Tuesday, September 13, 2016

The most commonly missed cause of ACNE!

It is time I made a public service announcement about this skin truth.  I see it almost every day in my dermatology practice.  I have had dreams that it should be taught in secondary school, maybe in health class.  I also plan to teach my colleagues who practice dermatology because I have seen even experienced dermatologists miss this.  It is too common to ignore.

It might surprise you to hear that one of the most common causes of acne is a form of bad hygiene, or at least misguided or improper hygiene.  I will not totally blame it on hygiene though, because stress and hormones may underlie this type of acne.  Hopefully you are still reading with excitement as this is going to blow your mind.

DANDRUFF, yes those flakes on the scalp, even a case from a year ago, can cause ACNE!!

Here is the story...and it begins with the sebaceous oil and normal yeast flora of the scalp.
We all have sebaceous oil in our scalp and we all have a yeast on our skin that thrives in this oil called Pityrosporum ovale/malassezia furfur and will overgrow with oil and humidity.  Dermatologists now believe that dandruff in the scalp (seborrhea) may be entirely caused by this yeast overgrowing.  Therefore, dandruff is NOT a problem with dry scalp, but the opposite, oily scalp.  Any condition that increases scalp oil production may result in more dandruff.

Causes of excess scalp oil, or yeast overgrowth,  and more dandruff:
1.  Inadequate washing/shampooing of the scalp
2.  Hormone changes such as those of pregnancy
3.  Stress
4.  Taking oral antibiotics which kills some healthy bacteria that may be keeping the pityrosporum in check.
5.  Hereditary excess scalp oil
6.  pH changes in the skin


If the dandruff is neglected long enough the pityrosporum yeast can find their way to the face, neck and chest.   Often it will be worse by the hairline and go from there.  Some people or even doctors wrongly diagnose it as pomade (greasy hair product) acne.  While pomade acne exists, it is surely overdiagnosed.

I call this yeast acne "Pityrosporum Acne or Follculitis".  It may respond to over-the-counter dandruff shampoos, but you will have to let the shampoo sit on the affected skin for extra minutes and do it daily for at least two weeks.  I usually prescibe my patients an antiyeast lotion or pill when I see them in the clinic.

PITYROSPORUM ACNE has a certain look to it.  It is usually pink or skin-toned, very fine bumps 1-2 mm or less that appear on the face, chest and back.  They will often cluster on the forehead, and hairline.  
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