that moment, I only had a small oozing lesion on the side of my nose, without crust formation yet. She look at my face from a distance and said: you have impetigo, followed by: “Which treatments did you use?”, on which I replied “Which treatments? This is the first time I see a dermatologist, I haven’t had any treatment yet”. So I think she may have assumed that it’s impetigo because I came up with it thinking that other doctors told me it was impetigo and gave me treatments.
Next, she took a culture swab from the nose, and gave me topical fusidic acid ointment (antibiotic). This didn’t work. And the swab tests came back negative.

In later visits, more cultures where done: nose, throat and perineum, all negative. Skin care advice for hydration didn’t help. Then she wanted to give me oral antibiotics. At first, I was reluctant to use it, because I thought I was healthy and because of this, the problem should disappear without the need of oral antibiotics, right? (Also I never took oral antibiotics before.) But I had no choice, if nothing else helps, I have to take it. The 10 day oral flucloxacillin (antibiotic, a penicillin) seemed to improve my overall skin appearance, but the problem continued to appear during the treatment at day 5 and 7. But after day 10, the problem was gone for about 1 week, then it reappeared. I’m not sure whether the 1 week symptom free period was due to the antibiotic, or it was random luck. (During the period, I thought I was cured.)

After this dermatologist, she send me to an internist, who did a blood tests, which showed no problems. He also said that the problem should be examined by a dermatologist instead of his profession. Next, we tried a anti fungi treatment (using oral itraconazole), because some fungal skin diseases may mimic impetigo, but this didn’t help.

Then went to another dermatologist, who said it was folliculitis, based on the photos that I showed. Those were mostly photos without yellow crusts, because the other dermatologist once said that it would be interesting to know what underlying skin problem I may have. So I usually took photos with yellow crusts clean up. This probably made him think it was folliculitis, also due to a high amount of small normal pustules on my forehead that I temporary had during that time.
He gave me a corticosteroid (triamcinolone) combined with clindamycin (antibiotic), prepared all in one lotion. This removed the complete problem after 3 days. I used it for 1 month, but did notice thinning of the skin and redding of the skin, and maybe also sensitive eyes to sunlight. Because of this, it didn’t felt good using the lotion, especially not on the long term. After this, we moved over to only clindamycin (antibiotic) lotion, which made the problem reappear. Also, I got acne from the withdrawal of topical triamcinolone (corticosteroid), about 1 week after stopping it, and this withdrawal problem (rebound effect) continued for about 1 month.

During all this time, I tried a number of different home treatments, such as more hygiene, bleach baths, creams etc. But that didn’t solve the problem.

Currenly, I’m taking Soolantra (topical ivermectin), which seem to have some effect, but it is too early to make conclusions.

Current treatment:

  • Only cold water contact with face.
  • Facial Moisturizing PM Lotion in the afternoon, every day
  • Shave every few days before going to bed, followed by
  • Facewash with Cerave Hydrating Cleanser every night.
  • Soolantra before going to bed
  • No caffeine
  • Lower shower temperature, ~35 degrees celsius instead of ~38

List of things I currently do, but also did before clear or remembered result:

  • Daily exercise
  • Biking for 1 hour once every few days, to get sunlight.
  • ginger tea
  • self made healthy fruit smoothie, daily
  • drinking filtered water

Daily log:

  • 2015-09-30: no new oozing lesions, healing deep acne pustule on left cheek and right cheek, small pustule on chin from yesterday. Mental state: positive about the treatment.