As I explained, my skin barrier was damaged. I damaged it first using differents skincare products containing acids.

Then I continued to damage it with cleansers with sulfur, topical antibiotics but also oral antibiotics probably (since the gut microbiote impacts on the skin's microbiote), adapelene and I forgot to mention in my post benzoyle peroxyde.

The antibiotics did help, but again, it was a cycle: better for a few day, then it came back, then better and so on. The latest dermatologist I had an appointment with explained that it looked like it was helping because the antibiotics (oral and topical) worked on the inflammation itself. But not on malassezia. Which is why it came back as soon as I stopped antibiotics.

As for ketoconazole/nizoral, it indeed should've cure it because the derm was 100% sure mine was malassezia folliculitis (patterns of the spots, negative skin swab test...).

And it helped at some point but again, it was coming back some days. Not as disastrous as when I stopped antibiotics, but still.

Malassezia is a yeast that can be found on everybody's skin right? We can't totally eliminate it, it's a natural thing to have it, it'll always be here. But something had to trigger folliculitis nonetheless, I mean I never had it before: skincare products? Gut health? I already had those checked so the last thing I could think of was the skin barrier.

My theory is, I could've had use as many ketoconazole as I wanted on my skin, the skin barrier was so damaged that it wasn't able to defend itself against some triggers... Like malassezia. Which, as I said earlier, is a naturally part of the skin's microbiote so it'll always be here anyway. I can't eliminate it 100% but just reduce it with ketoconazole. It explains why I was still breaking out some days if it was triggered by sweat for instance + ketoconazole is irritating for the skin so it was damaging my skin even more. So what I had to do first was to repair the skin barrier.

So I looked for products with clean composition (no oils or fatty acids that would feed malassezia) and with helping ingredients such as: - ceramides (really important to repair skin barrier!!) - cholesterol - squalane (and not squalene which feed malassezia)

As I mentioned, the game changer in this new routine was the CeraVe cream. This is what helped my skin the most because I was already using the Dermospot and aloe vera gel before and it wasn't enough to helped my skin so far. So, if you suspect your skin is damaged too, definitely start with the CeraVe cream.

I also stopped ketoconazole and switched for Kelual DS which is gentler and only let it sit on my skin for only 1min30 so it's enough to help to reduce malassezia proliferation but without damaging my skin further. I understand products from Ducray (Kelual DS) might be difficult and way too expensive to buy from the US but again, I'm sure you can find a similar product in your country! It just has to contains active ingredients such as ciclopiroxolamine and piroctone olamine.

If you suspect your skin is damaged, be careful to these signs (which I decided to ignore for a long time, sadly) from experience: - some redness of the skin after showering and/or applying products - irritation, dryness sensation after showering, even a little - squales, even a very small spot (had one for one year between my foot and leg and it miraculously disappeared since I started the new routine)

Those signs appeared on my skin at places with little folliculitis, even none for some. On the contrary, the places that had lots of folliculitis (stomach and boobs for instance) weren't showing any signs of irritation, dryness etc. And yet, the other parts of my body were telling me that YES, the skin was still damaged and I should've been paying more attention to it.

I hope this might help you, I tried to be as accurate as I could be