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Thread: Seb Derm? Pictures, treatments, diet and everything else!

  1. #1
    Junior Member Jayco89's Avatar
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    Default Seb Derm? Pictures, treatments, diet and everything else!

    Hi everyone, I've been lurking around here off and on for a month or so now and thought I'd finally make a thread (it includes pictures as well, which I always like seeing in other people's posts!)

    A quick background, I've had redness around my nasal folds for probably 5 years and it's always been a bit of a confidence killer for me, along with reddish skin in general and occasional acne - not good when I'm so pale skinned. Over the past 2 years things got considerably worse and both sides of my nose started flaking / scabbing / scaling uncontrollably, I hid from everyone and lost a relationship as a result of my low confidence and general fear of being seen. Even going to work was hard. I finally addressed the scabs/scales by using a basic cleanser and 'skin-repair' moisturiser, however the redness was still prominent. Since January / New Year the redness has continued to get worse and I'm starting to lose hope

    I've also been seeing a dermatologist once every 3 months or so for the past 18 months and they've been little to no help whatsoever. They've diagnosed it as rosacea / seb derm, but in truth, I don't think they have a clue, just like the doctors before them (for 2 visits, her advice was "if only we could change your skin type" - helpful, right?). I've been prescribed so many things I've lost count, but nothing has really helped and it wouldn't surprise me if the months of anti-biotics have actually created further issues. I see a lot of chronic skin / health issues leading back to problems with the gut. My diet is average, but decent, I avoid all junk food and focus on meats, grains, fruits and water, I do lack veggies and I've cut out milk and dairy as much as possible. I'm currently trying Gluten free, but I might transfer to low sugar / FODMAPs diet and see if it benefits me at all, my only worry is losing more weight. I'm barely 60kg at 5'10...

    This brings me to where I am now. I've read up on a lot of things here from Auburn's Honey treatment and Jeff's Lotrimin solution, to Tom's incredible knowledge of pretty much everything on Seb Derm. I've started with Honey (excluding coconut) and I'm 2 weeks in with little improvement, in fact, the redness seems to be getting worse and my skin is drier than normal due to no moisturiser. I've also tried a bit of Lamisil as the active ingredient is Terbinafine, but it didn't seem to have an effect in the 2 days I used it, maybe it's worth a bit more time. I'm going to continue the honey for another 2 weeks and see if the redness subsides, I hold very little hope though.

    A few questions, what can I use to moisturise that won't feed the Seb Derm and won't cause me to break out? MCT oil seems hard to get a hold of in the UK, I have very little faith in making my own things and apparently the Cerave formulation has changed recently - I'm at a loss! Would someone with good knowledge of ingredients / carbon chains (Tom) be able to help out and let me know if the following are safe to use? Or even better, let me know how to work out whether certain ingredients will feed Malassezia please?

    Code:
    Aqua
    Olea Europeae
    Glycerin
    Pentylene Glycol
    Palm Glycerides
    Olus
    Oleic Triglycerides
    Hydrogenated Lecithin
    Squalane
    Betaine
    Palmitamide MEA
    Acetamide MEA
    Sarcosine
    Hydroxyethylcellulose
    Sodium Carbomer
    Carbomer
    Xanthan Gum
    Even if I get no replies, I'll try and keep this updated with treatments and pictures in the hope it's beneficial to someone else going through similar things. It's nice to know we're not alone

    Aaaaand, here are the pictures I promised. They're the worst ones I've ever taken of myself, so I've blurred my face out to avoid any further embarrassment. The picture with white scale / scabbing is from over 9 months ago, just for reference and the others are fresh today!
    Attached Images

  2. #2
    Senior Member Tom Busby's Avatar
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    Hi Jayco, you could go to your local Boots and get Nizoral 2% shampoo. If you see some results after 2 weeks, then you have a positive diagnosis for seb derm induced by malassezia. Then you could order some Hegor 150, or Hegor 50, from baroness.co because climbazole is a lot more effective than ketoconazole.

    CeraVe PM lotion should be in the UK too, because Walgreen bought Boots about 2 years ago, and US stores now have a lot of UK products, and I assume that US products are showing up in UK Boots stores. I just checked CeraVe's website and the PM lotion in the US still has the same "good" ingredients.

    Terbinafine doesn't work at all, in my experience.

    If the Nizoral shampoo works, even a little, then go to NHS and get a script for Nizoral 2% cream. I'm not a fan of Nizoral (ketoconazole), but it's much better than nothing. You can apply the cream twice a day. Using these topical treatments takes about 6 months, and you might get to the point where no one, other than you, will notice. Be patient.

    The lotion you ingredient-listed looks bad from a seb derm point of view, because olive oil is the 2nd ingredient. If you have some of that, give it away. These types of lotions are most likely a big part of the problem. They were a problem for me -- it was a viscous cycle, where I formerly thought that flaking skin means I should add more lotion/oil, but commercial lotions make the problem much worse, unless they contain only capric/caprylic triglycerides.

    Diet doesn't have any effect on this type of seb derm. If you still want to stay within some kind of specialty diet, based on your weight, you need to eat a lot more food. I'm not an expert on diet, but I believe that one or two 3 ounce tins of sardines every day would fit into any specialty diet, and that way you'll be getting a little more nutrition. Sardines packed in tomato sauce taste better to me, and I've been told that the acid in the tomatoes helps dissolve the little sardine bones, and the bones themselves provide a lot of trace minerals.

    Based on the location and appearance, I would say your condition is 100% seb derm induced by malassezia. It's treatable, but chronic, so you have to stick with the anti-fungal products, forever. I'm surprised your docs didn't prescribe or recommend ketoconazole, as that information is well-known worldwide.

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    Jayco, please let me know how things work out for you with the honey treatment. I am in a similar place right now with my seb derm (just began week 3 of honey treatment without the coconut oil) and have not seen great results. Holding out hope though, having used steroids for short periods of time on my face (5 days at most) in the past, perhaps the treatment is just taking longer to work.

  4. #4
    Junior Member Jayco89's Avatar
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    @Tom, thanks for such an in depth reply! I currently have both a Ketocozanole based shampoo and the Nizoral 2% cream (one of the many things that were prescribed to me) along with Daktacort, Finacea, Duac, Epiduo, Metronidazole and countless anti-biotics over the last 3 years. I recall trying a coal tar wash on the sides of my nose and applying the Nizoral for a while, but I was put off during the flaking as it seemed to make things worse 'scabbier'. I'll trial it again - what kind of time period should I be patient for to see any kind of results? 2 weeks?

    I've ordered the CeraVe PM lotion and I'll relegate the other moisturiser to elsewhere on my body or unaffected areas on my face. Since I started using it in November it hasn't caused breakouts in acne and felt like it smoothed my nose, but if it's feed the Malassezia, I'll bench it for the time being along with the Lamisil. If you're not a fan of Nizoral, what would be your preferred topical treatment that can be purchased?

    Sardine tip is great as well, I've been meaning to start eating a few more fish to boost my Omega 3 intake, so I'll put that on the shopping list along with salmon! I've not noticed anything regarding Seb Derm and diet, but I guess it can't harm as long as I'm hitting my macros and not becoming deficient in anything. I definitely see the point people make working from the inside out, but I also agree that some things need to be helped topically.

    Glad you think it's also Seb Derm, I was put off by those saying it was Rosacea as I don't feel have 'flare-ups' or anything. It's just permanently there and not much seems to make it worse/better. It becomes redder after washing, but that's just my skin type I believe. Another question regarding cleansing, what would you suggest? I'm currently just using Raw Honey and chlorine free water. Previously I used Boots Simply Sensitive Foaming Wash; (Aqua (Water), Cocamidopropyl betaine, Sodium chloride, Sodium cocoamphoacetate, Glycerin, Sodium citrate, PEG-120 methyl glucose dioleate, Phenoxyethanol, Methylparaben, Sodium benzoate, Citric acid, Propylene glycol, Tetrasodium EDTA, Aloe barbadensis leaf extract, Tocopherol). I also used a konjac sponge gently to exfoliate the area as sometimes it felt a bit 'gritty'.

    Regarding the Malassezia feeding off sebum the skin produces, is it reasonable to think that Accutane / Isotretinoin would be beneficial to conditions such as these? I've read a few studies which seem to show low dose treatment can keep the condition at bay along with Rosacea, Acne etc. I feel like that will be a step I'd take in the future if I have no success with anything else. Obviously with my bodyweight I'd only consider something along the lines of 5mg/day.


    @Alfred, of course! I will definitely keep this updated as at the end of the day we're all in this together, and if we can offer support / help in any way, shape or form, that's great for our confidence and hope. I know the feeling with the honey treatment, but it's probably worth sticking it out just to cross it off the list... Best of luck with it, I'll keep an eye on your posts!

  5. #5
    Senior Member Tom Busby's Avatar
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    Hi Jayco, the length of time for ketoconazole to show results is not known to me, except that it's a very long time. The reason I say this is because I used ketoconazole for about 4 months, and then switched to climbazole. I could see that ketoconazole provided some relief, so I had a good self-diagnosis for seb derm induced by malassezia, but I could see that ketoconazole wasn't really the answer to my problem.

    Using climbazole, another 8 months passed before I looked ok, to the point where I would notice but no one else would. A long time, certainly, but that's because fungi are eukaryotes and so are mammals -- our cell walls are very similar so antifungals simply aren't very strong, compared to say, the effect that antibiotics have on bacteria.

    This skin condition is an allergy to malassezia, so it's chronic, and can be minimized but not eliminated. Find a simple treatment, and stick with it forever. If you like, you can call it an innate immune response to malassezia, but calling it a skin allergy is much simpler and equally accurate.

    In social settings, some people will be clods and ask, "What's wrong with your face," or nose, or whatever, and you'll find it's important to simply say, "I have a skin allergy." Or, you could say, "I have a genetic condition where my skin produces an excess of keratin," but I reserve that for people who are annoying in the first place. You'll find there's more peace of mind to simply owning up to the problem.

    I make my own lotion and shampoo/shower gel, using climbazole as the active ingredient, and MCT oil is the only oil. However, I've exchanged private messages with people in the UK, and you can't buy climbazole powder like I can in the US, so your best plan is to buy Hegor's climbazole-based "150" or "50" shampoo, and use Nizoral 2% cream.

    Antibiotics will make everything worse if you have seb derm induced by malassezia. Don't take them unless you are truly in a life-threatening situation.

    Accutane is a bad idea. Even with Accutane, sebum production never goes down to zero, and you wouldn't want it to, because body oil is part of a healthy skin barrier. If you want to take a pill, the only choice is Itraconazole, which is an antifungal drug. The problem with Itraconazole is that it's not possible to take it very long because it can cause liver damage. Topical treatment is always better for a chronic lifelong condition, as a logical conclusion, I believe.

    I've found that anti-dandruff products like Head and Shoulders or Selsun Blue may work on dry dandruff, which is merely an annoyance, but don't work at all on chronic oily dandruff, where the skin looks flaky but at the time is very adherent, and doesn't scrub off. For example, I tried an electric Clarisonic brush (like a super loofah) and found it did not help at all. My experience is that you have to treat this condition with topical antifungals, rather than any kind of exfoliating method.

    While it's healing, your skin will likely go through a period where it looks much more red. This is because effective antifungal chemicals will allow your immune system to suddenly recognize the fungus as "not self," and then your body's inflammatory response will start up, as inflammation is the body's first line of defense to foreigners, like fungus. Don't get discouraged. Realize that in several months you'll see improvement.

  6. #6
    Junior Member Jayco89's Avatar
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    Hi Tom, thanks again for imparting your knowledge on me - definitely paying off as I understand more and more each time I read a post!

    Am I hoping too much expecting to see results or even partial results within a month or so of using Ketoconazole? A bit of relief would do wonders to my self esteem and give me a bit of hope that things will get better (as well as confirming the fact that it is actually Seb Derm).

    I'm strictly avoiding anything anti-biotic for as long as I possibly can, along with steroids; they both seem to do more bad than good. I certainly agree that sebum/oil is required to ensure a healthy skin barrier, however, if one was overproducing sebum, would Accutane help normalise it on an extremely low dose? I've read several studies of low dose Isotretinoin being beneficial to erythema, seb derm, rosacea, acne and various other skin conditions. At the same time I've heard it can also induce various skin problems, so it's a bit hit and miss from what I've seen. But very few 'low-dose' studies are as low as I'm considering...

    Do you know if anti-fungal drugs in the short term would help get the problem under control quicker and then allow it to be managed topically? Itraconazole I believe was my dermatologist's next step in treating my skin, but they were reluctant to prescribe that as my redness had actually decreased back in December/January. I also read the following on Fluconazole (sure you've already seen it, but I'll link it anyway) - http://www.ncbi.nlm.nih.gov/pubmed/16918053

    I hope that's what my body's currently doing as things are looking rather inflamed at present. Is a gentle cleanser suitable / recommended as well? I'm currently using honey but just wanted to get your thoughts on the 'Boots Sensitive Foaming Facial Wash', (Ingredients: Aqua, Cocamidopropyl betaine, Sodium chloride, Sodium cocoamphoacetate, Glycerin, Sodium citrate, PEG-120 methyl glucose dioleate, Phenoxyethanol, Methylparaben, Sodium benzoate, Citric acid, Propylene glycol, Tetrasodium EDTA, Aloe barbadensis leaf extract, Tocopherol).

    P.S. I'm liking the "it's a skin allergy" comment, I haven't really had anyone comment on it luckily, but I'm sure I'll encounter it at some point.

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    Hi Jayco89, It sounds like you have made progress on the flakiness of your skin so hopefully the redness will eventually clear too.

    I have had some success with the raw honey treatment but it hasn't cured it. When I first tried it my skin was really jacked and I saw instant results. At the time I didn't know I had seb derm and was treating the area all wrong (corticosteroids, moisturizers, coconut oil). I had some seb derm patches on my upper lip/mustache area that I think had gotten infected. Raw honey can be used to treat infections and has antibacterial properties so maybe that is why I responded so well to it. At first I thought it would cure me all the way but that didn't happen. I still use it often though and find that it offers instant relief if I have any burning or itching. I definitely do not use coconut oil on my face. I've done that in the past and had very bad results.

    I am currently using Ducray Kelual DS cream on my face and have had good results. It is MCT based and according to the box it "limits proliferation of Malassezia, yeast". It is made in France and I ordered it online from Belgium. I wanted to make my own lotion but I was not able to find a source for climbazole. However, I have learned so much from Tom's thread and I think it has some of the best info I've seen online.

    I wash my face with Hegor 150 but found a cleanser I like more. I had gotten a prescription for PromiSeb lotion. I think it is available in the UK but it has a different name. The lotion was good/bad but the prescription also included a bottle of PromiSeb "scalp wash". It was no good as a shampoo but it has been working great as a face cleanser. If I use it twice a day it seems to get rid of the bulk of my day-to-day symptoms. I wish it got rid of ALL the symptoms as I still get smaller but less frequent flares. As a soap it is really pleasant and washes off clean and easy. The Hegor was pleasant enough but seemed a little more chemical-ish and was harder to completely rinse off. I have tried Nizoral in the past but am not a big fan of it.

    I have experimented a lot with diet. I have never found anything specific that makes the seb derm better or worse. In fact I was eating very healthy well before the seb derm attacked my face. I continue to eat healthy; grains, beans, vegetables, no processed foods, etc because long term overall health is even more important to me now. The only diet advice I would give is to stay away from foods which promote inflammation. Also balancing omega3 and omega6 fatty acids is supposed to reduce inflammation. Flaxseed oil is a great source of omega3.

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    Don't mean to sound cliche, but I completely understand what you're going through Jayco. I've barely left the house the past 4 years, even for work, and have also lost a girlfriend, too.

    Good luck, all the best.

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    Junior Member Jayco89's Avatar
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    Hey folks, sorry for the delayed reply with this. Trying not to lurk the forum too much as I've found whilst it can lift you up and give you hope, it can also bring you down by constantly remembering the issues and making it appear bigger than they seem! So a bit of time off here and there definitely goes a long way.

    @Gils, not even sure how much flakiness I have any more, I did notice a small 'scab' type thing appear in the crease of my nose over the last few days, but I try not to pick at them in the hope they go away through natural washing. Glad to see you've had success in controlling it with raw honey (I've just done my last of 4 weeks treatment and I'm not convinced it's provided any benefit for me personally). I don't think my redness has decreased particularly, some days I feel better than others about it, but it's hard to tell as I try not to take photos - maybe I should to document progress, if there is any!

    Great find with that Ducray Kelual cream, they seem to have a few formulations that appear to be based around MCT oils. Is this the one you use? http://www.cocooncenter.co.uk/ducray...40ml/9002.html. Interesting that you use a shampoo for your face wash... What ingredients do they have in them? And do you wash them off immediately or let them 'sit' for a while?

    Nice to hear someone else had very little correlation with diet and skin issues. I've tried a fair few things over the last couple of weeks and noticed no change whatsoever really. How long have you had your seb derm out of curiosity? I always wonder what triggers it if it isn't something gut / immunity related. Trying hard to regulate Omega 6 to 3 with flaxseed in a fruit/protein shake, the problem is on an anti-inflammatory diet, it's hard to maintain weight. I'm struggling to eat more than 1800 calories a day, everything apart from veg and Omega 3s are inflammatory!

    @Matthew, it definitely sucks, I know how hopeless it can feel letting the stuff that means the most to you slip away. I think at some point we need to 'get over it' and just realise that life is there to be lived, even if we feel like we look strange. Would we judge others because they have some red marks on their face? I wouldn't and I doubt you, or any other adults would either! How we get to the point of accepting ourselves, I think that's the journey and something we have to do some way or another. Best of luck to you too, I'll check in with progress soon.

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    Sorry to hear about the raw honey. I was hoping it would help relieve some of your symptoms. If hasn't improved anything by this point it doesn't seem like it's going to help. I would keep it around though in case you want to try it again.

    Yeah that is the Ducray cream that I am using. It's no magic bullet but I think it is helping. I'm using it on breakouts or on areas that are threatening to break out. Spots are healing faster then they use to but it is hard to tell if it is because of the cream. It doesn't seem to be making anything worse which is a rare thing for me.

    I am taking a break from the using the scalp wash on my face. My face would look and feel so good for a few hours after use but 4-5 hours later my face would get extremely oily. I've never felt my face get this oily. The skin on my nose and cheekbones just didn't seem right and was starting to feel smooth and slightly numb and stingy. I'm a little nervous that this might be rosacea. Luckily no SD flares though. Initially I had great results with this wash. I thought if I rinsed my face twice a day with it that I could eventually keep all the SD at bay. I'm going to shelf it for a couple of weeks and then see if I can slowly incorporate it back into my routine. It has piroctone olamine in it which is an antifungal but it also has some oils in it.

    I actually don't know how long I've had SD. I started seeing a dermatologist just over a year ago. I was probably struggling with SD symptoms for a year before that. I've had psoriasis since I was a kid and I thought that's what my early SD rash was. Looking back I realize that I had symptoms during the last 10 years. During that time I would have long periods where my face was clear and periods where I would have very minor breakouts. It never really bothered my until probably 2 years ago when it got out of hand. The dermatologists were no help and my condition peaked in Dec 2014. I finally figured out that I had SD from this forum. I have improved a lot since then but I still have quite a ways to go.

    Do you have beans in your diet? They are high in omega3-s and are a good way to get some calories. If you are not used to eating them then slowly introduce them into your diet. They can be hard to digest at first. And make sure they are fully cooked for the same reason. I try to eat fish (but not shellfish) a few times a week and I try to eat beans 1-3 times a day. Quinoa is another good option. Brown rice and other whole grains are probably not anti-inflamatory but are still going to be beneficial. I am eating healthy to support my immune system but I no longer expect my diet to make any major changes to my SD.

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