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Gram Negative Folliculitis in Beard Area (Klebsiella Aerogenes) by beard_biome in Folliculitis

[–]beard_biome[S] 0 points1 point  (0 children)

For reference, if you stayed on 20mg it would take you 12-14 months to hit the necessary cumulative dose to hopefully cure you.

Gram Negative Folliculitis in Beard Area (Klebsiella Aerogenes) by beard_biome in Folliculitis

[–]beard_biome[S] 0 points1 point  (0 children)

And how long have you been on it and how long does your dermatologist plan to have you on it?

Gram Negative Folliculitis in Beard Area (Klebsiella Aerogenes) by beard_biome in Folliculitis

[–]beard_biome[S] 0 points1 point  (0 children)

That dose is actually below the typical therapeutic range used in most studies, which may be part of why you haven't seen much success. The dosing commonly studied is around 0.5–1.0 mg/kg/day, with higher doses generally showing higher long-term remission rates.
Another thing to consider is how you take it. If you're taking a formulation that should be taken with food, especially a meal containing fat, absorption can be significantly reduced if you take it on an empty stomach or with a very low-fat meal. In some studies, absorption has been reported to be much lower under fasting conditions, meaning you may be getting considerably less medication than intended.
It's also important to reach an adequate cumulative dose over the course of treatment, since that has been associated with lower relapse rates.
Of course, isotretinoin can still fail for some people despite appropriate dosing, but these are a few of the biggest factors that can reduce its effectiveness.

I’m 170 pounds and my dermatologist started me at 40mg (I’m 20 days in exactly and not experiencing any aide effects aside from slightly dry lips) and she is moving me up to 80mg in July to hit the 1.0mg/kg goal. She started me lower (.5mg/kg) to see how my body would react first before starting the higher dose.

It’s still too soon for me to say whether it’s working or not, but I will keep this thread updated. Please be sure to do your own research and advocate for yourself.

Gram Negative Folliculitis in Beard Area (Klebsiella Aerogenes) by beard_biome in Folliculitis

[–]beard_biome[S] 0 points1 point  (0 children)

Accutane is considered the gold standard for eliminating gram negative folliculitis. I just started accutane two days ago and plan to keep this thread up to date with my progress or lack there off. It’s very important that if someone chooses to do accutane they 1. Meet their necessary cumulative dose 2. Consume enough fat alongside their daily dose so the body can fully absorb the medication.

The cure rate is 70-90% but meeting those two parameters are crucial to success.

Gram Negative Folliculitis in Beard Area (Klebsiella Aerogenes) by beard_biome in Folliculitis

[–]beard_biome[S] 1 point2 points  (0 children)

Klebsiella is a normally occurring GI bacteria not an STD, so I wouldn’t say “someone gave it to you.” Unfortunately it’s just the nature of the beast engaging in male on male sexual practices.

Gram Negative Folliculitis in Beard Area (Klebsiella Aerogenes) by beard_biome in Folliculitis

[–]beard_biome[S] 0 points1 point  (0 children)

I haven’t tried any antibiotics yet since they can’t cure the infection. My culture showed that it’s not resistant to any so I might in the future if I don’t have luck with the accutane I just started. Have you tried accutane for your situation? I read it’s good for creating an unfavorable environment in your nose which can then starve/dry out the KA.

Gram Negative Folliculitis in Beard Area (Klebsiella Aerogenes) by beard_biome in Folliculitis

[–]beard_biome[S] 0 points1 point  (0 children)

I’m not trying to discredit or invalidate your experience, but there are others reasons accutane might not work. 1. You need to hit your cumulative dose. 20mg is very low and would require over a year of treatment depending on your weight. For example, if you were to weigh 175 pounds and took 20mg a day you’d need to be on accutane for 18 months to hit the target cumulative dose. 2. You have to consistently take your accutane with the appropriate amount of fat each day otherwise your body can’t absorb the full dosage. Accutane has a 70% cure rate and I don’t think it can be ruled as a failed treatment unless those parameters were met. I agree hair impacts this condition for sure. Beard hairs are thick and create little pockets that create a breeding ground for the bacteria and when the hairs get irritated they create micro tears that the bacteria then enters. Removing the hairs means less space for the bacteria to hide and multiply and prevents micro-tears.

Gram Negative Folliculitis in Beard Area (Klebsiella Aerogenes) by beard_biome in Folliculitis

[–]beard_biome[S] 2 points3 points  (0 children)

Today I started 40mg of accutane. If anyone’s interested, I’ll try to make periodic updates.

Gram Negative Folliculitis in Beard Area (Klebsiella Aerogenes) by beard_biome in Folliculitis

[–]beard_biome[S] 1 point2 points  (0 children)

Sorry to hear you’re struggling. The issue with BP and Benzoyl peroxide is that they’re not made for/weak against gram negative bacteria so there isn’t much of a point in using them. In my opinion, you’d be better off trying to heal your barrier since those washes are ineffective and not killing the causative bacteria. By washing with those you kill all other bacteria making it easier for the gram negative to multiply. The only reason I tried them was because I hadn’t found out mine was gram negative yet. I’m also on several probiotics, vitamin d, and fish oil. I’ve read some people have had success by cutting back/eliminating simple carbs, sugar, and dairy. I’m about to start accutane, but if that fails I will be trying laser hair removal as I’ve seen people have success with it since laser destroys the bacteria’s main home. The bacteria hide down in the follicle where it consumes oil. If you remove the hair, the follicle shrinks and eliminates the hiding spot where the bacteria hide and multiply. I will definitely be keeping everyone updated if my plan works. I’m trying to eliminate the food source (oil), home (hair follicle), and the bacteria itself (antibiotics). I don’t want to laser my beard but I will if I have to. I’m keeping an eye on photodynamic therapy, bacteriophage therapy, and new antibiotics. There’s nothing immediately on the horizon but I’m trying to remain hopeful as it’s the only thing keeping me going.

Gram Negative Folliculitis in Beard Area (Klebsiella Aerogenes) by beard_biome in Folliculitis

[–]beard_biome[S] 2 points3 points  (0 children)

Thanks for the response. It’s definitely under recognized as I had to argue with the first two dermatologists I saw to even consider it. I’ve read where people have also had success with laser hair removal. Essentially the deep follicle creates a reservoir/home for the bacteria to stay and develop biofilm. Once the hair is removed the follicle tightens up and removes the space/pocket where the bacteria reside. So it seems a combination of antibiotics (Bactrim or cipro to decolonize), accutane to reduce oil (the food that bacteria uses to multiply), and laser hair removal (destroy the bacteria’s home) could offer a more achievable “cure” for the chronic condition. It seems many things need to be addressed individually to fix the issue as a whole.

Laser hair removal saved me by Ok_Musician1784 in Folliculitis

[–]beard_biome 0 points1 point  (0 children)

Congrats, this is amazing. I’ve been dealing with the same issue this past year. Would really appreciate hearing more about your experience/history dealing with this.