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Thread: Papules

  1. #1
    Junior Member Malia's Avatar
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    Default Papules

    Last week, in an effort to find something other than hydrocortisone to control seb derm, I shampooed and washed my forehead with Nizoral shampoo. While nothing adverse happened on my scalp, on my forehead erupted several papules. I stopped using the Nizoral, but the papules are still there. The crazy thing is, they are non-existent when I wake up in the morning, then appear during the day. Is that typical of rosacea papules? I thought rosacea papules would appear and stay for a while.

    Any help would be appreciated.
    Thanks!
    Malia

  2. #2
    Senior Member TheMediumDog's Avatar
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    I find that the behaviour of papules can be rather unpredictable.

    Some persist for a long time. Others come and go almost within a matter of hours. Some are recurring - they 'flare' and then disappear, but come back in the same place at some time later.

    In my case, after a long time 'studying' them, I can tell roughly how long any given papule will stick around. I find it is quite heavily related to their cause, and (more obviously) their size and 'depth'.

    The phenomenon you mention of papules not appearing in the morning, but doing so later in the day, is not uncommon. I think it has to do with the playing out of various daily bodily rhythms. The fact that (for some, myself included) flushes happen at a set time each day is, I think, part of the same phenomenon.

    (Incidentally, Nizoral would certainly be harsh enough to cause papules, so its quite possible that what you refer to are indeed rosacea papules).

  3. #3
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    Agree with you dog.
    What is it about those flushing patterns at specific times of the day ? I can almost set my watch by ones i have had in the past.

  4. #4
    Junior Member Malia's Avatar
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    Default Hypothesizing

    So you think that these papules could be either 1) contact dermatitis from the Nizoral or b) rosacea flare due to the irritant of Nizoral? Since I'm pregnant I guess it could also be just my super-sensitive skin reacting to Nizoral. I should also mention that the red bumps are along the hairline, which makes me think it's still a Nizoral problem.
    Last edited by Malia; 27th May 2008 at 07:44 PM.

  5. #5
    Senior Member J-Mill's Avatar
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    Default Papules

    Contact dermatitis would not recoccur if you ceased applying the product (once it cleared). The more likely explanation is a Rosacea flare.

    Nizoral is nasty stuff IMO from a formulation point of view. It contains a number of known skin irritants, not the least of which is a pointless fragrance, why anybody making products for skin conditions, that are known to sensiitize and inflame skin, put fragrance in their products (single handedly the most common cause or irritant and contact dermatitis in cosmetics) is beyond me.

    Here are the ingredients:

    coconut fatty acid diethanolamide, disodium monolauryl ether sulfosuccinate, F.D.&C. Red No. 40, hydrochloric acid, imidurea, laurdimonium hydrolyzed animal collagen, macrogol 120 methyl glucose dioleate, perfume bouquet, sodium chloride, sodium hydroxide, sodium lauryl ether sulfate, and purified water.

    I can't even use this stuff on my scalp as it aggravated the hell out of it. I now use Stieprox, for which there is a cream/lotion for the face (Loprox).
    "Get busy living or get busy dying."

  6. #6
    Senior Member TheMediumDog's Avatar
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    Malia,

    I would draw a distinction between a flare of some kind cause by irritation or sensitivity to an ingredient of the Nizoral, on the one hand, and rosacea p&p's caused by its harshness, on the other.

    A rosacea p&p occurs when small holes appear in capillaries, which releases various substances into the surrounding tissue. In fact this phenomenon of the capillaries opening up is part of the body's defence mechanism - the substances released are, I believe, white blood cells, and the idea is that they go and attack an external pathogen.

    The response is exaggerated in rosacea sufferers, so all sorts of things trigger it, even when there is no external pathogen to be attacked. One such thing is mechanical aggravation (like rubbing), and a similar one would be very harsh cleansers.

    This account is roughly right, I think, although I'm no specialsit. Anyway, it is quite different from any sort of allergic reaction.

    I might be inclined to think your problem was the latter, because the hairline is not, as far as I'm aware, the most sensitive part of the skin, or a place of particularly high concentration of blood vessels - and this is where rosacea p&p's tend to occur.

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    Moderator Melissa W's Avatar
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    Alex,
    Do you find that taking an antihistamine is at all helpful for p&p's or not really?

    Thanks,
    Melissa

  8. #8
    Senior Member TheMediumDog's Avatar
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    Melissa,

    I've never tried them, although they're on my list (I'm trying to sort out my dry skin at the moment. Being a boy, I can only do one thing at a time ).

    I can't remember anything - do you take them?

  9. #9
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    J-Mill,

    I had steroid induced rosacea which then turned into a nasty widespread case of SebDerm....at least this is what my derm has told me.

    I have been confused as to what I really have because the redness from the steroids have diminished significantly over the past year but I still have redness, flakes over entire face (powdery like flakes, with rough skin) and I get itchy red bumps.

    I keep thinking I may have rosacea but I don't flush or blush...other then the flakes, my main complaint is the itchy red bumps I get...mainly in my cheeks.

    Dr. Nase's book (sorry to reference him but his book still is very helpful) indicates that one of the main differences between Rosacea and SebDerm is that the inflammatory papules of SD are usually located in the hair follicle.

    Any thoughts on this theory?

    Thanks

  10. #10
    Senior Member J-Mill's Avatar
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    Default Seb Derm and pustules/papules

    Monte,

    Generally speaking seb derm is not associated with any pustules/papules. The literature would suggest no such symptoms being caused by seb derm.

    That being said, the same yeast organism that is associated with seb derm can also be a component of a fungal folliculitis, this would cause the development of red pustules (mostly, with some paps) that are located right beside the hair follicle (hence the term folliculitis). It is literally an inflammation of the hair follicle. This BTW is easy to test as the doctor can take a swab of the pustule and check to see what critters are mucking about (bacterial folliculitis would reveal a bacterial overgrowth, fungal the yeast overgrowth or neither which would be suggestive of a different condition).

    As for Steroid Rosacea, I think this is an often abused term that is thrown around quite a bit. I think a number of people with "steroid rosacea" have actual rosacea that flared, quite possibly from something in the base of the steroid as much from any steroid itself (most pharmaceutical topicals contain absolute crap in their bases, a number of steroid lotions contain perfums, Sodium Lauryl Sulfate, Propylyn Glycol and a number of other known skin irritants). Steroid Rosacea is curable unlike normal Rosacea and literature suggests a maximum timeframe of 6 months to complete resolution with substantial improvement after 6 weeks of antibiotic use. Don't know what steroid you were using on your face, but if it was a more potent flourinated steroid it is possible you developed a steroid dermatitis also known as "burning face sydrome" where the skin is just red and irritated all the time, characterized by sudden flares (deep redness, pustules, burning, itching) which scale (flake) and resolve but then repeat. This condition normally only clears with complete abstinence from topical steroids and takes the same length of time to clear as one was using the steroid (so if you got it from using say betmethasone on your face for 1 year, normally these flares go on for 1 year). If you were using a weak steroid like 1% hydrocortisone this is highly unlikely, you would be the first recorded case in the literature (at least what I have read).

    A final consideration would be an atopic (allergic) response such that the flaking/redness could be irritant contact dermatitis from something you are using on your face (a cleanser/moisturizer/medication). This type of inflammation can also provoke folliculitis (bacterial or fungal), as can using a substance that is too occlusive, such as a really thick cream or vaseline, even though they are not technically speaking comeogenic.

    If the pustules/paps are right beside the hair follicle then folliculitis is likely, but that is only half the battle as you need to determine what is causing the inflammation in the follicle (I developed folliculitis early in my Rosacea battle trying to use vaseline as a moisturizer, when I stopped, it cleared...not to say everyone would have probs with vaseline btw, as I know some use it without probs). One piece of info I am sure you will not be happy to hear, most effective way to clearing folliculitis and resolving the inflammation...topical steroids.

    I would ask your derm to swap them and see what comes back, if it is fungal folliculitis you might be able to clear it with a topical antifungal or even better, an oral one (which avoids problems of having a bad reaction to a new cream. For fungal skin infections I always think itraconazole as it has a low sde effect profile and much less chance then say oral ketoconazole of causing liver damage over longterm usage.
    "Get busy living or get busy dying."

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