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Thread: Pityriasis Folliculorum- white scales and dead skin build up due to Demodex

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    Default Pityriasis Folliculorum- white scales and dead skin build up due to Demodex

    Hi All,

    I'm going to finally post about this condition officially so that others can hopefully find my post with a search engine in the future, and also, as a place to guide people to so I don't have to continue to reiterate my symptoms.

    Here is a little background information that may be useful:

    1) I have subtype 1 rosacea mostly- I have always been a "flusher". I flush to the usual triggers--warm rooms, emotions, spicy foods, chocolate, alcohol, etc.

    2) A little over a year ago, I started to develop pustules. I'm 40 years old, on birth control, so there were no changes in my hormones or even diet at the time. On a side note, I follow a whole foods, plant based diet (extremely clean, no processed foods), so I couldn't really attribute the breakouts to diet either.

    3) The breakouts would happen after I had been exposed to heat and/or sun. Overall, my breakouts were minimal though...only a few superficial pustules at the time.

    4) Then hell broke loose on my face from then on. I was flushing consistently every day and my triggers were much worse. I couldn't even wash my face without a huge flush, so I stopped washing my face thinking that would help bring the inflammation down.

    5) During this time period, I noticed a very thick layer of skin building up, plus many white follicular scales all over my cheeks and chin. It was like there was a white plug in every pore. After about 6 months of not washing or using minimal water, I decided that something was very wrong. My skin barrier was not "right". So, I began experimenting with oil cleansing, washing with honey, and then, gentle cleansers. Nothing I would do would touch this flaky, dead skin on my face. I was also breaking out regularly in superficial pustules (1-2 per day). After a few weeks, I would have to manually exfoliate this dead skin with my fingers....dead skin would literally ball up and roll off of my face.

    6) Since I didn't have the typical symptoms of subtype 2 rosacea (highly inflammatory, with a lot of p&ps), it never crossed my mind that I had a demodex infestation until another member brought it to my attention. I began to research like crazy and this is what I found:

    Pityriasis Folliculorum-

    This is a condition that is characterized by a massive demodex infestation, but generally lacks the inflammatory component. One theory is that my immune system was not reacting to the mites, therefore I was not suffering the inflammatory lesions that mark the classic demodex related subtype 2. Another theory is that given time, my immune system would have started reacting, so pityriasis folliculorum could be the initial stages of demodex related rosacea lesions.

    Here were my symptoms spelled out clearly:

    1) Follicular scales. As I mentioned, these scales are like tiny little white plugs in each pore (actually a conglomeration of demodex protruding from the pores...GROSS).

    2) Due to these follicular scales, I had a sandpaper like texture of the skin. It was very rough and I thought for a long time that my skin was dry.

    3) Dead skin build-up. My skin would build up like crazy!

    4) Superficial pustules. I would get tiny little inflamed pustules here and there.

    5) Redness/Erythema especially where the scales appeared.


    You notice that I am writing these symptoms in the past tense. It is because my symptoms have now been completely resolved within TWO WEEKS of an anti-demodectic. I have been on Soolantra now for 21 days. My skin is smooth, even toned and there is absolutely no scaling or roughness. I still flush (subtype 1) but it seems like my face is less reactive. I will continue to update the Soolantra thread (in prescription medication) to report my results. I am hoping that my flushing threshold will become lower now that my skin barrier can heal without the boatload of mites on board.

    If you have any of these symptoms, I would encourage you to try either Soolantra or ZZ cream. I would also advise a gentle cleanser to keep your pores free of dead skin, debris and oils that demodex feed on. Using oils like jojaba and coconut can feed demodex mites. Remember, they thrive on your sebum (oil) and dead skin, so decreasing nourishment, in my opinion, is important if you are prone to demodicidosis.

    Here is some research you can peruse in light of this condition:


    http://www.jaad.org/article/S0190-96...789-5/fulltext

    http://medf.nsu.ru/files/%D0%A0%D0%B...0%BA%D1%81.pdf

    https://www.ncbi.nlm.nih.gov/pubmed/22017468

    http://www.microbiologyresearch.org/...308661D481B318

    I hope this posting can help someone else! Please feel free to ask me any questions or private message me.

    -M.
    Last edited by MissM; 8th September 2017 at 07:27 PM.

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    Excellent post which will surely help those with similar symptoms who are yet to understand that Demodectic Rosacea / Demodex infestation can manifest in other forms than just the common Rosacea Subtype 2 (redness and P&Ps).
    How I was cured from Demodectic / Demodex Rosacea (Types 1 & 2 & nearing 3), Seborrhoeic Dermatitis and Eczema

    Got a smartphone? Then please post a non-revealing pic of your face/skin to www.imgur.com, instead of using walls of text to describe it to us. It may be the best thing you've ever done!

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    Senior Member laser_cat's Avatar
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    So glad you found some clues to your condition and some relief!!

    Just curious, if you knew what happened / why demodex became a problem when it did? I guess I'm reading one possibility could be an innate genetic defect in the immune system ... so nothing "obvious" would trigger it?

    I especially am intrigued by the second link -- particularly figure 6 ... Must be so satisfying to get rid of the protruding tails LOL! (Suddenly I'm remembering my perverse fascination with what would come out of those biore pore strips i used to use as a kid ha)

    Most derms I've seen associate demodex to visible bumps, which sadly seems incorrect/outdated. As in "there is no use for you to try soolantra because you have no bumps"...

    Keep us posted if your flushing improves with continual use of soolantra!

    //Lizzy

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    Quote Originally Posted by laser_cat View Post
    So glad you found some clues to your condition and some relief!!

    Just curious, if you knew what happened / why demodex became a problem when it did? I guess I'm reading one possibility could be an innate genetic defect in the immune system ... so nothing "obvious" would trigger it?

    I especially am intrigued by the second link -- particularly figure 6 ... Must be so satisfying to get rid of the protruding tails LOL! (Suddenly I'm remembering my perverse fascination with what would come out of those biore pore strips i used to use as a kid ha)

    Most derms I've seen associate demodex to visible bumps, which sadly seems incorrect/outdated. As in "there is no use for you to try soolantra because you have no bumps"...

    Keep us posted if your flushing improves with continual use of soolantra!

    //Lizzy

    You know, I'm not sure. Last year when the pustules and flushing started, I was actually in an upswing in my life. I was happily traveling at the time the pustules began, and overall, starting to really enjoy my life again. Two years prior I went through a TON of life changes and stress (divorce, selling my house, moving to a new city, changing careers....ALL at once). Maybe that stressful time had changed something in my system for the demodex to proliferate and fester? I can say this: I've always had super sensitive skin. I suffered from acne as an adolescent, weird rashes, inflammation, etc. Some people have sinus issues, chronic ear infections, GI issues....for me, it has always been skin stuff. So, if something was "off" in my immune system, I'm not surprised that it would somehow manifest as skin symptoms.

    Haha...biore pore strips, I sure do remember those and my own infatuation with removing that grossness in my pores.

    I totally agree! Most derms do NOT know about pityriasis folliculorum. In my opinion, there is likely a continuum of symptoms from pityriasis folliculorum to the full on inflammatory lesions of the disease. One needs to fully advocate for themselves and bring in studies (like the ones I posted) and INSIST on trying Soolantra (if you decide against ZZ cream). My derm wasn't even interested in what I had to say, or the articles I brought in, sadly. But, at the very least, I was able to get her to write me a prescription.

    I will definitely keep everyone posted, especially on the flushing aspect.

    -M.
    Last edited by MissM; 8th September 2017 at 09:44 PM.

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    Senior Member Brady Barrows's Avatar
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    MissM,

    Frank Powell, MD, a foremost expert on rosacea, in his book, Rosacea: Diagnosis and Management, writes the following:

    “Pityriasis folliculorum [PF] is an often over-looked clinical entity” and cases are ‘mostly female.’

    He explains that there is ‘usually a history of rarely using soap or water to cleanse the facial skin but instead using cleansing creams.’ These individuals often apply moisturizers and complain of a burning or itchy sensation. He states that the diagnosis of PF is ‘facilitated by use of dermatoscopy, which shows a distinctive picture of the presence of multiple white keratotic material consisting of keratin encrusted demodex mites protruding upwards from the follicular orifices.’ This condition ’seems to be caused by an over population of mites facilitated by the frequent use of creams and the lack of face washing with soap and water.’ source
    Brady Barrows
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    Quote Originally Posted by Brady Barrows View Post
    MissM,

    Frank Powell, MD, a foremost expert on rosacea, in his book, Rosacea: Diagnosis and Management, writes the following:

    “Pityriasis folliculorum [PF] is an often over-looked clinical entity” and cases are ‘mostly female.’

    He explains that there is ‘usually a history of rarely using soap or water to cleanse the facial skin but instead using cleansing creams.’ These individuals often apply moisturizers and complain of a burning or itchy sensation. He states that the diagnosis of PF is ‘facilitated by use of dermatoscopy, which shows a distinctive picture of the presence of multiple white keratotic material consisting of keratin encrusted demodex mites protruding upwards from the follicular orifices.’ This condition ’seems to be caused by an over population of mites facilitated by the frequent use of creams and the lack of face washing with soap and water.’ source
    Hi Brady!

    Yes, I've read this very exact quote. I'm so glad you posted this. I do believe that part of the reason my situation got out of hand was because I wasn't cleansing properly. I thought that I was causing more irritation with cleansers. Sigh.

    For me, washing only with water or a non-cleanser (like honey or oil cleansing) was not adequate to remove the debris and oils that feed the mites. On top of that, I would occasionally use jojoba or coconut oil to moisturize my face because I thought it was dry (flakiness means dry, right?! NOPE).

    In my opinion, if rosaceans are more prone to demodex infestation, it might be better to find a gentle cleanser to wash (if possible) than to not wash at all. This is just from my experience. I will never ever ever ever go back to not washing my face after going through this.

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    Hi MissM,

    This is an interesting thread because since I am in this forum, I read people here and there who have this condition and ask for explanation or help, but they had rarely an answer.

    I did or I had all what you describe. I have subtype 1 (redness, flushing) + SD + occasionally p&p. I think all my condition was caused by sun and sunburnt on my face and lack of face hygiene during my adolescence. I'm now 25.
    The result of each face wash was a red face for hours, so I stop washed my face and just washed with water once or twice a week. I did this for years, my face had a strange texture (rough, dry like) and color (like pink-orange) but redness was reduced. The explanation is by the accumulation of scales and dead skin that hid the redness all over my face. So one day I decided to remove it and I recognized myself when you said "it roll off ". Since this day I can now see this tiny white/yellow spikes in pores, every day. I tried to remove them with twizzers but they always come back.

    I went to my derm, a professor, a reputable one in my country and diagnosed me with " pytyriasis folliculorum" or in other words demodex infestation. He did skin scrapping and it reveals a lot of demodex. He said that demodex love in particular the vascular areas of the face, areas with dilated vessels.
    So he gave me Soolantra, I had to stop because it flared my SD. So I searched for an alternative : a lotion that can treat demodex without triggering my SD. Soolantra is a Cétaphil base cream and SD doesn't like that...

    I treat it now with a lotion SD trigger free with piroctone olamine (to treat demodex) and climbazole (to treat SD). The white spikes (demodex) and SD had greatly reduced. I have now a better skin texture (no more roughness), no more stinging, redness reduced, flakes reduced, skin less reactive in general , however I have to every day remove a lil bit of persistent dead skin but nothing to compare before the treatment, and I think this dead skin is due to SD and not demodex.

    Here is my routine for 1 year :

    Evening
    - I wash my face very gently with a gently soap and with mineral water (bottle). Lukewarm.
    - I don't dry my skin. Not yet.
    - I remove the dead skin / white scales with a cotton pad with hot water in. To easily remove it.
    - I dry my face with a tissue but I let my skin a little bit wet and then I apply the lotion with piroctone olamine and climbazole. Then, I dry the remaining wet areas.

    Morning
    - nothing

    Other tips :
    - I change my pillowcase every day
    - I respect the routine every day even when I travel
    - I do exercice ( running ). It helps to dynamize the skin and good for mental.
    - I have a good diet (lot of vegetables)

    I recently have a visit to my derm and he said that demodex greatly reduced and he can't see anymore massif white spikes. I will now do 3 purpura Vbeam seance to treat the underlying redness caused by dilated vessels caused by years of suns.





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    Quote Originally Posted by Optimismum View Post
    Hi MissM,

    This is an interesting thread because since I am in this forum, I read people here and there who have this condition and ask for explanation or help, but they had rarely an answer.

    I did or I had all what you describe. I have subtype 1 (redness, flushing) + SD + occasionally p&p. I think all my condition was caused by sun and sunburnt on my face and lack of face hygiene during my adolescence. I'm now 25.
    The result of each face wash was a red face for hours, so I stop washed my face and just washed with water once or twice a week. I did this for years, my face had a strange texture (rough, dry like) and color (like pink-orange) but redness was reduced. The explanation is by the accumulation of scales and dead skin that hid the redness all over my face. So one day I decided to remove it and I recognized myself when you said "it roll off ". Since this day I can now see this tiny white/yellow spikes in pores, every day. I tried to remove them with twizzers but they always come back.

    I went to my derm, a professor, a reputable one in my country and diagnosed me with " pytyriasis folliculorum" or in other words demodex infestation. He did skin scrapping and it reveals a lot of demodex. He said that demodex love in particular the vascular areas of the face, areas with dilated vessels.
    So he gave me Soolantra, I had to stop because it flared my SD. So I searched for an alternative : a lotion that can treat demodex without triggering my SD. Soolantra is a Cétaphil base cream and SD doesn't like that...

    I treat it now with a lotion SD trigger free with piroctone olamine (to treat demodex) and climbazole (to treat SD). The white spikes (demodex) and SD had greatly reduced. I have now a better skin texture (no more roughness), no more stinging, redness reduced, flakes reduced, skin less reactive in general , however I have to every day remove a lil bit of persistent dead skin but nothing to compare before the treatment, and I think this dead skin is due to SD and not demodex.

    Here is my routine for 1 year :

    Evening
    - I wash my face very gently with a gently soap and with mineral water (bottle). Lukewarm.
    - I don't dry my skin. Not yet.
    - I remove the dead skin / white scales with a cotton pad with hot water in. To easily remove it.
    - I dry my face with a tissue but I let my skin a little bit wet and then I apply the lotion with piroctone olamine and climbazole. Then, I dry the remaining wet areas.

    Morning
    - nothing

    Other tips :
    - I change my pillowcase every day
    - I respect the routine every day even when I travel
    - I do exercice ( running ). It helps to dynamize the skin and good for mental.
    - I have a good diet (lot of vegetables)

    I recently have a visit to my derm and he said that demodex greatly reduced and he can't see anymore massif white spikes. I will now do 3 purpura Vbeam seance to treat the underlying redness caused by dilated vessels caused by years of suns.





    Envoyé de mon iPhone en utilisant Tapatalk


    Thank you so much for sharing this, Optimismum! It feels good to know that what I went through was affirmed by an actual dermatologist (my derm knew nothing about this) and that you had the same symptoms and were able to resolve it.

    Did your derm say that you would likely have to continue to use the piroctone olamine for maintenance? I'm thinking that after the 3 months I will continue to use Soolantra 1-2 times per week because I'm scared these little buggers will come back.

    Also, I can resonate with what you said about sun exposure...I too have damage on my face from not protecting myself. The places on my upper cheeks where I have broken caps is where I suffered the most damage. I would like to try lasers in the future too. So, please keep us updated on your progress.

    Again, I appreciate you chiming in on this and sharing your experience!

    -M.

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    Quote Originally Posted by MissM View Post
    I'm thinking that after the 3 months I will continue to use Soolantra 1-2 times per week because I'm scared these little buggers will come
    The answer is in your post. It is exactly what he said : Maintenance !

    He confessed me that there are still some mysteries about this conditions and that he don't have all keys. But a recidivism is possible. I will try later to stop my treatment and see how my skin react, and update here te results.

    Btw, he has 3 patients with this condition and they responded very well to Soolantra treatment with encouraging results.

    I think Soolantra, Zz Cream and piroctone olamine are interesting ways to treat pytiriasis folliculorum, demodex infestation with no (or unknown?) side effects.

    Thanks you to start this thread.

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    Quote Originally Posted by Optimismum View Post
    I treat it now with a lotion SD trigger free with piroctone olamine (to treat demodex) and climbazole (to treat SD)

    thanks very much, what are you using?

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