Seborrheic Dermatitis & Folliculitis -- Review of OTC Treatments for Malassezia

[Tom Busby]

I've attached my review of products that provide effective treatment for seborrheic dermatitis. Citations to online medical articles are for those who want to learn more.

I'm not selling anything and hope to help others.

It's amazing to me how difficult it is to treat this condition, and how many people have the same chronic problem.

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EDIT3 : Here's the latest update from Tom as of Jan 24 2014
-mfm

Here’s my latest update. I can’t edit my first post but you can, and so when I got your PM, I was thinking that you wanted to add the latest Review as an attachment to my first post, because there’s a lot thread for people to scroll through in the “sticky,” but do whatever you think is best. The evolution of the concept is interesting to me too.

You’ll notice in my latest Review, at the very end, that I found a way to make the MCT body wash sufficiently thick, by adding collagen, which swelled up and made the body wash look nearly like a commercial shower gel product. The Vitamin Shoppe sells collagen -- it doesn’t feed malassezia or do any harm to skin and probably nourishes hair.

The next step for me is to experiment to determine if the MCT body wash and MCT lotion when combined with pectinase and Xylitol might be enough by themselves, so that climbazole will become unnecessary. As I make my products, in the next batch, I plan to dial down the climbazole to zero and see what happens. However, I make 500 ml batches of products, so I won’t know for about 4-5 more months if this idea has merit.

Sincerely,
Tom Busby

see attached paper
Review of OTC Treatments for Malassezia skin conditions-final-3.pdf

http://www.rosaceagroup.org/The_Rosacea_Forum/attachment.php?attachmentid=2194&d=1390544172

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Below are Tom's original papers

Edit1: Tom's original paper
Fungus-Wash your entire body with an over the counter antifungal shampoo-final-3.pdf

http://www.rosaceagroup.org/The_Rosacea_Forum/attachment.php?attachmentid=1770&d=1366919254

Edit2: Tom's first follow up paper
Review of OTC Treatments for Malassezia skin conditions-final-2.pdf

http://www.rosaceagroup.org/The_Rosacea_Forum/attachment.php?attachmentid=1998&d=1379092890

-mfm

[man_from_mars]

I've attached my review of products that provide effective treatment for seborrheic dermatitis. Citations to online medical articles are for those who want to learn more.

I'm not selling anything and hope to help others.

It's amazing to me how difficult it is to treat this condition, and how many people have the same chronic problem.

This is a good paper Tom Busby - thanks

Do you have a medical background?

[Tom Busby]

Thanks. No I don't have a medical degree -- I have degrees in English and Law. About 6 months ago I started to research seb derm treatments. I spent about two months learning medical terms and adjusting to the weird writing style used in medical research articles. At first I felt like MacGyver with a paper clip and a rubber band. Now, I believe I’ve found an inexpensive, effective, topical treatment, within all medical and legal guidelines. If I can help one person like me, hurray.

[oxfordrebel]

follow up for Tom

Tom:

How long have you used the protocol you describe in the PDF, i.e., washing the entire body with the anti-fungal shampoos and letting it sit 5-10 minutes? What would you say was your "percent" improvement using this protocol from when you were at your worst?

I am very intrigued by your protocol because a very similar protocol has worked very well for me on my scalp. I had scalp dandruff and itching years before it spread to my face and I've always been able to have pretty good success on the scalp by rotating selson blue, nizoral, head and shoulders, and t-gel coal tar on a daily basis, taking breaks from time to time as well. I never really committed to it on my face or rest of my body because I have mild to moderate rosacea and my skin is sensitive. But given your success, I like the idea of treating the entire body with an antifungal shampoo rotation similar to how it helped my scalp. Why would it work for only the scalp and not the rest of the body if the source is the same? I might just put up with any rosacea irritation because seb derm definitely seems to be my major problem right now.

I do agree with Drummond, however, that something is going on deep inside the systemic body, most likely nervous system related, and the skin symptoms are merely the end result that we see. Of course if a big part of that "internal" issue is genetics, which is never going away, might as well try to come up with the best topical, symptom treating thing we can find.

Would love your thoughts -- hoping what works for my scalp would work for the rest of my body, including my face.

[Tom Busby]

My "calendar of treatments" on page 8 of my paper shows a timeline for the treatments, which was the result of my belief that I could have completely clear skin. I'm almost there, as the only plaques are on my back and at the hairline. I would say the last 4 months have been the most effective. My perspective now is that I wasted a lot of time with less effective treatments for the first 7 months.

In the past 4 days, I've discovered that Aloe Vera appears to be effective. Here's another paragraph I've tentatively added to my working paper:

Aloe Vera gel is effective at dissolving what appears to be dead skin, which is most likely protein, fat and polysaccharide bonds formed by the interaction of malassezia and the skin. There is very little scientific evidence for why Aloe Vera is effective, but it is confirmed by my own experience and in A Double-Blind, Placebo Controlled Trial Of An Aloe Vera Emulsion In The Treatment Of Seborrheic Dermatitis, J. Dermatol. Treatment, 1999, 10, 7-11, Vardy et al. 1999, where it was reported that improvement occurred for 60% of the patients with Aloe Vera, compared with only 20% of the control group. See also, http://www.e-ijd.org/viewimage.asp?i...45_26942_1.jpg Aloe Vera’s best use is to apply it about an hour or two before showering, because it apparently dissolves loosened skin plaques and isn’t by itself a treatment, in my opinion.

[Tom Busby]

Recently I found that 1 gram of Salicylic Acid can be dissolved in 1ml of Glycerin and 2ml of Isopropanol, and heated in water bath to 130 degrees, and then it will not precipitate out of 200ml of the KLIO lotion, and will effectively lower the pH of the lotion. Previously I had been attempting to add salicylic acid using only ethanol or isopropanol as a solvent, but it would always precipitate out of solution. Food grade, vegetable-based Glycerin can be mail ordered from Walgreens.

[Tom Busby]

For more information on compounding a Climbazole Lotion, on 26 February 2013, the Scientific Committee on Consumer Safety (SCCS) issued an addendum (SCCS/1506/13) to its original Opinion on Climbazol (SCCP/1204/08).

The EU’s 2009 report authorized the use of Climbazole in face lotions at 0.5% concentrations, and so by inference it would be used on only 13% of the total skin area, and so by additional inference an allover body lotion would be compounded with no more than 0.065% Climbazole. The 2013 EU report supports these inferences more explicitly and with more examples, like a foot lotion.

I use a 0.065% allover body lotion because it’s impossible to see where malassezia yeasts have colonized the skin until the skin gets inflamed and flakes off. The effectiveness of this super-tiny percentage of Climbazole is greatly enhanced by lowering the pH of the lotion to about 5, by adding 0.5% Salicylic Acid and 0.1% Citric Acid, both of which are OTC.

Accordingly, if you are compounding 234 ml of a Climbazole lotion at 0.065%, you would need 0.152 grams of Climbazole -- this is a very tiny amount and impossible to weigh accurately without buying an expensive, extraordinarily accurate scale.

To avoid this problem, I measure Climbazole by volume rather than by weight. I use an aluminum tubeless tire valve cap that holds exactly 0.2 ml of water. Here’s a picture of the same valve cap: http://www.care4car.com/productdispl...Caps.html.html If you want to locate a similar valve cap in US auto supply stores, they are marketed for use on tires filled with nitrogen instead of air. If you can’t find them, a regular-size plastic valve cap holds 0.4ml of water, costs practically nothing, and you could saw one in half and then measure it to see what the volume is.

It’s easy to measure and verify the volume of this valve cap, or any other tiny cap you may have in your house, by using water and a 1ml pipette, or if you don’t have a pipette a 1ml plastic syringe is free for the asking from any CVS pharmacist.

Climbazole has a density of 0.76mg/ml, which results in the 0.2ml valve cap holding 0.152 grams of Climbazole, which will make 234 ml of lotion with 0.065% Climbazole.

100% Isopropanol is the best solvent to dissolve Climbazole and Salicylic Acid powders. They are also soluble in 95% ethanol (190 proof EverClear), but ethanol causes Cetaphil lotion to become clumpy rather than creamy. Citric Acid is soluble in water.

[man_from_mars]

I always enjoy reading the latest on your own meticulous research Tom
Keep up the good work!

I'll never have the patience or knowledge to do my own compounding
but will happily volunteer to trial any concoction you may come up with in the end.


-mfm

[Davo]

Tom, I'd like you to know how much I appreciate you sharing the results of your research. I read your paper in the midst of a especially bad flare and although I haven't followed your regime, the thinking behind it has informed my own response and the results have been great so far…

Eczema runs in my family and I have coped with it since I was a toddler. I presume I had the genetic predisposition to SD which set in about four years ago (not long after I turned 40 and during a very stressful time at work) and made my life miserable. After reading your paper and various posts I began the following regime:

1. The ACV Formula as a body wash but with a liberal amount of both the Head and Shoulders and Nizoral shampoos. I start with a hot shower to open up my pores while lathering my scalp with Nizoral shampoo. Then I apply the ACV formula all over my body, leave it on for 3-5 minutes and then wash it all off under cold water. The acidity of the ACV stings any broken skin and the cold water is very bracing but I believe this combination enables greater penetration of my skin. This reduced the SD lesions around my body by about 95% in a few weeks!

2. Lotrim Ultra & Nizoral cream on my face

The SD on my face was terrible. Until a few weeks ago my face was literally covered with thick, hard plaques, scaly flaky skin, cracks in the corners of my mouth, eyes, nose, ears and fissures along my smile lines. SD had reduced me to a shadow of my former self leaving me unable to express myself properly because twisting my head or simply raising my eyebrows caused pain and discomfort.

Several months ago, inspired by Jeff's experience with Lotrim Ultra cream, I purchased several tubes via eBay (it's not available here in Australia) and applied it to my face with good results initially. But after several days the effectiveness appeared to plateau and then regress.

This time I followed Jeff's advice more strictly by shaving my beard completely to keep the malessezia out of my hair follicles and to ensure the cream could directly penetrate my skin. When I shaved the first time I was shocked to see how thick the plaques were underneath. The bio-film was like a grey wax and especially thick on my chin. I applied the Lotrim Ultra to my face and trouble spots twice a day for about 8-9 days and then changed to Nizoral cream. Early on, both creams caused crimson flushing which would have troubled me in the past… Thanks to your research, I now recognised this was good news i.e. the cream making the malassezia visible and my immune system was kicking in. The amount of skin/biofilm that came off my face during this time was as plentiful as it was disgusting!! I was amazed to realise that this crap had covered my face for so long. My face is now about 95% improved and gets a little better every day. I couldn't be happier.

Like many of the posters here, I've had plenty of false dawns in the past and have deliberately waited three weeks, until I was confident this breakthrough is sustainable. If I stop the regime for more than a few days the SD comes back so I expect to be doing this for a long time. I plan to go back to the Lotrim Ultra every couple of weeks and I might trial ciclopirox as well. I also plan to add Hegor to the ACV Formula soon.

Tom, thanks for helping me get my face back!!

[aj1]

Great Information

Hey Tom,

First and foremost, I want to thank you for sharing your vast knowledge on Seb Derm. I'm currently 23 and have had this on my face and scalp since I was 8 and behind my ears for longer than that. It started in a small area but has spread a lot.

I have read every post you have made on these forums (I will be reading your pdf tonight) and first saw a post from you on another websites comments section (http://www.squidoo.com/seborrheic_dermatitis).

I Googled your screen name hoping to find more information you have provided to the community and saw this forum.

I joined the forum today to specifically read all information by you.

I will post again once I have read your PDF and would love to speak to you later on as I have been on a huge journey with Seb Derm and would love to share it with everyone as I continue on my Journey to get my life back.

Thanks.

[Davo]

I know you use/d Nizoral cream on your face and am wondering if you have tried Lotrimin Ultra?

According to Jeff's research azoles interfere with yeast growth but don't do much to kill existing yeast wheres allylamines kill live yeast. In my experience Butenafine (an allylamine available in Lotrimin Ultra) is more effective than Ketoconazole (an azole available in Nizoral cream). Unfortunately Butenafine is not available in Australia and although I import it via eBay, I mostly rely on Nizoral. Interestingly, Turbenafine is useless on my face but reasonably effective in my groin area. Perhaps because it's a different strain of Malassezia, or the biofilm is less entrenched?

I'm interested in your thoughts... Lotrimin Ultra is OTC in the US, perhaps you have been down this path already?

[Tom Busby]

I never used Lotromin Ultra so I can't say from my own experience. I was glad to see that Jeff found it worked and posted his results.

I did try Lotromin AF fairly early-on in my attempts to find a treatment and it did nothing at all. I wish I would have tried Lotromin Ultra, and I think I'll try it now, although I'm almost at complete cure so it will not be a very conclusive test.

The manufacturer's website has a $2 off coupon too.

[aj1]

My story has been created and if I start with Toms recommendations my progress will be In that thread.

http://www.rosaceagroup.org/The_Rosacea_Forum/showthread.php?29297-My-Seb-Derm-Story-Need-Help-Suggestions-Questions

Any suggestions would be appreciated.

[Tom Busby]

Here’s a cool looking new product that daneel just posted about -- Bioderma Sensibio Foaming Gel, with climbazole, piroctone olamine and xylitol. This should be very effective, and other reviewers say it smells great too. I had never heard of it before.

Here’s a link from Amazon to order a giant sized 500 ml bottle that ships from Portugal: http://www.amazon.com/gp/offer-listi...&condition=all

[Tom Busby]

Another new shampoo containing 0.5% piroctone olamine and 0.45% climbazole is made by Eucerin, and is called DermoCapillaire Antidandruff Gel Shampoo.

It's also the subject of a 2013 medical research article, "Highly Efficient Rinse-Off/Leave-On Scalp Care Treatments to Reduce Moderate to Severe Dandruff," and posted at: www.scirp.org/journal/PaperDownload.aspx?paperID=26935.

It’s currently sold only on Amazon and eBay as far as I can tell.