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dermdoc19, Dermatologist
Category: Dermatology
Satisfied Customers: 4069
Experience:  30 years practice in general and cosmetic dermatology
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I have small bumps on my forehead and they seem to be spreading,

Customer Question

Hi I have small bumps on my forehead and they seem to be spreading, it started a few months ago and seem to be spreading. I've used antibiotics in the past. I'm currently using cetaphil and epiduo and it doesn't seem to be working. I read online it could be fungal or yeast related. What do you think? I also read somewhere to use nizoral shampoo on your face? What do you suggest?
Submitted: 1 year ago.
Category: Dermatology
Customer: replied 1 year ago.
I attached a picture. Let me know if you need more.
Expert:  dermdoc19 replied 1 year ago.
This might be a Pityrosporum infection, which is a yeast like organism. So it is possible you are on the right track. Nizoral shampoo can be used on the face but should be rinsed off. However, I have not found it terribly effective for this problem and usually use a related oral mediation called Diflucan. Another possibility is demedocosis. This can occur in the forehead and around the nose area, especially in patients with oily skin. In my opinion this is underdiagnosed. I have found a new medication called Soolantra ( topical Ivermectin) to be excellent in treating this infestation. ( Demodecosis is caused by a common mite, which in some patients can proliferate wildly. These are two suggestions that most physicians do not think of, so I would suggest it to yours. Trying a 2 week course of an oral antibiotic such as Doxycycline Hyclate 100 mg. twice a day might be the first approach and using the above medications if there is not a response. ( While Epiduo gel is a good topical sometimes it just will not do the trick and a trial with an oral antibiotic might be necessary. Thank you for requesting me and thank you for having the foresight of sending a picture with your questions.
Expert:  dermdoc19 replied 1 year ago.
Feel free to ask further questions.
Customer: replied 1 year ago.
Yes, I have used antibiotics, I think I have used Doxycycline in the past and they work great, but since you cannot be on antibiotics for very long, the bumps come back when I get off the oral antibiotic. I also have an itchy scalp and dandruff and oily skin. So you would say ask my dermatologist about Difluca and soolantra and doxycycline?
Expert:  dermdoc19 replied 1 year ago.
Yes, if you have been on an antibiotic and the condition did not resolve, or, in fact, worsened, the possibility of a yeast ( Pityrosporum) or Demodecosis is greater. It is easy to test for the latter, just placing a slide over the area and looking for the mite under a microscope will do. However, yeast needs a biopsy we usually treat that empirically ( just treat it using our clinical judgment rather than a lab test.).
Customer: replied 1 year ago.
Wow I looked up Pityrosporum and that seems like exactly like what I have.
Expert:  dermdoc19 replied 1 year ago.
It often goes along with patients who have dandruff and an oily scalp.
Customer: replied 1 year ago.
Makes sense! So what have you found to be the most effective to treat it?
Expert:  dermdoc19 replied 1 year ago.
Diflucan 150 mg. once a week for a month is the safest way to go. Topical Nizoral cream ( Ketoconazole) helps but you probably would need an oral therapy.
Customer: replied 1 year ago.
Awesome thank you so much!!
Expert:  dermdoc19 replied 1 year ago.
Very welcome.Good luck.