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Seb Derm--help please with diagnosis and effective treatment

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  • Seb Derm--help please with diagnosis and effective treatment

    I was diagnosed with rosacea 1.5 years ago. In the last few months, I have also been diagnosed with SD but my symptoms don't seem consistent with many of these postings. I have pink/red, slightly scaly patches above and between my eyebrows, on my upper forehead, and worst, on my temples extending down in a semi circle to the tops of my cheeks and under my eyes. Most recently, I also have a small patch on my nose and my stomach is starting to look a bit patchy and itch. My scalp is not particularly itchy and the red patches on my face feel a bit irritated sometimes but are not itchy. Recently, after I shower or wash my face, all of the spots get much more pink and irritated and then settle back down after a few hours. I do notice some very small white flakes after I shower in the areas that are most red as well as a few slightly raised bumps. Finally, my skin is oily and seems more so since I have had this condition.

    Over the last few months, I have been prescribed topical Ketoconazole, Elidel, and Promiseb cream, all of which have appeared to do nothing, and meanwhile, my condition continues to get worse and spread. I have been stressed about being diagnosed with a second life-long condition and the impact on my appearance, which I'm sure isn't helping, but it's kind of hard not to be stressed when all treatments have been a total failure so far.

    I have three quick questions--first could my condition be malassezia-induced even though I have very little itching on my face? Perhaps my SD is still new enough that the itching will come later (when winter comes for example?) or does this mean that it is likely caused by something else? If so, how do I figure out what is the cause and potential solutions?

    Second, if it is malassezia-induced, is using the E45 shampoo as both a shampoo and face/body wash the simplest potentially effective solution with minimal side effects? I'm not going to do a good job of being my own chemist so I need a relatively straightforward solution recognizing that it might not be as effective as making my own wash or lotion. I also need a solution that will not exacerbate my rosacea.

    Third, I have not been using a moisturizer because my skin is so oily. It's of course hard to know if my skin is oily because it's oily or because it's too dry and overproducing sebum as a result, but I have been thinking the former and so have avoided moisturizer. I have read that Cerave PM might be ok, but wondering, given my symptoms, if there is any real upside to using any kind of moisturizer where there are seemingly obvious downsides.

    I appreciate any insights or advice you can offer. The internet can be both a blessing and a curse as you read about all of the "miracle" cures that everyone expounds, and I have appreciated the clinical, research-based, and patient approaches expressed in these threads. Thanks so much for your time and wisdom.

    -Josh

  • #2
    I haven't used an over the counter moisturizer in years. Most of them contain a form of alcohol that burns with any type of sore and gives the added benefit of drying out your skin. Also my dermatologists have cautioned me time and again about ingredients in moisturizers causing further reactions or being responsible for initial reactions. When I feel dry, and to avoid my skin overproducing sebum as a result of dryness I rely on organic coconut oil. My Nutritionist suggested this because the chances of a person having a reaction to coconut oil is close to impossible. I would be careful with the type, how much and how frequently you apply it as too much may not be so great for clogging pores on your face.

    Sent from my Nexus 5X using Tapatalk

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    • #3
      Originally posted by Joshuaeweb View Post

      Third, I have not been using a moisturizer because my skin is so oily. It's of course hard to know if my skin is oily because it's oily or because it's too dry and overproducing sebum as a result, but I have been thinking the former and so have avoided moisturizer. I have read that Cerave PM might be ok, but wondering, given my symptoms, if there is any real upside to using any kind of moisturizer where there are seemingly obvious downsides.

      -Josh
      What downsides to a moisturizer are you worried about? If you do have seb derm induced by malassezia yeast then it will feed off of coconut oil, so I would not try that out to start off with.

      Many on this forums, myself included, have found climbazole very effective at treating seb derm so E45 would be a good starter body / face wash. Take a look at the numerous posts from Tom Busby about this subject.

      My seb derm was never itchy either!

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