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Thread: Stuck with Seb Derm

  1. #1
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    Default Stuck with Seb Derm

    Hey guys I've been a long term lurker on this site. Finally made an account because I'm so desperate for help!

    Been reading Tom Busby's research on here and am so grateful for the information.
    Sorry for this long backstory but it is what started this whole mess for me.

    I have had mild scalp dandruff since I was about 12 years old. I never thought anything of it and it would always go away after a wash or two with any antidandruff OTC shampoo. I had great skin until I was about 18 years old; I started breaking out in pustular and occasionally mild cystic acne that never really bothered me until other people started to notice. Of course I made myself an appointment at the local derm office in Connecticut and he took one quick look at my skin and prescribed me .3 differin gel (adapalene) and 5% duac BP gel. He told me to use one at night and one in the morning. Being a naÔve kid I of course followed his instructions and within 6 months all my acne cleared up. It was severely drying so I made a follow up appointment after being clear and asked him if I should discontinue or wean off. He looked at me and said keep using it indefinitely, I was confused as my skin was super dry and uncomfortable but of course I was going to listen to the doctor. I kept using for another 6 months until I couldnít handle it anymore. My skin was red, flaking, dry, cracked, and looked like I was 60 years old. I made an appointment at a new derm and after looking at me he told me that it was rosacea and I needed antibiotics. I should have done my research but I of course thought this new derm would be great. I took Minocycline for 5 months and my skin went absolutely crazy. Tiny bumps all over my forehead, itchy scalp and eyebrows, yellow crusting skin, and weird acne like bumps that would form in a line of 4 or 5 across my nasal folds and cheeks. I moved to Boston and was so embarrassed to even go outside so I thought I would try one more derm, thank god he looked at me and correctly diagnosed me with pityrosporum folliculitis a.k.a. malassezia. He prescribed me oral ketoconazole 10 days and Promiseb topical cream. He also told me I could wash with Nizoral 1% to help speed up the process. Two weeks later WOW all the bumps were basically gone and about 50% of the redness. I was far from perfect but just happy to have a correct diagnoses. Itís been almost a month since then and Iíve been all over rosacea group reading posts and trying to educate myself. I am currently reading about the ďbiofilmĒ that I know I have, as every time I wash my face there is the grey snakeskin appearance on my cheeks. I have ordered the hegor 150 off eBay as well as local raw honey and started using an electric shaver. I have access to promiseb and basically any prescription topical I want. I am also willing to spend any amount of money necessary to try and treat this. I also wake up with 1-4 tiny folliculitis whiteheads usually on my chin and they leave little marks that can last weeks. I have certainly made progress but I have plateaued now and am at my wits end with what to do. I am hoping that because most of this condition was caused by topicals I can treat it easier than someone who just gets it out of the blue but I have no real evidence to support that theory. This seb derm has destroyed my confidence and left me a hermit confided to my apartment. I have lost contact with many friends because of this and am desperate for a solution (Iím only 21). Any advice is appreciated. I just want normal skin and a normal life.

    Thank you to anyone who reads this.

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    Default Photos

    Hey Guys, thought I would add some photos to help. Really stuck and need advice on how to proceed.
    Currently using hegor 150 on face and hair.
    I just got out of the shower in these pics so you can see how dry everything is and the folliculitis patches in my facial hair and regular hair.
    Screen Shot 2015-11-02 at 11.42.28 AM.jpgScreen Shot 2015-11-02 at 11.43.17 AM.jpgScreen Shot 2015-11-02 at 11.45.46 AM.jpgScreen Shot 2015-11-02 at 11.46.24 AM.jpg

    Please help.

    Thanks

  3. #3
    Senior Member Tom Busby's Avatar
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    You could try Nizoral 1% shampoo, which is OTC in the US and will arrive more quickly than Hegor 150, which ships from Bulgaria. Topical climbazole is much more effective than topical ketoconazole, but Nizoral is still better than nothing.

    How did you get a prescription for oral ketoconazole? The FDA banned it's use in the US in November, 2014, except for highly resistant cases, and I thought Canada and the EU made the same ruling soon thereafter. I thought I'd also read that the manufacturers stopped selling it at the same time. Itraconazole is the only pill available now, to treat seb derm induced by a malassezia-allergy.

    Don't be a hermit -- people who are worth knowing won't judge you.

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    Quote Originally Posted by Tom Busby View Post
    You could try Nizoral 1% shampoo, which is OTC in the US and will arrive more quickly than Hegor 150, which ships from Bulgaria. Topical climbazole is much more effective than topical ketoconazole, but Nizoral is still better than nothing.

    How did you get a prescription for oral ketoconazole? The FDA banned it's use in the US in November, 2014, except for highly resistant cases, and I thought Canada and the EU made the same ruling soon thereafter. I thought I'd also read that the manufacturers stopped selling it at the same time. Itraconazole is the only pill available now, to treat seb derm induced by a malassezia-allergy.

    Don't be a hermit -- people who are worth knowing won't judge you.
    Hey Tom,

    Huge fan of yours here on the forum!
    I already have the hegor 150 and am currently switching between that and nizoral 1%. It's a super slow process but I think I am making some headway. The biofilm is just so thick and stuck on there. From the photos do you think that what I am using is effective? They're not the best quality so I can always upload more but I would love to hear your expert opinion on what you see. I had no idea that ketoconazole was banned, my derm simply prescribed it and made me promise not to drink any alcohol while on it and said he can only prescribe it this once for me. He prescribed me 10 days of 200mgs. Not sure if he was bending the rules here or what but I was able to pick it up here at CVS in Boston no problem. Maybe it was so bad he was aloud to do it? No idea... Anyway thank you for responding and please let me know what you think from the photos. I only have a little bit of malassezia on the chest which is managable and its not something anybody but myself sees so I am not as concerned about it as my face. Do you think I should continue washing my face with the plain hegor 150 or should I make my own lotion like the ones you have developed and kindly shared?

    Thank you in advance!

    James

  5. #5
    Senior Member Tom Busby's Avatar
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    Hi James, keep using Hegor 150 for 2 weeks, and tell us if you see any changes, like increased flaking and localized redness. You can use the Nizoral if you like, but topical is ketoconazole is barely effective. Climbazole is much more effective in a topical wash.

    MD's are allowed to prescribe oral ketoconazole only if the condition is non-responsive to other treatments. As climbazole is not the subject of a "final monograph" from the FDA, climbazole isn't allowed to be sold in the US, and it's certainly fair to say that the condition isn't treatable by Nizoral, Selsun Blue, or Head and Shoulders, so I suppose an MD who doesn't know that climbazole is very effective, could logically prescribe oral ketoconazole.

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    Quote Originally Posted by Tom Busby View Post
    Hi James, keep using Hegor 150 for 2 weeks, and tell us if you see any changes, like increased flaking and localized redness. You can use the Nizoral if you like, but topical is ketoconazole is barely effective. Climbazole is much more effective in a topical wash.

    MD's are allowed to prescribe oral ketoconazole only if the condition is non-responsive to other treatments. As climbazole is not the subject of a "final monograph" from the FDA, climbazole isn't allowed to be sold in the US, and it's certainly fair to say that the condition isn't treatable by Nizoral, Selsun Blue, or Head and Shoulders, so I suppose an MD who doesn't know that climbazole is very effective, could logically prescribe oral ketoconazole.
    Thanks for getting back to me Tom!

    I have been using the hegor as a face wash already for about 5 days and am noticing increased flaking but I'm not sure what you mean exactly by "localized redness", could you elaborate? I have been getting new spots like zits but they are not actual puss filled pimples but rather flat red marks like you can see on the very last picture that seem to just come up out of the blue. As I begin to try to combat the bio-film it seems like their are just little red dots and marks everywhere underneath my many layers of dead skin, is this normal? Yes my doctor mentioned nothing of climbazole to me but I am still happy with him as I would still be clueless with what condition I had if it weren't for him. So far he has given me script wise: 10 days oral ketoconazole (completed), topical promiseb cream that I use as a moisturizer, and 2% topical ketoconazole cream which literally doesn't do anything. Let me know your thoughts, I can upload more pictures too if it's helpful. Thank you so much for reading my posts. I will do anything to treat this and will share my experiences with the forum.

    Best,
    James

  7. #7
    Senior Member Tom Busby's Avatar
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    Hi James, everything you wrote above about flat red marks, that aren't pus filled, red dots under the surface, and what appears to be an extra layer of skin over the top, are exactly the signs I experienced. Your photos look more like seb derm than any photos I've ever seen on this forum, so additional photos aren't necessary.

    Also, I agree with your observation that ketoconazole cream doesn't seem to do anything.

    "Localized redness" is redness around the bumps or under the extra layer of skin -- it's the opposite of red-everywhere, which would happen if you had a reaction to SLS. Very few people have a reaction to SLS, and most people don't, but it's worthwhile to point out the possibility.

    Promiseb is ok, but it's a really odd prescription cream, with no active ingredients. What does it cost, with insurance?

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    Hey James, i'd like to see some clearer pictures. Ones where you can see the texture of your skin. I see similarities to my own skin but the photos aren't great so it's kinda hard to tell.

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    Hey Tom and Johnny,

    The promiseb cost me 35 dollars with my insurance. I don't think it's doing a lot to help but its definitely not hurting the situation either so I keep using it but only as a moisturizer to help relieve the tightness when I get out of the shower. I am relieved that your experience was/is similar to mine as I have felt like a freak of nature these past months not having a correct diagnoses. Here are some more photos (better I hope) I am just using an Iphone camera so I apologize they aren't the best quality. Thank you both for responding and let me know what you see in the more detailed pictures. Screen Shot 2015-11-03 at 4.26.16 PM.jpgScreen Shot 2015-11-03 at 4.25.54 PM.jpgScreen Shot 2015-11-03 at 4.25.37 PM.jpgScreen Shot 2015-11-03 at 4.26.42 PM.jpg

  10. #10
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    Default Promiseb

    I believe I have Malassezia induced Folliculitis and was considering asking my doc for Promiseb at my next visit, but not sure now if I should bother. Please keep us updated!

    I am currently on day 10 of oral Itraconazole (200mg/day) but it doesn't seem to be helping much. I have good days and bad - always made worse by things that bring up my body temperature (like taking my kids to their swimming lessons or too hot showers). I have noticed bubblebaths in Nizoral shampoo (I'm in Canada, our Nizoral is 2% concentration) help the most so far. I think it's bc a thin film of the Nizoral is left on my skin after I get out of the tub. And I try to air dry my skin as much as possible.

    Anyways, please keep us posted on the Promiseb!

    ETA: Tom, hope you don't mind my asking... did you have Folliculitis and/or pimples/pustules along with your seb derm?
    Last edited by Daners; 4th November 2015 at 07:59 PM.

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