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Thread: Biofilm Busting, Xylitol, and Simplicity!--Question for Tom Busby and Other Experts

  1. #11
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    Have you ever shared and pictures on this forum Joshuaeweb? I also have facial SD and rosacea I believe. Wondering how similar our conditions are..

  2. #12
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    Hi Josh, I believe xylitol is a preventative measure, not a treatment, but I've never tried xylitol, alone, to see if it will actually prevent seb derm reactions to malassezia. It's a good theory, but someone else will have to try it. I use 0.09% climbazole, which I believe is a very low dose, every day.

    Ketoconazole is not very effective in my experience, like you noticed. It works well enough to provide a positive diagnosis for seb derm induced by malassezia, so it's not completely useless -- just not very effective.

    You asked about two other topicals. What are the ingredients in Elidel Cream, 1%? It appears no one knows for sure, because Valeant, the manufacturer, provides only a bogus label. The primary ingredient, water, is listed last instead of first. And the 2nd to last ingredient, “triglycerides” is not an actual thing as far as INCI labelling is concerned. We are left to guess which oil is actually being used. The whole ingredient list seems to be listed backwards.

    Here’s Valeant’s label information: Active ingredient: pimecrolimus
    Inactive ingredients: benzyl alcohol, cetyl alcohol, citric acid anhydrous, mono-and di-glycerides, oleyl alcohol, propylene glycol, sodium cetostearyl sulphate, sodium hydroxide, stearyl alcohol, triglycerides, and water


    Promiseb contains shea butter so it’s a “bad oil” for malassezia, and butylene glycol is sticky and likely part of the flaky skin-matrix formed by the skin’s interaction with malassezia:
    Purified Water, Isohexadecane, Butyrospermum parkii, Pentylene glycol, Ethylhexyl palmitate, Cera alba, PEG-30 Dipolyhydroxystearate, Bisabolol, Polyglyceryl-6 polyricinoleate, Tocopheryl acetate, Hydrogenated castor oil, Acifructol complex, Butylene glycol, Magnesium sulfate, Piroctone olamine, Allantoin, Magnesium stearate, Disodium EDTA, Vitis vinifera, Ascorbyl tetraisopalmitate, Glycyrrhetinic acid, Propyl gallate, and Telmesteine.

    These two products are unlikely to help with a seb derm treatment. If they are helpful to anyone, it's likely that the skin condition is not seb derm induced by an allergic reaction to malassezia.

  3. #13
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    Quote Originally Posted by Tom Busby View Post
    You asked about two other topicals. What are the ingredients in Elidel Cream, 1%? It appears no one knows for sure, because Valeant, the manufacturer, provides only a bogus label. The primary ingredient, water, is listed last instead of first. And the 2nd to last ingredient, “triglycerides” is not an actual thing as far as INCI labelling is concerned. We are left to guess which oil is actually being used. The whole ingredient list seems to be listed backwards.

    Here’s Valeant’s label information: Active ingredient: pimecrolimus
    Inactive ingredients: benzyl alcohol, cetyl alcohol, citric acid anhydrous, mono-and di-glycerides, oleyl alcohol, propylene glycol, sodium cetostearyl sulphate, sodium hydroxide, stearyl alcohol, triglycerides, and water
    .
    They're listed in alphabetical order. It frustrates me when companies do that, since it makes the composition of their products even more vague, but it's not uncommon.

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    Thanks again for the reply. Curious then about how to reconcile and make sense of all of the research studies, including blind placebo trials, that show all of these creams improve seb derm and specifically reduce malassezia proliferation? I'm not doubting your feedback as much as trying to get my head around why the accepted science and research results that clearly work for some people don't work for others...

    If not one of these topicals, what's the best approach for those of us who want to decrease our symptoms but lack the expertise and acumen to make our own antifungal product? Is it using a climbazole based shampoo as a face wash such as e45 as I suggest above and then hoping a leave on product such as ketoconazole will do no harm and have some small effect?

    Any advice you could share Tom would be really helpful not just for me but I think for the many folks out there who are looking for relief but daunted by the impressive but complex regime you have established. Thanks again for your time and assistance.

    -Josh

  5. #15
    Senior Member Tom Busby's Avatar
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    Hi Josh, I suspect the problem is that seb derm isn't a well-defined term, and that why I generally write seb derm induced by malassezia -- it's really an allergic reaction to the by-products of malassezia, but there's no scientific test to confirm that it is in fact an allergic reaction, and there's no purpose in testing or looking for malassezia on the skin because of course there's malassezia -- all mammals have resident populations of malassezia.

    Tacrolimus (Elidel) suppresses the immune system, and likely treats the immune system's allergic reaction to malassezia, but not very well, and it's better to suppress malassezia than to treat one of the signs of a malassezia allergic reaction. Plus Elidel is prescription only and very pricey in the US because of our broken health care system.

    Your best OTC options are E45 shampoo and ketoconazole cream, as you pointed out.

    If a person uses ketoconazole or climbazole, and has reaction such as increased flaking at first, then you have a positive diagnosis for a problem with malassezia. Otherwise all red bumps look very similar.

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    Thanks again Tom. Last inquiry and then I'll stop bothering you! I used the Ketoconazole cream on my face for about 5 weeks. During this time, I can't say I have seen much of a reaction at all other than my condition continuing to spread to other parts of my face as it has for the last 3 months and the most affected spots turning slightly more pink and producing isolated tiny white flakes . Would you take this to indicate basically no reaction at all and thus maybe my seb derm (and I'm confident it is seb derm however poorly defined) is not an allergic reaction to malassezia? If not, any thoughts on the most common alternative cause and potentially effective treatment or at least options to try? Or is it possible that the biofilm is preventing much of a reaction given the limited efficacy of Ketoconazole, and the use of the e45 shampoo will be a more definitive test? As another piece of context, like I believe you reported, my skin is very oily to the point where I have sebaceous hyperplasia if that helps with determining cause and potential solutions.

    Thanks again for your time and advice. It's been a struggle to get used to this on type of my rosacea so any light at the end of the tunnel is of enormous benefit.

    -Josh

  7. #17
    Senior Member Tom Busby's Avatar
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    You can test for malassezia by buying Nizoral shampoo -- it's sold OTC at Target and other big box stores. Use it daily for at least 2 weeks, and you should get a response. If you have essentially no response, then you can cross off malassezia as a potential troublemaker. If you get a response, use it daily for 10 months or longer, or switch to E45 shampoo.

    Ketoconazole cream is in a mineral oil base, which is an occlusive that doesn't penetrate any part of the stratum corneum, so it doesn't work very well.

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    The problem with the anti-fungal creams available to us is that none of them is actually designed for facial skin. They're all meant for other parts of the body, mostly your feet, chest, or crotch. They therefore tend to be very thick and sticky and don't absorb effectively. A lot of them also contain a highly pore-clogging ingredient, isopropyl myristate, which wrought havoc on my acne-prone face when I tried them.

    My guess as to why anti-fungals like ketoconazole have been more successful for treatment of facial SD in scientific trials is that the researchers went through the trouble of formulating their own delivery vehicles for it, optimised for facial skin, rather than just giving the subjects a commercially available cream that's designed for athlete's foot.

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