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  • #16
    As I understand it, Malassezia yeast live in sebum, that is their environment. So people who have a lot of sebum will be much more likely to have a proliferation of Malassezia. However, it seems likely that the Malassezia irritate the skin, which may make the sebaceous glands produce more sebum, in a vicious circle. And demodex mites eat sebum, so lots of sebum = much higher likelihood of demodectic rosacea. All working together to make an environment where they thrive and we suffer.

    When I was first diagnosed with seb derm, I was put on an antifungal cream that was very effective, the idea being that you kill the yeast, you put seb derm into remission. The problem was that my previous dermatologist gave me an antifungal that also had a topical steroid in it, and of course, using a topical steroid causes steroid-induced rosacea. Which I probably also have. This is why I suggest anyone wanting to treat seb derm with an antifungal should avoid those that have steroids in them -- yes, the steroid definitely helps calm the skin down (it won't do anything for redness though) but in the long term it is disastrous.

    I have no oiliness to speak of now, but I would not rank "oiliness" as one of my worst seb derm/rosacea symptoms (maybe because I had so many other bad ones that this one just didn't register with me). I was mostly dry actually with seb derm because of all the scales. That crud was dry as a desert.

    Thanks for the compliment

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    • #17
      Originally posted by dryad View Post
      My seb derm symptoms were basically: my skin had patches of dry/dead skin that I thought of as "plaques" or "scales", and there was a fair amount of oil but not a crazy amount. The scaliness was usually present but fluctuated with flares, definitely associated with my menstrual cycle (ovulation and PMS were the worst). It was that "dry and oily at the same time" skin type. It is difficult though for me to definitely say which of my symptoms were seb derm and which were demodex because they work together to make each other worse and they can be hard to tease apart. For example I also had a lot of redness, which could have been either. Before treatment, I ALWAYS had at least some pustules/pimples, and during flares I had over 100 pustules at a time (that has to be demodex though).

      Based on your description it sounds like you have overactive sebaceous glands (which is what seb derm is). I don't know if demodex causes that but I sincerely believe that these two conditions work together so disrupting one of them disrupts both. I had a complete remission of my seb derm after my demodex die-off, which has not been adequately explained (beyond the fact that I use a moisturizer formulated for seb derm sufferers).

      As far as how I'm going... I think pretty great! I've been treating since August. My only lingering symptom is some pink color on my cheeks/chin, and visible capillaries on my cheeks and nose. I'm continuing treatment for the pink, and may do laser in about a year. I work hard for this (a lot of skincare (all of it from France), not particularly cheap, regular dermatologist visits), but it is worth it. Now that it's December I do have a tiny bit of dryness on my forehead if I go overboard with face powder. Very rarely (1x/month) I will have stray pustule that does not recur if I brush it away. Zero acne type pimples, no scales, no oily skin. Overall very very satisfied. Bearing in mind I was unable to leave the house as recently as mid-August. I have other posts on here with my hideous photos if you're interested lol.
      Congrats on your success dryad - your recent experience sounds the mirror-opposite of mine; I achieved complete clearance of my symptoms from June-mid August, but have since suffered a terrible relapse and have often (including presently) been confined to my house too.

      May I ask how you got your demodex situation under control?

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      • #18
        Originally posted by davem81 View Post
        Congrats on your success dryad - your recent experience sounds the mirror-opposite of mine; I achieved complete clearance of my symptoms from June-mid August, but have since suffered a terrible relapse and have often (including presently) been confined to my house too.

        May I ask how you got your demodex situation under control?
        I'm so sorry to hear that, I live in fear of a relapse myself. Every morning the very first thing I do is reach for my mirror and inspect my face carefully for any signs.

        The stuff I used in treating my skin since August (all by dermatologist prescription) is:

        - tea tree essential oil mixed into Uriage DS Emulsion regulating cream (low concentration) -- for a very brief period in the beginning
        - levocetirizine by mouth 1x/day for 1 week in the beginning
        - wash 2x/day with Bioderma Hydrabio micellar water (never let tap water touch my face)
        - Bepanthol cream for immediate relief of pain and pulling during acute phase (only for a couple days)
        - doxycycline 50mg every 12 hours for 16 days in the beginning
        - probiotic/prebiotic 6 hours after doxycycline, 1x/day, for 16 days, concurrent with doxycycline
        - Octenisept octenidine spray (similar to hydrogen peroxide but formulated for mucous membranes) 2x/day, then switched to 1x/day after a few months
        - fucidic acid burn cream morning and night during acute phase
        - Uriage DS Emulsion cream 2x/day (this is my regular moisturizer throughout)
        - COMPLETE exclusion from sunlight in the beginning, then Bioderma Photoderm AR SPF 50+, 30 minutes before going outside, but avoid sun if possible, use wide brim hat.
        - clindamycin 1% lotion 2x/day for first month; 1x/day for months 2-3; withdrawn in early November
        - metronidazole 0.75% gel at night starting 5 weeks after treatment started (gradually introduced this)
        - As often as desired, spray face with thermal water spray (I cycle through Avene, Vichy, La Roche Posay, and Uriage)

        (I was briefly on tranexamic acid by mouth in November but stopped because I had some health issues, so just to be safe I'm not taking that now.)

        Also, not by prescription but by my own initiative, I use La Roche-Posay Serozinc zinc sulfate solution spray on my face in the morning after washing, before moisturizing. I also use the Uriage Cica-Levre Baume protecteur lip balm on my lips after applying the Octenisept because it burns.

        In addition to all of the above, my dermatologist did cultures and loads of blood tests to rule out autoimmune disorders.

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        • #19
          Originally posted by aussiechick84 View Post
          I sure have Daners, I am more familiar with that webpage than I’d care to admit �� I feel like the little bumps seem to be more consistent with MF than seb derm..? Tried ketoconazole (Nizoral) but it just irritates my skin ☹️
          Keep trying other antifungals - there are several malassezia strains, but not all respond to ketoconazole. There's climbazole, terbinafine, piroctine olamine, ciclopirox, selenium sulfide, etc.

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          • #20
            Originally posted by aussiechick84 View Post
            Tried ketoconazole (Nizoral) but it just irritates my skin ☹️
            Is it possible you used too much? I started using metronidazole gel and it irritated my skin so much my dermatologist was moved to do an allergy test, but she was also shocked when I showed her the tube ("There shouldn't be so much gone from the tube already!!") I was using far, far too much. She had me cut down to about 1/5 as much as I had put on myself. With that one she also had me mix it into my moisturizer and only use it 3x/week to start, then gradually using it more often and on its own. I don't know if that's an appropriate way to do ketoconazole but it could be a case of too much too soon.

            A simple test my doctor had me do with the metronidazole was to find a freckle on the inside of my arm and apply it just under the freckle every night for three nights. If the skin reacted, I had an allergy. If it didn't, I didn't have an allergy, I just had irritation prone skin on my face, and the problem was not the drug, but the amount and the shock of it. I had no reaction on my arm; so we proceeded; now I use it every night without any irritation.

            Comment


            • #21
              Originally posted by Daners View Post
              Keep trying other antifungals - there are several malassezia strains, but not all respond to ketoconazole. There's climbazole, terbinafine, piroctine olamine, ciclopirox, selenium sulfide, etc.
              Thanks a lot Daners and Dryad.. I think the problem is that my skin can not tolerate sulphates (SLS/SLES) and couldn’t even before this issue arose and nizoral contains these ingredients. Are there any antifungal washes that you are aware of that don’t contain sulphates? I know there dr eddies happy cappy but we can’t get that in Australia unfortunately. Could use a cream I guess but i imagine that wouldn’t look or feel great and my skin seems to detest anything on it and get worse eg Malassezia safe creams, honey, especially if they are occlusive.. 😔

              Comment


              • #22
                Originally posted by dryad View Post
                As I understand it, Malassezia yeast live in sebum, that is their environment. So people who have a lot of sebum will be much more likely to have a proliferation of Malassezia. However, it seems likely that the Malassezia irritate the skin, which may make the sebaceous glands produce more sebum, in a vicious circle. And demodex mites eat sebum, so lots of sebum = much higher likelihood of demodectic rosacea. All working together to make an environment where they thrive and we suffer.

                When I was first diagnosed with seb derm, I was put on an antifungal cream that was very effective, the idea being that you kill the yeast, you put seb derm into remission. The problem was that my previous dermatologist gave me an antifungal that also had a topical steroid in it, and of course, using a topical steroid causes steroid-induced rosacea. Which I probably also have. This is why I suggest anyone wanting to treat seb derm with an antifungal should avoid those that have steroids in them -- yes, the steroid definitely helps calm the skin down (it won't do anything for redness though) but in the long term it is disastrous.

                I have no oiliness to speak of now, but I would not rank "oiliness" as one of my worst seb derm/rosacea symptoms (maybe because I had so many other bad ones that this one just didn't register with me). I was mostly dry actually with seb derm because of all the scales. That crud was dry as a desert.

                Thanks for the compliment

                Hm, that’s super interesting! I agree re Malassezia - I didn’t have oily skin whatsoever until I got this rash so I definitely think it is caused by the yeast as opposed to the yeast being caused by lots of oil. I know oily skinned ppl are more prone to it, but I totally agree that, like you say, the Malassezia irritate the little oil glands or something and make them over-produce sebum. This theory is supported by the fact that people get ‘oily dandruff’, in which their hair becomes crazy oily and becomes oily very soon after washing when it wasn’t like that prior to the dandruff. Also, dogs that get ‘oily seborrhea’ from yeast overgrowth.. anyway, I’ve clearly spent far too muchc of my life thinking about this 😆 but I guess it’s necessary to know the cause of the initial issue to best tackle it.

                Interesting, see I don’t get ‘scales’ as such, just slightly peely skin at times but hat could just be the accutane 🤷🏼*♀️ Yes, I never have and never will use a steroid cream on my face, no matter how ‘weak’ it is.

                Hope you are all getting ready for a lovely break from work over Christmas 😊

                Comment


                • #23
                  Originally posted by aussiechick84 View Post
                  Thanks a lot Daners and Dryad.. I think the problem is that my skin can not tolerate sulphates (SLS/SLES) and couldn’t even before this issue arose and nizoral contains these ingredients. Are there any antifungal washes that you are aware of that don’t contain sulphates? I know there dr eddies happy cappy but we can’t get that in Australia unfortunately. Could use a cream I guess but i imagine that wouldn’t look or feel great and my skin seems to detest anything on it and get worse eg Malassezia safe creams, honey, especially if they are occlusive.. [emoji17]
                  Have you ever tried an oral anti fungal like fluconzole?

                  Sent from my WAS-LX1A using Tapatalk

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                  • #24
                    Originally posted by aussiechick84 View Post
                    Thanks a lot Daners and Dryad.. I think the problem is that my skin can not tolerate sulphates (SLS/SLES) and couldn’t even before this issue arose and nizoral contains these ingredients. Are there any antifungal washes that you are aware of that don’t contain sulphates? I know there dr eddies happy cappy but we can’t get that in Australia unfortunately. Could use a cream I guess but i imagine that wouldn’t look or feel great and my skin seems to detest anything on it and get worse eg Malassezia safe creams, honey, especially if they are occlusive.. ��
                    I'm not qualified to understand this comment I don't actually know what counts as a sulphate and what doesn't... for example I spray my face every morning with La Roche-Posay's Serozinc which is a zinc sulfate solution in water, I love it, it's for oiliness in fact! It mattifies the skin like magic and feels amazing - but is that the kind of thing that would irritate you, I don't know. I didn't pay attention in chemistry class lol.

                    I don't use any "wash" on my face at all, in fact I'm "not allowed" to get tap water on my face so I am limited to using micellar solution on a cotton pad to cleanse my face (which works better than any wash I've ever used, to be fair). I use Hydrabio micellar solution by Bioderma and I love it, but I have no idea if it has something in it that would irritate your skin (or if it's available outside the EU, that's another problem of course, we talk about what we use but we're spread out all over the globe!)

                    Although I no longer have detectable seb derm on my face, I continue to use a moisturizer formulated for seborrheic dermatitis sufferers (there are a few, I use DS Emulsion by Uriage, "DS" in the name of any pharmacy skincare product means it's for us! Ducray has one too I believe). I love this one, I think it's a smidgeon better than Ducray because it has the Uriage thermal spring water in it which I fangirl over. On the Uriage site they do talk about how this thing is antifungal because of Malassezia so it's not just another moisturizer with a fancy label. I have seb derm on my scalp also, which I never bothered to treat before because I had bigger fish to fry, but now that my face is happy, I've started putting the DS Emulsion on my scalp as well. It's too expensive to go on like that though so I'm going to start using the shampoo from the same product line (Uriage DS Gel Nettoyant) 2-3x/week to try to knock out the seb derm on my scalp as well. However I am waiting until I get my long hair cut really short so I can have a clean slate. I know this makes no logical sense but I always feel like my scalp can breathe and is healthier when my hair is short and I'll be using far less expensive seb derm shampoo if my hair is 2 cm long vs. half a meter long.

                    Do you have seb derm symptoms on your scalp too? Mine is worse along my hairline, I think this is pretty standard.

                    I forgot to mention before, you said you were prescribed Soolantra, that means your doc thinks you have demodectic rosacea, I think, because as far as I know, that's the only use for Soolantra.

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                    • #25
                      Originally posted by Andrew P View Post
                      Have you ever tried an oral anti fungal like fluconzole?

                      Sent from my WAS-LX1A using Tapatalk
                      Hi Andrew,

                      Thanks for your suggestion - I have tried taking Fluconazole orally but I can’t say it did a lot? I wish I was less ‘special’! Haha

                      Jess

                      Comment


                      • #26
                        Originally posted by dryad View Post
                        I'm not qualified to understand this comment I don't actually know what counts as a sulphate and what doesn't... for example I spray my face every morning with La Roche-Posay's Serozinc which is a zinc sulfate solution in water, I love it, it's for oiliness in fact! It mattifies the skin like magic and feels amazing - but is that the kind of thing that would irritate you, I don't know. I didn't pay attention in chemistry class lol.

                        I don't use any "wash" on my face at all, in fact I'm "not allowed" to get tap water on my face so I am limited to using micellar solution on a cotton pad to cleanse my face (which works better than any wash I've ever used, to be fair). I use Hydrabio micellar solution by Bioderma and I love it, but I have no idea if it has something in it that would irritate your skin (or if it's available outside the EU, that's another problem of course, we talk about what we use but we're spread out all over the globe!)

                        Although I no longer have detectable seb derm on my face, I continue to use a moisturizer formulated for seborrheic dermatitis sufferers (there are a few, I use DS Emulsion by Uriage, "DS" in the name of any pharmacy skincare product means it's for us! Ducray has one too I believe). I love this one, I think it's a smidgeon better than Ducray because it has the Uriage thermal spring water in it which I fangirl over. On the Uriage site they do talk about how this thing is antifungal because of Malassezia so it's not just another moisturizer with a fancy label. I have seb derm on my scalp also, which I never bothered to treat before because I had bigger fish to fry, but now that my face is happy, I've started putting the DS Emulsion on my scalp as well. It's too expensive to go on like that though so I'm going to start using the shampoo from the same product line (Uriage DS Gel Nettoyant) 2-3x/week to try to knock out the seb derm on my scalp as well. However I am waiting until I get my long hair cut really short so I can have a clean slate. I know this makes no logical sense but I always feel like my scalp can breathe and is healthier when my hair is short and I'll be using far less expensive seb derm shampoo if my hair is 2 cm long vs. half a meter long.

                        Do you have seb derm symptoms on your scalp too? Mine is worse along my hairline, I think this is pretty standard.

                        I forgot to mention before, you said you were prescribed Soolantra, that means your doc thinks you have demodectic rosacea, I think, because as far as I know, that's the only use for Soolantra.
                        Haha, ah yep sulphates (sulfates in USA) are confusing! The main ones that can irritate are sodium lauryl sulphate, sodium laureth sulphate and ammonium lauryl/laureth sulphate. They are foaming agents that are extremely ‘stripping’ to the skin and therefore irritate a lot of people’s skin, especially sensitive/rosacean skin. Zinc sulphate is fine 😊

                        Yeh, I’d love to not use water/face wash but the oiliness makes it far worse if I don’t. I do use Bioderma Sensibio micellar water to remove make up which still makes my skin red and a bit irritated (I’m extremely ridiculously sensitive!!) but it’s not too bad. I don’t really have any dandruff and never have, just a dry scalp from the roaccutane of late.

                        I just use cerave cream as a moisturiser as it’s listed as safe on the simple skincare science page for Malassezia conditions. I don’t use it all over my face as any cream makes my skin oilier and therefore worsens it.

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                        • #27
                          Originally posted by aussiechick84 View Post
                          Haha, ah yep sulphates (sulfates in USA) are confusing! The main ones that can irritate are sodium lauryl sulphate, sodium laureth sulphate and ammonium lauryl/laureth sulphate. They are foaming agents that are extremely ‘stripping’ to the skin and therefore irritate a lot of people’s skin, especially sensitive/rosacean skin. Zinc sulphate is fine 😊

                          Yeh, I’d love to not use water/face wash but the oiliness makes it far worse if I don’t. I do use Bioderma Sensibio micellar water to remove make up which still makes my skin red and a bit irritated (I’m extremely ridiculously sensitive!!) but it’s not too bad. I don’t really have any dandruff and never have, just a dry scalp from the roaccutane of late.

                          I just use cerave cream as a moisturiser as it’s listed as safe on the simple skincare science page for Malassezia conditions. I don’t use it all over my face as any cream makes my skin oilier and therefore worsens it.
                          Okay that makes a lot of sense. I do know that sodium laureth sulphate is more gentle than sodium lauryl sulphate, but that's all I knew about. That sucks that Sensibio irritates your skin, you really are a sensitive one! They make a different one called Sensibio DS which is supposed to be for seb derm folks but I haven't tried it because I don't think we can get it in Greece yet.

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                          • #28
                            Originally posted by dryad View Post
                            Okay that makes a lot of sense. I do know that sodium laureth sulphate is more gentle than sodium lauryl sulphate, but that's all I knew about. That sucks that Sensibio irritates your skin, you really are a sensitive one! They make a different one called Sensibio DS which is supposed to be for seb derm folks but I haven't tried it because I don't think we can get it in Greece yet.
                            Ok so I bit the bullet and tried Lotrimin Ultra and it just made the bumps and texture next to my nose (ie the whole problem) worse.. Ketoconazole for nearly a week a while ago also achieved nothing, same with de la Cruz Sulfur for 10 mins over a few days.. all did nothing or made it worse..

                            Would this indicate it’s unlikely to be seb derm? 🤨🧐🤪

                            Thanks,

                            Jess

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                            • #29
                              I was going to ask if anyone had taken an oral antifungal like diflucan (fluconazole) myself, and maybe in conjunction with applying Lotrimin Ultra topically for seb derm? I plan to see my GP next week and ask for fluconazole and make a trip to the drug store for some Lotrimin Ultra. I still don't even really know what I have and I have been dealing with it for almost 4 years now. Started as seb derm in April 2015 then I had a few days of bad flushing in July 2015 and now I have permanent pinkness across my face almost like a mask. I can feel seb derm buildup in my ears too, and in my glabella region. I can scratch off flakes from my glabella and just see it raining down like dandruff (well it is dandruff). It builds up a lot in my nose creases, but my entire nose is affected like it's caked on my nose. When it's not acting up I can pick off scales and not have too much inflammation but I always have the background pink/redness. I don't have P&Ps, but I was told by the derm in 2015 it was seb derm, and then he said rosacea the second time. They really don't know.. I think if I can get my seb derm under control it could help any rosacea I might have. I do have Nizoral non-prescription I use a lot as a face wash in the shower. I lather it and let it sit... usually in two or three days time it'll calm the seb derm down to the point I can pick off scales of skin and it not be irritating to my face (i.e., making it very red and weeping/crusting over).

                              The first time to the GP in April 2015 or so he prescribed me Mometasone furoate (Elocon) which I think I only used for a few days. I definitely didn't use it much because I read a lot online about steroids on the face. When I went to a derm in Sept 2015 he prescribed me minocycline and metrogel. I took minocycline 100mg daily for probably 6-8 months before I stopped - I never really had P&Ps so not sure why I was on this... also the metrogel just seemed to make things worse for me and I never used it more than a few days at a time. I think I've only touched the stuff twice. He also prescribed me 2% Nizoral which I've ran out of a long time ago and now just use OTC Nizoral. I just keep using it in the shower as a lather on my face because it doesn't seem to hurt me. I am hoping a combo of Nizoral, Lotrimin Ultra, and diflucan can help me.

                              Edit: I see aussiechick tried this - has anyone else with seb derm had success?
                              Last edited by aafdup; 1 March 2019, 07:09 PM.

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