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Thread: Seborrheic dermatitis and Eyebrow Loss

  1. #1
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    Default Seborrheic dermatitis and Eyebrow Loss

    Hi everyone,

    Over the last year I have lost nearly 40-50 of my eyebrows. It started in August 2013 with uncontrollable itching on my scalp and slight itching of my eyebrow area. While waited for the results of the biopsy, my dermatologist, Dr-A, prescribed 2% ketoconazole shampoo as a precaution for a fungal infection. 2 Wks later at at the follow-up Dr-A said the biopsy results were indicative of lichen planopilaris (LPP). However, by that time itch had virtually disappeared. Dr-A mentioned that it was a bit usual for LPP to go into remission or stop so quickly/suddenly. Fast forward a year later to November 2014 and the symptoms reappeared. It was quite poor timing as I was making several big life changes that resulted at the time in me being unemployed, uninsured, and out of the country. However, by late November I was able to get some clobetasol solution (This was initially prescribed for the LPP). In March I was finally able to see a dermatologist again. She, Dr-B, based her care around the diagnosis of the initial biopsy. She then started me out on placing and cubetasol shampoo. The cubetasol shampoo seemed to stop the itch but only for a day or 2. So a month later she prescribed me with a 7 weeks of prednisolone which was to be used in conjunction with the other medications. In addition I received corticosteroid shots in my eyebrows because I seemed to be quickly losing hair there. Prednisone stopped the symptoms however 3-4 wks after the end of the 7 week course of prednisone the symptoms reappeared. Oddly enough at this time I also remembered the ketoconazole shampoo I received at first. In Australia its over the counter so I started using it. It stopped the scalp itch almost immediately (over a wk or 2 really). It also temporarily stopped the ear and facial itching and burning. However, it never seemed to last long and I was still losing eyebrow hair. Therefore in June Dr-B prescribed the Mycophenolate Mofetil and I decided to get a second opinion. I went to a new dermatologist, Dr-C, who is supposedly a world expert. Dr-C looked at the old biopsy report/analysis, blood work, gave me a physical examination, listened to my symptoms. He thought the only thing that what was linking LPP to this was the biopsy report and believed that was misinterpreted. He diagnosed me as having atopic dermatitis and male pattern baldness. Strangely I thought this was an improvement. I wanted to reconcile Dr-B and Dr-C's opinion so I scheduled another follow up appointment with Dr-B. Dr-B maintained that her diagnosis seemed more valid as atopic dermatitis does notches eyebrow loss or follicular loss which she thought I had. It she be pointed out that Dr-B refuses to consult with Dr-C about this. I was really confused so I scheduled yet another appointment with Dr-C. Dr-C listened to Dr-B's thoughts voiced through me and said he doesn't see anything that he would classify as follicle loss or any plaques indicative of LPP. He prescribed another round of prednisolone and corticosteriod creme for my face. However, I still wasn't convinced of either of their options so I scheduled an appointment with a 3rd dermatologist, Dr-C. My reasoning was that since Dr-B would not consult with Dr-C and their diagnosis's were quite different then I should consult with an independent one to compare their thoughts. After reviewing everything and listening to my symptoms (of itchy scalp, ear, eyebrow loss, and accompanying rash on my forehead and between my eyebrows, intense stinging and burning after sweating) Dr-D diagnosed me with seberroric dermatitis and/or possible attic dermatitis. Additionally my primary care doctor agrees that it seems more like seborrhoeic dermatitis although he admits to not being that familiar with LPP. At any rate, I am now treating it is seberroric dermatitis. My concerns though are that it seems like adults who have atopic dermatitis have a history of eczema and/or even family history of it but I don't. Similarly, it seems like the people who suffer from seberroric dermatitis have plaques and dandruff. I don't think I have scalp dandruff although when I shave my hair I often see it but I think that it is really just the dried Minoxidil. I certainly don't notice large amounts of it on my eyebrows. But as the majority of doctor agree that it is not LPP it seems like the best way to treat it. So now after spending literally thousands of dollars, possibly sustaining scalp atrophy from corticosteroid use, and more importantly losing massive amount of my eyebrow I am left with a possible diagnosis I believe or at least seems close to the mark. I am now using Nizarol creme (with 2% ketoconazole) and a 2% ketoconazole shampoo. I have only been using the creme for 2 days so I don't think I have given it enough time to be able to say whether or not it is working but I'm hoping it does.

  2. #2
    Senior Member Tom Busby's Avatar
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    Eyebrow loss is called madarosis and has numerous causes. Seb derm induced by malassezia is not one of them. Most likely the problem is caused by demodex, and you might ask for the miticide, Soolantra. Your eyebrow hair will grow back if this is true.

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    Hi Tom,

    I would like the issue to be demodex, but really I don't know if that is it. I also have the rash and scaling behind my ears. This morning I woke up with dry and scaling skin on my forehead and in all the areas where I applied the Nizarol creme yesterday. I don't know if this is a sign that the creme is working or if it is a negative reaction to it. For that matter I don't know if this is a sign that I have atopic dermatitis and the Nizarol has irritated my skin. I'm super worried about this and it seems that I can't make it in to see any of my dermatologist till next Monday. Has this occurred to anyone after using Nizarol or ketoconazole creme?

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    Sorry I forgot to add that there is also a stinging/burning sensation when reapplying the Nizoral.

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    Hi Tom,

    I have been using Nizoral 2% cream for 2 days now and I have started to accumulate lots of dead skin and possibly peeling. I read one of your post where you gave a detained explanation of this process and I understand that it is a good sign. However I was wondering if there was a way to remove the dead and peeling skin other than scrubbing it off. I'm reluctant to scrub because my skin is quite sensitive and I would prefer not to damage it anymore than it has been already. So for I have just stayed home for the last 2 days like I hermit but I would like to be able to go outside soon.

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    Senior Member Tom Busby's Avatar
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    Hi Problems15, your reasoning is correct, that you can't safely scrub off the extra layers of peeling skin. You can rub gently with the pads of your fingers when you get out of the shower, and that will seem to help, but barely. Your skin has to heal itself. The healing process takes months.

    Exfoliant face scrubs, and mechanical exfoliants like Clarisonic, didn't help me either. No need to be a hermit -- there are worse things than peeling skin.

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    Thanks Tom,

    This whole thing is so frustrating. It really stands out on me because my skin is dark and of course the flakes are light colored. However it is well worth it and more if this can stop the SD and save my eyebrows. BTW- I read a posting where you commented that one of the things you have noticed has the most effect for you is the temperature. I have read research papers and such where the authors comment that SD is diminished by sunlight. I was wondering if that was what you were referring to.

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    Senior Member Tom Busby's Avatar
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    Did you read the "5 months in the Jungle" thread? That thread contains a lot of interesting observations about sunlight and temperature.

    Sunlight is hard to explain, because tinea versicolor on light skinned people is a dark spot of concentrated melanin, but on dark skinned people tinea versicolor is a light colored spot with very little melanin. It seems there are two different metabolic interactions between malassezia and melanin, and/or between malassezia and sunlight. Solving this contradiction would be very useful. There aren't any research articles.

    Here's what I meant by temperature -- in the past, when I was working outside in a very cold climate and then had to go back and forth to a heated room, my skin would be at its worst in a week or two.

    Sunlight never had any positive results for me.

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    Hi Tom,

    As always thanks for the additional info. I just started reading the '5 months in the Jungle' thread. It's interesting because when my SD first started I was living in Seattle (wet and humid) and was going in and out of heated and cooled rooms all the time. However, it stopped abruptly during the summer when the temperature was warm. The present flare up started while I was living in Northern Thailand and while it was super warm and humid outside my AC was on constantly. I am now living in Melbourne, Australia and summer is just starting here. I expect it will be very warm if not humid so maybe I will get some relief. Unfortunately, I don't think I can really adjust the PH of my shower here.

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    On the topic of temperature or weather though. I would have thought that a jungle conditions would have made the SD worse. I feel the stings and burning sensation the most when I workout or sweat. The rash also seems to spread more after long workouts with profuse sweating.

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