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

  1. #611
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    Is it normal for seb derm to be all over my nose? I can scrape my finger on my nose pretty much from the bridge down and all along the sides and see a flaky trail left behind. It's like my entire nose is covered with scale/flakes. The biggest flakes are the ones on the nose sides and in the creases when I pick those off. Right now it's not as irritated so they take on a more white/chalky appearance and texture. When it's irritated they are more greasy and can be yellowish and sometimes I can pick off clearish looking flakes from my nose when it isn't as irritated. These seem to slough right off as if they're more fresh or something... less effort to get them off. Also have a lot of flaking in my glabella area and onto my cheeks with a pink malar mask undertone...

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    Okay I asked a lot of questions, some of which are already discussed here in this thread/forum. Sorry for that, it is such a broad range of information, and I just started reading/learning about SD when I was writing this posts.

    But one thing that would really interest me, mainly targeted towards Tom:
    What is your understanding nowadays what kind of reaction from the body is SD? You reffer often to an allergy towards Malassezia. Can you maybe describe me your detailed persumtion / understanding of SD nowadays when it comes to this?

    And if it is an allergy-type, do antihistamines change anything when you have SD? I have a dust mite allergy and take daily one pill of Desloratadin.

  3. #613
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    Hiya,

    I live in Australia where it is hard to come across climbazole products. I came across a foam shampoo for babies suffering from cradle cap called Mustela Newborn Foam Shampoo, which contains climbazole in an unspecified amount but it is mid-way through the ingredient list. It seems to have good reviews for cradle cap but I couldn't find any for adults with SD.

    https://www.mustela.com/en/content/F...ampoo-newborns

    The ingredient list also seems to contain no ingredients that feed malassezia. I wondered if anyone had tried or had any success with this product? I have never seen anyone write about it. Would especially love to hear Tom Busby's opinion if you're floating around Tom?

    Thanks,

    Jess

  4. #614
    Senior Member Tom Busby's Avatar
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    Hi aussiechick, I tried Mustella Foam very early in my attempts to treat SD with climbazole, and found it to be completely ineffective. I believe that the climbazole in it isn't dissolved and emulsified.

    Later, I figured out how to dissolve climbazole in alcohol (which can be isopropanol or ethanol) and then emulsify it into an oil-in-water lotion and shampoo. Only in this way, I found that climbazole was very effective -- this is the foundation for my best guess as to why Mustella is worthless. It also illustrates that we can't just dump climbazole into something and expect it to work.

    And spiritus asked my current opinion as to the chicken or egg, in other words, which comes first, an allergy to malassezia or what? Good question.

    After testing one ingredient after another, in individual succession, to isolate the "first cause," it seems in my case that an excess of keratin created an environment where the fungus malassezia could thrive. My opinion is based on my subsequent use of Vitamin A, a super mild retinol, and sodium hyaluronate, HMW, both of which slowly dissolve the excess keratin layer. Sure, climbazole will nuke the fungal load, but the excess keratin layer requires more time and effort, and requires the ingredients I mentioned above. It has become apparent in my case that it should have been most important to remove the excess keratin layer. Well, live and learn.

    With hindsight, I can now see what I had been battling. Not only an allergic reaction to malassezia, but to everything else that goes wrong from having a sticky layer of excess keratin. For example, the awful windblown glochids from prickly pear, cholla, and other desert cacti that can became embedded in excess keratin. Look up glochids and you can see how they get embedded -- I think malassezia works in a similar way.

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    Thanks a lot Tom, I won’t waste my money on Mustela then! Very interesting re the keratin layer also. Thanks for taking the time to share your knowledge and experience with everyone, you have obviously helped so many people

  6. #616
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    How do I get reprieve from this horrible condition? I swear sometimes I think the SD is worse than the rosacea and if I could just keep the SD at bay my rosacea wouldn't be that bad. I just started 2% ketoconazole shampoo again (lathering on face and letting sit for 5-10 mins) and this morning my beard was extremely dry in a particular patch at the edge of my cheek. It looked like the dried cracked desert you see on some landscapes, except it was just patches of large flakes. My beard isn't even that long.. I have it at a 2 guard right now. Might just have to shave it no guard (I can't use regular razors as my skin is too sensitive).

    I'm also on a course of fluconazole 200mg/day for paronychia. Does fluconazole do anything for seb derm? Doubt it... wishful thinking I guess.

  7. #617
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    All ketoconazole shampoos are made with sulfate-surfactants and you may be experiencing skin irritation and skin drying from the surfactants.

    Or, the dry skin may be an excess of keratin, which is a separate condition but probably creates a favorable environment for malassezia, initially. It's a chicken or egg kind of question, in my opinion.

    Either way, you'll be better off trying the shampoo daily for 2 weeks and then deciding whether you're getting positive results, overall.

    3-4 minutes is long enough to leave the lather on your skin. Be sure to rinse completely -- the sulfate surfactants must be washed off completely. The best way to ensure that you're rinsing completely is to wash off the shampoo in the shower. Splashing in the sink is not nearly as good for rinsing. And rinse about twice as long as you think is necessary, either in the shower or in the sink.

    Fluconazole didn't do anything for me.

  8. #618
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    Quote Originally Posted by Tom Busby View Post
    All ketoconazole shampoos are made with sulfate-surfactants and you may be experiencing skin irritation and skin drying from the surfactants.

    Or, the dry skin may be an excess of keratin, which is a separate condition but probably creates a favorable environment for malassezia, initially. It's a chicken or egg kind of question, in my opinion.

    Either way, you'll be better off trying the shampoo daily for 2 weeks and then deciding whether you're getting positive results, overall.

    3-4 minutes is long enough to leave the lather on your skin. Be sure to rinse completely -- the sulfate surfactants must be washed off completely. The best way to ensure that you're rinsing completely is to wash off the shampoo in the shower. Splashing in the sink is not nearly as good for rinsing. And rinse about twice as long as you think is necessary, either in the shower or in the sink.

    Fluconazole didn't do anything for me.
    How long and how much did you take of the fluconazole? I am taking 400mg (2x 200mg/pills) a week. I just clarified with my GP today and they said take two pills each week which I will just do on Fridays. I have been taking 200mg/day since getting the script on Monday because the bottle said 200mg/day. But I remembered the conversation with my GP and I knew we discussed weekly. So this 30 pill supply will last me 3 months. He said taking it daily is useless as it needs time to build up in the tissue. Also... does anything reduce redness from this? I am unsure how much redness is from the seb derm and what's from rosacea. I haven't come to term with this in the 4 years I've had this... finding it difficult to get through every day now.

    In regards to the ketoconazole, what is a good maintenance dosing? 1x/week? 2x/week? Is a cream more effective than a shampoo? I have only ever been prescribed shampoos and I don't have scalp SD. Just regular dandruff which isn't that bad anymore with daily use of head and shoulders. I wonder if getting on H&S regularly YEARS ago caused the dandruff to migrate from my scalp to my face? Is that just farfetched thinking?
    Last edited by aafdup; 31st May 2019 at 08:33 PM.

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    Does anyone know how to add Zinc Pyrithione into a shampoo?

  10. #620
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    Zinc pyrithione (ZP) doesn't dissolve in anything so you can't add it to a shampoo. You can add it of course, but don't expect much from a dump-in method. It will clump up either at the top or the bottom of the shampoo.

    You could probably try to suspend the ZP particles of ZP in a shampoo by mixing some pre-neutralized 0.05% sodium carbomer in water and glycerin (roughly 50/50), and then add ZP, and then dump it in a base shampoo, so the ZP is 2% of the base. This would be really bad aesthetically.

    But more importantly, ZP doesn't do anything useful as to seb derm, because it has no effect on malassezia. You can google all of the main manufacturer's research articles if you want to know more. Long story short, the manufacturer has several in-house chemists who tried to determine what ZP does, and have stated that it binds to copper on the skin and thereby works as a super-mild exfoliant. The manufacturer's last study, before they apparently gave up trying, found that it's functionality was similar to live brewer's yeast. (???) Really. I don't know why anyone buys a product with ZP.

    The manufacturer has a great advertising campaign, I'll give them that. ZP was first marketed as H&S in the 1960's (and is therefore grandfathered under the old rules, which don't require any proof of effectiveness), so the FDA allows them to claim it treats dandruff. Bad laws allow for useless products.

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