Guest guest Posted June 26, 2002 Report Share Posted June 26, 2002 Marjorie Thanks for your reply which was both interesting and helpful. You write that: " It is part of normal adult skin flora but I don't believe normally in the follicles/glands -- I think it stays on the topmost surface of the epidermis, the stratum corneum . . . " and " we all have malassezia all over our bodies and it typically stays on the surface, it normally doesn't infect our follicles " That's interesting. My Merck Manual says it is " a common lipophilic yeast which is normally present in the follicles . . . " Admittedly, this is an old edition (16th) I have from my student days so perhaps the information is out of date? You go on to say: " I'm very much in learning mode, so please understand that the above is my knowledge at the time of writing. I would appreciate it if anyone who can add or clarify my knowledge to anything above. I may not have the most current understanding. " I would also be really interested if anyone knows anything more about current thinking on seb. derm. and the role of mallassezia furfur? I like the name, particularly in the light of maxigee's description of these organisms under the microscope. I visualise furry beachballs! Finally: " Either you like the letter " o " or you were educated/live under British rule? " Yes, I am a British oestrogen deficient ex-homoeopath with seborrhoeic dermatitis and rosacea though, thankfully, no oedema! :-) Hazel Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 26, 2002 Report Share Posted June 26, 2002 -I think you both raise a lot of good points on the complexity of this issue--I have a couple of thoughts as well after reading alot of info on both PF and SD: My first issue is that we all know that SD is treated largely by some kind of immunosuppressant, either topically or systemically but from what I have read about PF is that those who have compromised immunity seem to have proliferation of PF--it is also true that 80% of AIDS patients have SD. So, why is it that suppressing the immune system through treatment of choice, the SD seems to go into some remmission in a non-AIDS patient and at the same time someone who has a naturally compromised immune system is even more susceptible to SD--this has always confused me. To add to the confusion about of all of this, why is that immunosupression is contraindicated for those with PF, but not for those with SD? Therefore, does it not seem logical, that for someone with SD who is using immunosuppresants of any kind, that while they may be addressing the immune response associated with SD that they are at the same time leaving the door wide open for a proliferation of PF? Could this be part of the so-called rebound effect of using steroids? Is it a cycle of initial inflammation (becuase of a slight T-cell defect or some other unknown reason), treatment of the inflammation through immunosuppression, and then the rebound effect is actually some kind of secondary fungal infection that is made worse by even further use of immunosuppressants? I hope some of this is making sense to someone and I would appreciate any feedback on this--I for one will be going to the derm this Friday and will be asking for an oral antifungal--the Sporonex seems relatively safe compared to the stronger Nizoral so I will ask for that one--from everyhting I have read, I cannot see anyway in which a killing off of the P.ovales will make SD worse--topical 2% Nizoral may work as well at killing the fungus, but not as effectively as oral treatment (from what I have read)--I tried the topical Nizoral and it was too irritating and drying so I was never able to determine if could have a positive effect. Please, your thoughts. -- In rosacea-support@y..., " Hazel Roots " <hazroots@w...> wrote: > Marjorie > > Thanks for your reply which was both interesting and helpful. > > You write that: > > " It is part of normal adult skin flora but I don't believe normally in > the follicles/glands -- I think it stays on the topmost surface of > the epidermis, the stratum corneum . . . " and > > " we all have malassezia all over our bodies and it typically stays > on the surface, it normally doesn't infect our follicles " > > That's interesting. My Merck Manual says it is " a common lipophilic > yeast which is normally present in the follicles . . . " Admittedly, this > is > an old edition (16th) I have from my student days so perhaps the information > is out of date? > > You go on to say: > > " I'm very much in learning mode, so please understand that the above > is my knowledge at the time of writing. I would appreciate it if > anyone who can add or clarify my knowledge to anything above. I may > not have the most current understanding. " > > I would also be really interested if anyone knows anything more about > current thinking on seb. derm. and the role of mallassezia furfur? I like > the > name, particularly in the light of maxigee's description of these organisms > under the microscope. I visualise furry beachballs! > > Finally: > > " Either you like the letter " o " or you were educated/live under > British rule? " > > Yes, I am a British oestrogen deficient ex-homoeopath with seborrhoeic > dermatitis and rosacea though, thankfully, no oedema! :-) > > Hazel Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 26, 2002 Report Share Posted June 26, 2002 > That's interesting. My Merck Manual says it is " a common lipophilic > yeast which is normally present in the follicles . . . " > Admittedly, this is an old edition (16th) I have from my student > days so perhaps the information is out of date? I find it great for an overview, but I don't regard the Merck Manual as authoritative because it contains so many mistakes, biases, and outdated references. ly, I don't regard my source as any more authoritative <g> but it's more current and the specific eMedicine's article on PF seems accurate to my ignorance(http://www.emedicine.com/derm/topic338.htm). It says: " Malassezia yeasts are classified as superficial mycoses that, by definition, do not invade past the cornified epithelium. In PF, however, the organism is present in the osteum and central and deep segments of the hair follicle. " I don't know that the point is important for us, except to illustrate how two mid-range medical references can contain blatantly different information. > Yes, I am a British oestrogen deficient ex-homoeopath with > seborrhoeic dermatitis and rosacea though, thankfully, no oedema! :- ) ....or paediatric disorder. <g> Why ex-homoeopath? Maerjoerioe (a playful anglophile) Marjorie Lazoff, MD Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 26, 2002 Report Share Posted June 26, 2002 > My first issue is that we all know that SD is treated largely by > some kind of immunosuppressant, either topically or systemically , I'm not sure if this is what you mean, but anti-fungal or anti-inflammatory agents are absolutely not immunosuppressants. Neither directly impacts on the core elements of the immune system, T or B cells or their immediate components and associated cells. Immunosuppressants can suppress an inflammatory response, but so can many non-immunosuppresants; aspririn and motrin are examples of effective anti-inflammatory agents that are not immunosuppressants. > but from > what I have read about PF is that those who have compromised > immunity seem to have proliferation of PF--it is also true that 80% > of AIDS patients have SD. > > So, why is it that suppressing the immune system through treatment > of choice, the SD seems to go into some remmission in a non-AIDS > patient and at the same time someone who has a naturally > compromised immune system is even more susceptible to SD--this has > always confused me. > To add to the confusion about of all of this, why is that > immunosupression is contraindicated for those with PF, but not for > those with SD? See if this makes sense to you: a compromised immune system (meaning some dysfunction within the immune system's core elements) is more open to attack by normally friendly microbes like M. furfur, which then causes an inflammatory response using an unaffection portion of the immune system (such as triggering the complement system, or cytokines, etc.). > Therefore, does it not seem logical, that for someone with SD who > is using immunosuppresants of any kind, that while they may be > addressing the immune response associated with SD that they are at > the same time leaving the door wide open for a proliferation of > PF? Could this be part of the so-called rebound effect of using > steroids? Just changing the normal skin flora by using anti-bacterials or through other mechanisms can allow overgrowth of otherwise benign organisms that a normal immune system isn't programmed to recognize and attack. > Is it a cycle of initial inflammation (becuase of a slight T-cell > defect or some other unknown reason), treatment of the inflammation > through immunosuppression, and then the rebound effect is actually > some kind of secondary fungal infection that is made worse by even > further use of immunosuppressants? Rethinking this cycle after considering the above may help clarify it for both of us. > I hope some of this is making sense to someone and I would > appreciate any feedback on this--I for one will be going to the > derm this Friday > and will be asking for an oral antifungal--the Sporonex seems > relatively safe compared to the stronger Nizoral so I will ask for > that one--from everyhting I have read, I cannot see anyway in which > a killing off of the P.ovales will make SD worse--topical 2% > Nizoral > may work as well at killing the fungus, but not as effectively as > oral treatment (from what I have read)--I tried the topical Nizoral > and it was too irritating and drying so I was never able to > determine if could have a positive effect. Another approach would be to ask your dermatologist's opinion regarding the role of p. ovale (m. furfur) in your condition and whether more aggressive treatment is indicated at this time. I don't know the source of your information regarding the efficacy and safety of topical vs oral anti-fungals, and I certainly don't know if any of this applies to your particular situation. Hope that helps. Marjorie Marjorie Lazoff, MD Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 27, 2002 Report Share Posted June 27, 2002 Approximately how long would someone need to use the ZNP bar on their face before it got rid of (at least temporary) Pityrosporum Folliculitis and Seb Derm? I don't want to use this bar for too long because it seems to aggrevate/dry out my skin a bit. Also, will using the ZNP bar for several days make the fungus not appear in a skin scraping? (Assuming the papules/redness remain?) Would a primary care doctor be trained well enough to test for Pityrosporum Folliculitis? Or would the skin scraping/microscope observation need to come from a dermatologist? I went to my derm months ago asking about PF. Antibiotics seemed to cause many of these problems ..but not until I had been on them for about a year. I have the redness/flushing but I also have the tons of tiny little itchy red bumps on my face and scalp. This all started about six months after my seb derm became a problem. I scoured this website that has pictures of like every skin disease known to man practically.. and the only one that visually matched many of my symptoms was Pityrosporum Folliculitis. I dont think this is my entire problem (As I had redness and MILD flushing before antibiotics (which is why I was put on them), and PF cant cause breathing problems/chest pains) But I do think its been a large contributing factor to the visual/cosmetic issues, and part of why my case has been so refractory to treatment. My derm told me he couldn't test for PF! He said the only way to test for it is to culture pustules... and it would have to be 50 or 60 of them at that.... and I don't have alot of pustules to culture.. Topical nizoral always calms my symptoms (especially the papules) but its too harsh for my skin, and I am never able to use it for long. Re: Pityrosporum Folliculitis > > My first issue is that we all know that SD is treated largely by > > some kind of immunosuppressant, either topically or systemically > > , I'm not sure if this is what you mean, but anti-fungal or > anti-inflammatory agents are absolutely not immunosuppressants. > Neither directly impacts on the core elements of the immune system, T > or B cells or their immediate components and associated cells. > Immunosuppressants can suppress an inflammatory response, but so can > many non-immunosuppresants; aspririn and motrin are examples of > effective anti-inflammatory agents that are not immunosuppressants. > > > but from > > what I have read about PF is that those who have compromised > > immunity seem to have proliferation of PF--it is also true that 80% > > of AIDS patients have SD. > > > > So, why is it that suppressing the immune system through treatment > > of choice, the SD seems to go into some remmission in a non-AIDS > > patient and at the same time someone who has a naturally > > compromised immune system is even more susceptible to SD--this has > > always confused me. > > To add to the confusion about of all of this, why is that > > immunosupression is contraindicated for those with PF, but not for > > those with SD? > > See if this makes sense to you: a compromised immune system (meaning > some dysfunction within the immune system's core elements) is more > open to attack by normally friendly microbes like M. furfur, which > then causes an inflammatory response using an unaffection portion of > the immune system (such as triggering the complement system, or > cytokines, etc.). > > > Therefore, does it not seem logical, that for someone with SD who > > is using immunosuppresants of any kind, that while they may be > > addressing the immune response associated with SD that they are at > > the same time leaving the door wide open for a proliferation of > > PF? Could this be part of the so-called rebound effect of using > > steroids? > > Just changing the normal skin flora by using anti-bacterials or > through other mechanisms can allow overgrowth of otherwise benign > organisms that a normal immune system isn't programmed to recognize > and attack. > > > Is it a cycle of initial inflammation (becuase of a slight T-cell > > defect or some other unknown reason), treatment of the inflammation > > through immunosuppression, and then the rebound effect is actually > > some kind of secondary fungal infection that is made worse by even > > further use of immunosuppressants? > > Rethinking this cycle after considering the above may help clarify it > for both of us. > > > I hope some of this is making sense to someone and I would > > appreciate any feedback on this--I for one will be going to the > > derm this Friday > > and will be asking for an oral antifungal--the Sporonex seems > > relatively safe compared to the stronger Nizoral so I will ask for > > that one--from everyhting I have read, I cannot see anyway in which > > a killing off of the P.ovales will make SD worse--topical 2% > > Nizoral > > may work as well at killing the fungus, but not as effectively as > > oral treatment (from what I have read)--I tried the topical Nizoral > > and it was too irritating and drying so I was never able to > > determine if could have a positive effect. > > Another approach would be to ask your dermatologist's opinion > regarding the role of p. ovale (m. furfur) in your condition and > whether more aggressive treatment is indicated at this time. I don't > know the source of your information regarding the efficacy and safety > of topical vs oral anti-fungals, and I certainly don't know if any of > this applies to your particular situation. > > Hope that helps. > > Marjorie > > Marjorie Lazoff, MD > > > > > -- > Please read the list highlights before posting to the whole group (http://rosacea.ii.net/toc.html). Your post will be delayed if you don't give a meaningful subject or trim your reply text. You must change the subject when replying to a digest ! > > See http://www.drnase.com for info on his recently published book. > > To leave the list send an email to rosacea-support-unsubscribe > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 28, 2002 Report Share Posted June 28, 2002 Adam, yeast may well be playing a role in your skin condition, esp if you have SD, I don't know and neither do you. Much more important, I get the sense that your skin is secondary to your obtaining a definitive diagnosis regarding your shortness of breath and chest pain. Given a normal echocardiogram, it's not tough for a competent internist to tell the difference between a psychosomatic and a physical cause for your chest symptoms, and then to put your dermatographia in perspective given your other skin symptoms, whether you're part of the normal 5% with that feature or it represents chronic urticaria or a primary mast cell condition. Marjorie Marjorie Lazoff, MD > Approximately how long would someone need to use the ZNP bar on their face > before it got rid of (at least temporary) Pityrosporum Folliculitis and Seb > Derm? I don't want to use this bar for too long because it seems to > aggrevate/dry out my skin a bit. Also, will using the ZNP bar for several > days make the fungus not appear in a skin scraping? (Assuming the > papules/redness remain?) > > Would a primary care doctor be trained well enough to test for Pityrosporum > Folliculitis? Or would the skin scraping/microscope observation need to > come from a dermatologist? I went to my derm months ago asking about PF. > Antibiotics seemed to cause many of these problems ..but not until I had > been on them for about a year. I have the redness/flushing but I also have > the tons of tiny little itchy red bumps on my face and scalp. This all > started about six months after my seb derm became a problem. I scoured this > website that has pictures of like every skin disease known to man > practically.. and the only one that visually matched many of my symptoms was > Pityrosporum Folliculitis. I dont think this is my entire problem (As I had > redness and MILD flushing before antibiotics (which is why I was put on > them), and PF cant cause breathing problems/chest pains) But I do think its > been a large contributing factor to the visual/cosmetic issues, and part of > why my case has been so refractory to treatment. My derm told me he > couldn't test for PF! He said the only way to test for it is to culture > pustules... and it would have to be 50 or 60 of them at that.... and I > don't have alot of pustules to culture.. Topical nizoral always calms my > symptoms (especially the papules) but its too harsh for my skin, and I am > never able to use it for long. > Re: Pityrosporum Folliculitis > > > > > My first issue is that we all know that SD is treated largely by > > > some kind of immunosuppressant, either topically or systemically > > > > , I'm not sure if this is what you mean, but anti-fungal or > > anti-inflammatory agents are absolutely not immunosuppressants. > > Neither directly impacts on the core elements of the immune system, T > > or B cells or their immediate components and associated cells. > > Immunosuppressants can suppress an inflammatory response, but so can > > many non-immunosuppresants; aspririn and motrin are examples of > > effective anti-inflammatory agents that are not immunosuppressants. > > > > > but from > > > what I have read about PF is that those who have compromised > > > immunity seem to have proliferation of PF--it is also true that 80% > > > of AIDS patients have SD. > > > > > > So, why is it that suppressing the immune system through treatment > > > of choice, the SD seems to go into some remmission in a non-AIDS > > > patient and at the same time someone who has a naturally > > > compromised immune system is even more susceptible to SD--this has > > > always confused me. > > > To add to the confusion about of all of this, why is that > > > immunosupression is contraindicated for those with PF, but not for > > > those with SD? > > > > See if this makes sense to you: a compromised immune system (meaning > > some dysfunction within the immune system's core elements) is more > > open to attack by normally friendly microbes like M. furfur, which > > then causes an inflammatory response using an unaffection portion of > > the immune system (such as triggering the complement system, or > > cytokines, etc.). > > > > > Therefore, does it not seem logical, that for someone with SD who > > > is using immunosuppresants of any kind, that while they may be > > > addressing the immune response associated with SD that they are at > > > the same time leaving the door wide open for a proliferation of > > > PF? Could this be part of the so-called rebound effect of using > > > steroids? > > > > Just changing the normal skin flora by using anti-bacterials or > > through other mechanisms can allow overgrowth of otherwise benign > > organisms that a normal immune system isn't programmed to recognize > > and attack. > > > > > Is it a cycle of initial inflammation (becuase of a slight T- cell > > > defect or some other unknown reason), treatment of the inflammation > > > through immunosuppression, and then the rebound effect is actually > > > some kind of secondary fungal infection that is made worse by even > > > further use of immunosuppressants? > > > > Rethinking this cycle after considering the above may help clarify it > > for both of us. > > > > > I hope some of this is making sense to someone and I would > > > appreciate any feedback on this--I for one will be going to the > > > derm this Friday > > > and will be asking for an oral antifungal--the Sporonex seems > > > relatively safe compared to the stronger Nizoral so I will ask for > > > that one--from everyhting I have read, I cannot see anyway in which > > > a killing off of the P.ovales will make SD worse--topical 2% > > > Nizoral > > > may work as well at killing the fungus, but not as effectively as > > > oral treatment (from what I have read)--I tried the topical Nizoral > > > and it was too irritating and drying so I was never able to > > > determine if could have a positive effect. > > > > Another approach would be to ask your dermatologist's opinion > > regarding the role of p. ovale (m. furfur) in your condition and > > whether more aggressive treatment is indicated at this time. I don't > > know the source of your information regarding the efficacy and safety > > of topical vs oral anti-fungals, and I certainly don't know if any of > > this applies to your particular situation. > > > > Hope that helps. > > > > Marjorie > > > > Marjorie Lazoff, MD > > > > > > > > > > -- > > Please read the list highlights before posting to the whole group > (http://rosacea.ii.net/toc.html). Your post will be delayed if you don't > give a meaningful subject or trim your reply text. You must change the > subject when replying to a digest ! > > > > See http://www.drnase.com for info on his recently published book. > > > > To leave the list send an email to > rosacea-support-unsubscribe@y... > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 28, 2002 Report Share Posted June 28, 2002 He thinks the chest pains and breathing problems are psychosomatic. Well, he thinks they're being caused by anxiety, so I don't know if thats psychosomatic or not. I'm glad its an easy diagnosis, so, maybe he's right, I just don't know that I believe him. I know he's the doctor, and he's the one with all the knowledge, it just doesn't make sense to me. My chest pains were so bad last summer that for 3 weeks I could barely stand up. And I was having a blast last summer. My skin was bad, but I was working part-time, going out with my friends alot, etc... even though it usually hurt like crazy. but there wasnt that much anxiety. But the chest pains were so severe I had to take over a month off my job, and spent most of it laying down. The breathing problems also started a few weeks after going on Clonidine (then sorta disappeared for a while) and have resurfaced every once and a while since then. Its not uncommon for me to go to sleep completely at peace, and then shoot awake an hour later gasping for air. I told him my concerns about the Clonidine. And about the ambien possibly contributing (since they both surpress the respiratory system) and about how Clonidine can cause Orthostatic Hypotension. He said it made sense, and was a possibility, but he still thinks its anxiety, and wants me to start the Effexor soon (which I'd like to do also) but that would be adding a third possible respiratory depressant into the mix, when my main symptom at the moment is difficulty breathing.. it seems a little risky for me. Anyway, I will be getting off the clonidine over the next week and a half. Hopefully it won't mess up my symptoms too bad! (But my low low BP was up 50 points at my last doctor's appointment, so, even if my doc wasnt concerned, I still think the Clonidine is doing something odd) Adam Re: Pityrosporum Folliculitis > > > > > > > > My first issue is that we all know that SD is treated largely by > > > > some kind of immunosuppressant, either topically or systemically > > > > > > , I'm not sure if this is what you mean, but anti-fungal or > > > anti-inflammatory agents are absolutely not immunosuppressants. > > > Neither directly impacts on the core elements of the immune > system, T > > > or B cells or their immediate components and associated cells. > > > Immunosuppressants can suppress an inflammatory response, but so > can > > > many non-immunosuppresants; aspririn and motrin are examples of > > > effective anti-inflammatory agents that are not > immunosuppressants. > > > > > > > but from > > > > what I have read about PF is that those who have compromised > > > > immunity seem to have proliferation of PF--it is also true that > 80% > > > > of AIDS patients have SD. > > > > > > > > So, why is it that suppressing the immune system through > treatment > > > > of choice, the SD seems to go into some remmission in a non-AIDS > > > > patient and at the same time someone who has a naturally > > > > compromised immune system is even more susceptible to SD--this > has > > > > always confused me. > > > > To add to the confusion about of all of this, why is that > > > > immunosupression is contraindicated for those with PF, but not > for > > > > those with SD? > > > > > > See if this makes sense to you: a compromised immune system > (meaning > > > some dysfunction within the immune system's core elements) is more > > > open to attack by normally friendly microbes like M. furfur, which > > > then causes an inflammatory response using an unaffection portion > of > > > the immune system (such as triggering the complement system, or > > > cytokines, etc.). > > > > > > > Therefore, does it not seem logical, that for someone with SD > who > > > > is using immunosuppresants of any kind, that while they may be > > > > addressing the immune response associated with SD that they > are at > > > > the same time leaving the door wide open for a proliferation of > > > > PF? Could this be part of the so-called rebound effect of using > > > > steroids? > > > > > > Just changing the normal skin flora by using anti-bacterials or > > > through other mechanisms can allow overgrowth of otherwise benign > > > organisms that a normal immune system isn't programmed to > recognize > > > and attack. > > > > > > > Is it a cycle of initial inflammation (becuase of a slight T- > cell > > > > defect or some other unknown reason), treatment of the > inflammation > > > > through immunosuppression, and then the rebound effect is > actually > > > > some kind of secondary fungal infection that is made worse by > even > > > > further use of immunosuppressants? > > > > > > Rethinking this cycle after considering the above may help > clarify it > > > for both of us. > > > > > > > I hope some of this is making sense to someone and I would > > > > appreciate any feedback on this--I for one will be going to the > > > > derm this Friday > > > > and will be asking for an oral antifungal--the Sporonex seems > > > > relatively safe compared to the stronger Nizoral so I will ask > for > > > > that one--from everyhting I have read, I cannot see anyway in > which > > > > a killing off of the P.ovales will make SD worse--topical 2% > > > > Nizoral > > > > may work as well at killing the fungus, but not as effectively > as > > > > oral treatment (from what I have read)--I tried the topical > Nizoral > > > > and it was too irritating and drying so I was never able to > > > > determine if could have a positive effect. > > > > > > Another approach would be to ask your dermatologist's opinion > > > regarding the role of p. ovale (m. furfur) in your condition and > > > whether more aggressive treatment is indicated at this time. I > don't > > > know the source of your information regarding the efficacy and > safety > > > of topical vs oral anti-fungals, and I certainly don't know if > any of > > > this applies to your particular situation. > > > > > > Hope that helps. > > > > > > Marjorie > > > > > > Marjorie Lazoff, MD > > > > > > > > > > > > > > > -- > > > Please read the list highlights before posting to the whole group > > (http://rosacea.ii.net/toc.html). Your post will be delayed if you > don't > > give a meaningful subject or trim your reply text. You must change > the > > subject when replying to a digest ! > > > > > > See http://www.drnase.com for info on his recently published book. > > > > > > To leave the list send an email to > > rosacea-support-unsubscribe@y... > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 28, 2002 Report Share Posted June 28, 2002 He thinks the chest pains and breathing problems are psychosomatic. Well, he thinks they're being caused by anxiety, so I don't know if thats psychosomatic or not. I'm glad its an easy diagnosis, so, maybe he's right, I just don't know that I believe him. I know he's the doctor, and he's the one with all the knowledge, it just doesn't make sense to me. My chest pains were so bad last summer that for 3 weeks I could barely stand up. And I was having a blast last summer. My skin was bad, but I was working part-time, going out with my friends alot, etc... even though it usually hurt like crazy. but there wasnt that much anxiety. But the chest pains were so severe I had to take over a month off my job, and spent most of it laying down. The breathing problems also started a few weeks after going on Clonidine (then sorta disappeared for a while) and have resurfaced every once and a while since then. Its not uncommon for me to go to sleep completely at peace, and then shoot awake an hour later gasping for air. I told him my concerns about the Clonidine. And about the ambien possibly contributing (since they both surpress the respiratory system) and about how Clonidine can cause Orthostatic Hypotension. He said it made sense, and was a possibility, but he still thinks its anxiety, and wants me to start the Effexor soon (which I'd like to do also) but that would be adding a third possible respiratory depressant into the mix, when my main symptom at the moment is difficulty breathing.. it seems a little risky for me. Anyway, I will be getting off the clonidine over the next week and a half. Hopefully it won't mess up my symptoms too bad! (But my low low BP was up 50 points at my last doctor's appointment, so, even if my doc wasnt concerned, I still think the Clonidine is doing something odd) Adam Re: Pityrosporum Folliculitis > > > > > > > > My first issue is that we all know that SD is treated largely by > > > > some kind of immunosuppressant, either topically or systemically > > > > > > , I'm not sure if this is what you mean, but anti-fungal or > > > anti-inflammatory agents are absolutely not immunosuppressants. > > > Neither directly impacts on the core elements of the immune > system, T > > > or B cells or their immediate components and associated cells. > > > Immunosuppressants can suppress an inflammatory response, but so > can > > > many non-immunosuppresants; aspririn and motrin are examples of > > > effective anti-inflammatory agents that are not > immunosuppressants. > > > > > > > but from > > > > what I have read about PF is that those who have compromised > > > > immunity seem to have proliferation of PF--it is also true that > 80% > > > > of AIDS patients have SD. > > > > > > > > So, why is it that suppressing the immune system through > treatment > > > > of choice, the SD seems to go into some remmission in a non-AIDS > > > > patient and at the same time someone who has a naturally > > > > compromised immune system is even more susceptible to SD--this > has > > > > always confused me. > > > > To add to the confusion about of all of this, why is that > > > > immunosupression is contraindicated for those with PF, but not > for > > > > those with SD? > > > > > > See if this makes sense to you: a compromised immune system > (meaning > > > some dysfunction within the immune system's core elements) is more > > > open to attack by normally friendly microbes like M. furfur, which > > > then causes an inflammatory response using an unaffection portion > of > > > the immune system (such as triggering the complement system, or > > > cytokines, etc.). > > > > > > > Therefore, does it not seem logical, that for someone with SD > who > > > > is using immunosuppresants of any kind, that while they may be > > > > addressing the immune response associated with SD that they > are at > > > > the same time leaving the door wide open for a proliferation of > > > > PF? Could this be part of the so-called rebound effect of using > > > > steroids? > > > > > > Just changing the normal skin flora by using anti-bacterials or > > > through other mechanisms can allow overgrowth of otherwise benign > > > organisms that a normal immune system isn't programmed to > recognize > > > and attack. > > > > > > > Is it a cycle of initial inflammation (becuase of a slight T- > cell > > > > defect or some other unknown reason), treatment of the > inflammation > > > > through immunosuppression, and then the rebound effect is > actually > > > > some kind of secondary fungal infection that is made worse by > even > > > > further use of immunosuppressants? > > > > > > Rethinking this cycle after considering the above may help > clarify it > > > for both of us. > > > > > > > I hope some of this is making sense to someone and I would > > > > appreciate any feedback on this--I for one will be going to the > > > > derm this Friday > > > > and will be asking for an oral antifungal--the Sporonex seems > > > > relatively safe compared to the stronger Nizoral so I will ask > for > > > > that one--from everyhting I have read, I cannot see anyway in > which > > > > a killing off of the P.ovales will make SD worse--topical 2% > > > > Nizoral > > > > may work as well at killing the fungus, but not as effectively > as > > > > oral treatment (from what I have read)--I tried the topical > Nizoral > > > > and it was too irritating and drying so I was never able to > > > > determine if could have a positive effect. > > > > > > Another approach would be to ask your dermatologist's opinion > > > regarding the role of p. ovale (m. furfur) in your condition and > > > whether more aggressive treatment is indicated at this time. I > don't > > > know the source of your information regarding the efficacy and > safety > > > of topical vs oral anti-fungals, and I certainly don't know if > any of > > > this applies to your particular situation. > > > > > > Hope that helps. > > > > > > Marjorie > > > > > > Marjorie Lazoff, MD > > > > > > > > > > > > > > > -- > > > Please read the list highlights before posting to the whole group > > (http://rosacea.ii.net/toc.html). Your post will be delayed if you > don't > > give a meaningful subject or trim your reply text. You must change > the > > subject when replying to a digest ! > > > > > > See http://www.drnase.com for info on his recently published book. > > > > > > To leave the list send an email to > > rosacea-support-unsubscribe@y... > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 28, 2002 Report Share Posted June 28, 2002 Your questions and concerns are valid, Adam, but clearly neither your physical nor your psychological care is advancing as it should. It's not unusual in smart young adults to have physical and psychological findings complicate the core health issues. You need and deserve to expeditiously arrive at a definitive diagnosis and treatment plan. You should absolutely not be dealing with this all alone. Have a sit-down with your parents -- show them what you've been writing online so they see themselves what's going on, and show them this post as well. Together, come to a decision how to proceed. One option is a final consultation by an internist or general medical facility that you, your parents, and your physician trusts. Marjorie Marjorie Lazoff, MD > > > Approximately how long would someone need to use the ZNP bar on > > their face > > > before it got rid of (at least temporary) Pityrosporum > > Folliculitis and Seb > > > Derm? I don't want to use this bar for too long because it seems to > > > aggrevate/dry out my skin a bit. Also, will using the ZNP bar for > > several > > > days make the fungus not appear in a skin scraping? (Assuming the > > > papules/redness remain?) > > > > > > Would a primary care doctor be trained well enough to test for > > Pityrosporum > > > Folliculitis? Or would the skin scraping/microscope observation > > need to > > > come from a dermatologist? I went to my derm months ago asking > > about PF. > > > Antibiotics seemed to cause many of these problems ..but not until > > I had > > > been on them for about a year. I have the redness/flushing but I > > also have > > > the tons of tiny little itchy red bumps on my face and scalp. This > > all > > > started about six months after my seb derm became a problem. I > > scoured this > > > website that has pictures of like every skin disease known to man > > > practically.. and the only one that visually matched many of my > > symptoms was > > > Pityrosporum Folliculitis. I dont think this is my entire problem > > (As I had > > > redness and MILD flushing before antibiotics (which is why I was > > put on > > > them), and PF cant cause breathing problems/chest pains) But I do > > think its > > > been a large contributing factor to the visual/cosmetic issues, and > > part of > > > why my case has been so refractory to treatment. My derm told me > > he > > > couldn't test for PF! He said the only way to test for it is to > > culture > > > pustules... and it would have to be 50 or 60 of them at that.... > > and I > > > don't have alot of pustules to culture.. Topical nizoral always > > calms my > > > symptoms (especially the papules) but its too harsh for my skin, > > and I am > > > never able to use it for long. > > > Re: Pityrosporum Folliculitis > > > > > > > > > > > My first issue is that we all know that SD is treated largely by > > > > > some kind of immunosuppressant, either topically or systemically > > > > > > > > , I'm not sure if this is what you mean, but anti- fungal or > > > > anti-inflammatory agents are absolutely not immunosuppressants. > > > > Neither directly impacts on the core elements of the immune > > system, T > > > > or B cells or their immediate components and associated cells. > > > > Immunosuppressants can suppress an inflammatory response, but so > > can > > > > many non-immunosuppresants; aspririn and motrin are examples of > > > > effective anti-inflammatory agents that are not > > immunosuppressants. > > > > > > > > > but from > > > > > what I have read about PF is that those who have compromised > > > > > immunity seem to have proliferation of PF--it is also true that > > 80% > > > > > of AIDS patients have SD. > > > > > > > > > > So, why is it that suppressing the immune system through > > treatment > > > > > of choice, the SD seems to go into some remmission in a non- AIDS > > > > > patient and at the same time someone who has a naturally > > > > > compromised immune system is even more susceptible to SD-- this > > has > > > > > always confused me. > > > > > To add to the confusion about of all of this, why is that > > > > > immunosupression is contraindicated for those with PF, but not > > for > > > > > those with SD? > > > > > > > > See if this makes sense to you: a compromised immune system > > (meaning > > > > some dysfunction within the immune system's core elements) is more > > > > open to attack by normally friendly microbes like M. furfur, which > > > > then causes an inflammatory response using an unaffection portion > > of > > > > the immune system (such as triggering the complement system, or > > > > cytokines, etc.). > > > > > > > > > Therefore, does it not seem logical, that for someone with SD > > who > > > > > is using immunosuppresants of any kind, that while they may be > > > > > addressing the immune response associated with SD that they > > are at > > > > > the same time leaving the door wide open for a proliferation of > > > > > PF? Could this be part of the so-called rebound effect of using > > > > > steroids? > > > > > > > > Just changing the normal skin flora by using anti-bacterials or > > > > through other mechanisms can allow overgrowth of otherwise benign > > > > organisms that a normal immune system isn't programmed to > > recognize > > > > and attack. > > > > > > > > > Is it a cycle of initial inflammation (becuase of a slight T- > > cell > > > > > defect or some other unknown reason), treatment of the > > inflammation > > > > > through immunosuppression, and then the rebound effect is > > actually > > > > > some kind of secondary fungal infection that is made worse by > > even > > > > > further use of immunosuppressants? > > > > > > > > Rethinking this cycle after considering the above may help > > clarify it > > > > for both of us. > > > > > > > > > I hope some of this is making sense to someone and I would > > > > > appreciate any feedback on this--I for one will be going to the > > > > > derm this Friday > > > > > and will be asking for an oral antifungal--the Sporonex seems > > > > > relatively safe compared to the stronger Nizoral so I will ask > > for > > > > > that one--from everyhting I have read, I cannot see anyway in > > which > > > > > a killing off of the P.ovales will make SD worse--topical 2% > > > > > Nizoral > > > > > may work as well at killing the fungus, but not as effectively > > as > > > > > oral treatment (from what I have read)--I tried the topical > > Nizoral > > > > > and it was too irritating and drying so I was never able to > > > > > determine if could have a positive effect. > > > > > > > > Another approach would be to ask your dermatologist's opinion > > > > regarding the role of p. ovale (m. furfur) in your condition and > > > > whether more aggressive treatment is indicated at this time. I > > don't > > > > know the source of your information regarding the efficacy and > > safety > > > > of topical vs oral anti-fungals, and I certainly don't know if > > any of > > > > this applies to your particular situation. > > > > > > > > Hope that helps. > > > > > > > > Marjorie > > > > > > > > Marjorie Lazoff, MD > > > > > > > > > > > > > > > > > > > > -- > > > > Please read the list highlights before posting to the whole group > > > (http://rosacea.ii.net/toc.html). Your post will be delayed if you > > don't > > > give a meaningful subject or trim your reply text. You must change > > the > > > subject when replying to a digest ! > > > > > > > > See http://www.drnase.com for info on his recently published book. > > > > > > > > To leave the list send an email to > > > rosacea-support-unsubscribe@y... > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 28, 2002 Report Share Posted June 28, 2002 Your questions and concerns are valid, Adam, but clearly neither your physical nor your psychological care is advancing as it should. It's not unusual in smart young adults to have physical and psychological findings complicate the core health issues. You need and deserve to expeditiously arrive at a definitive diagnosis and treatment plan. You should absolutely not be dealing with this all alone. Have a sit-down with your parents -- show them what you've been writing online so they see themselves what's going on, and show them this post as well. Together, come to a decision how to proceed. One option is a final consultation by an internist or general medical facility that you, your parents, and your physician trusts. Marjorie Marjorie Lazoff, MD > > > Approximately how long would someone need to use the ZNP bar on > > their face > > > before it got rid of (at least temporary) Pityrosporum > > Folliculitis and Seb > > > Derm? I don't want to use this bar for too long because it seems to > > > aggrevate/dry out my skin a bit. Also, will using the ZNP bar for > > several > > > days make the fungus not appear in a skin scraping? (Assuming the > > > papules/redness remain?) > > > > > > Would a primary care doctor be trained well enough to test for > > Pityrosporum > > > Folliculitis? Or would the skin scraping/microscope observation > > need to > > > come from a dermatologist? I went to my derm months ago asking > > about PF. > > > Antibiotics seemed to cause many of these problems ..but not until > > I had > > > been on them for about a year. I have the redness/flushing but I > > also have > > > the tons of tiny little itchy red bumps on my face and scalp. This > > all > > > started about six months after my seb derm became a problem. I > > scoured this > > > website that has pictures of like every skin disease known to man > > > practically.. and the only one that visually matched many of my > > symptoms was > > > Pityrosporum Folliculitis. I dont think this is my entire problem > > (As I had > > > redness and MILD flushing before antibiotics (which is why I was > > put on > > > them), and PF cant cause breathing problems/chest pains) But I do > > think its > > > been a large contributing factor to the visual/cosmetic issues, and > > part of > > > why my case has been so refractory to treatment. My derm told me > > he > > > couldn't test for PF! He said the only way to test for it is to > > culture > > > pustules... and it would have to be 50 or 60 of them at that.... > > and I > > > don't have alot of pustules to culture.. Topical nizoral always > > calms my > > > symptoms (especially the papules) but its too harsh for my skin, > > and I am > > > never able to use it for long. > > > Re: Pityrosporum Folliculitis > > > > > > > > > > > My first issue is that we all know that SD is treated largely by > > > > > some kind of immunosuppressant, either topically or systemically > > > > > > > > , I'm not sure if this is what you mean, but anti- fungal or > > > > anti-inflammatory agents are absolutely not immunosuppressants. > > > > Neither directly impacts on the core elements of the immune > > system, T > > > > or B cells or their immediate components and associated cells. > > > > Immunosuppressants can suppress an inflammatory response, but so > > can > > > > many non-immunosuppresants; aspririn and motrin are examples of > > > > effective anti-inflammatory agents that are not > > immunosuppressants. > > > > > > > > > but from > > > > > what I have read about PF is that those who have compromised > > > > > immunity seem to have proliferation of PF--it is also true that > > 80% > > > > > of AIDS patients have SD. > > > > > > > > > > So, why is it that suppressing the immune system through > > treatment > > > > > of choice, the SD seems to go into some remmission in a non- AIDS > > > > > patient and at the same time someone who has a naturally > > > > > compromised immune system is even more susceptible to SD-- this > > has > > > > > always confused me. > > > > > To add to the confusion about of all of this, why is that > > > > > immunosupression is contraindicated for those with PF, but not > > for > > > > > those with SD? > > > > > > > > See if this makes sense to you: a compromised immune system > > (meaning > > > > some dysfunction within the immune system's core elements) is more > > > > open to attack by normally friendly microbes like M. furfur, which > > > > then causes an inflammatory response using an unaffection portion > > of > > > > the immune system (such as triggering the complement system, or > > > > cytokines, etc.). > > > > > > > > > Therefore, does it not seem logical, that for someone with SD > > who > > > > > is using immunosuppresants of any kind, that while they may be > > > > > addressing the immune response associated with SD that they > > are at > > > > > the same time leaving the door wide open for a proliferation of > > > > > PF? Could this be part of the so-called rebound effect of using > > > > > steroids? > > > > > > > > Just changing the normal skin flora by using anti-bacterials or > > > > through other mechanisms can allow overgrowth of otherwise benign > > > > organisms that a normal immune system isn't programmed to > > recognize > > > > and attack. > > > > > > > > > Is it a cycle of initial inflammation (becuase of a slight T- > > cell > > > > > defect or some other unknown reason), treatment of the > > inflammation > > > > > through immunosuppression, and then the rebound effect is > > actually > > > > > some kind of secondary fungal infection that is made worse by > > even > > > > > further use of immunosuppressants? > > > > > > > > Rethinking this cycle after considering the above may help > > clarify it > > > > for both of us. > > > > > > > > > I hope some of this is making sense to someone and I would > > > > > appreciate any feedback on this--I for one will be going to the > > > > > derm this Friday > > > > > and will be asking for an oral antifungal--the Sporonex seems > > > > > relatively safe compared to the stronger Nizoral so I will ask > > for > > > > > that one--from everyhting I have read, I cannot see anyway in > > which > > > > > a killing off of the P.ovales will make SD worse--topical 2% > > > > > Nizoral > > > > > may work as well at killing the fungus, but not as effectively > > as > > > > > oral treatment (from what I have read)--I tried the topical > > Nizoral > > > > > and it was too irritating and drying so I was never able to > > > > > determine if could have a positive effect. > > > > > > > > Another approach would be to ask your dermatologist's opinion > > > > regarding the role of p. ovale (m. furfur) in your condition and > > > > whether more aggressive treatment is indicated at this time. I > > don't > > > > know the source of your information regarding the efficacy and > > safety > > > > of topical vs oral anti-fungals, and I certainly don't know if > > any of > > > > this applies to your particular situation. > > > > > > > > Hope that helps. > > > > > > > > Marjorie > > > > > > > > Marjorie Lazoff, MD > > > > > > > > > > > > > > > > > > > > -- > > > > Please read the list highlights before posting to the whole group > > > (http://rosacea.ii.net/toc.html). Your post will be delayed if you > > don't > > > give a meaningful subject or trim your reply text. You must change > > the > > > subject when replying to a digest ! > > > > > > > > See http://www.drnase.com for info on his recently published book. > > > > > > > > To leave the list send an email to > > > rosacea-support-unsubscribe@y... > > > > > > > > Quote Link to comment Share on other sites More sharing options...
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