long term maintenance of malassezia - itraconazole / fluconazole?
some background on my skin:
i've had the odd single itchy spot (always on my jaw, chin, neck, chest, sometimes back) since university, when i was (mis)diagnosed with stress related excema and given fucibet, which helped. but 3 years ago i had a huge flare up that lasted 2 years until dogged research and experimentation let me to figure out it was malassezia. i then took itraconazole solidly for 3 months which cleared it up, and since then i've made my entire bodycare products etc fungus-safe, used clotrimazole topically, and take a week of itraconazole at the beginning of the month, and this has cleared my skin almost completely. it clears after itraconazole use and then slowly comes back during the month, but only a few spots at a time. it's been a life changer for me. but my gp said this can't be long term, even though my liver remains seemingly unaffected and my bloods are good, so they referred me to a dermatologist as it was returning (half a dozen bumps or so) each month.
i just had that nhs dermatology appointment and was disappointed. the doctor asked me 3 standard questions (family history of diabetes / excema / hayfever) and then told me there was nothing to be done for my malassezia because there's no underlying condition that can be addressed. he then said that i should simply continue to observe myself, though when i said itraconazole works consistently he said i shouldn't pursue that long term, because it's hard on the liver and 'i know it's annoying to be slightly itchy but why take a medicine if you don't need it'. i appreciate he deals with much more severe and life limiting conditions than mine, but i did tell him that the 2 year flare up got so bad that it was painful, stopping me sleep and socialise, until i started itraconazole. i told him my history and my attempts to control flare ups, even though he never asked.
on the one hand i'm relieved; there's no elusive silver bullet to pursue / spend time and money on. on the other, i'm frustrated that he was dismissive of how the condition has affected my life and uninterested in engaging in my desire to find ways of dealing with it long term.
some advice he gave that might be helpful to others:
he told me the fungus reproduces by spores, which survive washing because they only 'die' at 140 degrees c. so he recommended ironing my pillows and other bedding.
he also said that creams are usually effective but need rubbing in to get down into the follicles - rub for 2 to 3 minutes, even if it feels like you're not rubbing anything in.
but he also said that any moisture helps the fungus, so keep your skin extremely dry. i showed him pics of my skin trying that technique and he literally shrugged.
and apparently it's not the sweat specifically but the moisture/humidity that helps the fungus, so washing isn't always a good idea as the skin takes a long time to dry out after - he recommended using a hair dryer on cold to dry out my skin after washing, eating, and before bed. (can anyone confirm from their own knowledge that this is true? or otherwise?)
has anyone landed on a maintenance regime for itraconazole or fluconazole (which i can get over the counter) which keeps it at bay? or has anyone had success taking oral antifungals responsively to flare ups? any long term advice welcomer - i don't mind the odd itchy spot but i can't let it get back to how it was.