This is my first post after just reading the forum for years.

Currently my whole face stings or pin pricks when I sweat. I use oracea and a just started a compounded medication of Cerave with .25 pyrithione zinc.

History:

I’ve had seb derm for a long time and in the last few months my skin has become so unbearable. Doctors aren’t sure if it’s irritant dermatitis, nerve damage, rosacea or perioral Dermatitis.

I was born with pink cheeks also known as keratosis pilaris rubra faceii. Now that I’m an adult most Doctors assume I have rosacea. None have them have ever asked if there was an onset of color change. I also never use sunblock and have a few threaded lines that are common with Rosacea.

I had seb derm on the face in both eyebrows and the sides of my nose. I was prescribed desonide which I used sparingly from 24 to 32. It never itched. It would come and go sometimes for months.

At 32 I started getting pimples and seb derm in the mustache then it exploded with new patches. Seb derm areas would sting or pin prick when I would sweat regardless of being red. I made an appointment at NYU Langone and tried to ween off steroids to protopic, elidel, loprox, ketoconazole and sulfur cleanser. The Derm assumed rosacea because of my cheeks. I told her that I was born with pink cheeks. I came to this forum and read about demodex and asked her to prescribe oral irvemectin and also oral fluconazole. She was hesitant but did prescribe the meds and pimples stopped. I also washed my face with a now discontinued OTC sulfur face cleanser.

I used elidel/protopic for about 18 months until Head&Shoulders came out with conditioner with 0.5 pyrithione zinc. I alternated this with the sulfur cleanser and then just used the conditioner for 7 years. Only twice I had one small spot appear under the eye. I used coal tar gel Psoriasin 3 times for two days on those spots.

Basically great skin for 7 years. I never used sunblock, ate spicey food, drank alcohol, and used saunas at gym. All things that someone with rosacea would not do.

7 months ago one my bottom eyelids was red along lashes and I started getting small pimple between eyebrows and in mustache.

I was on vacation and forgot my head&shoulders conditioner so I used the Head&Shoulders shampoo foam on face. Pimples would clear but new ones would reappear. Came back from vacation and realized the conditioner was finished so I bought a new one and noticed the inactive ingredients were slightly different. More little pimples. So I tried the shampoo and another shampoo with 2% pyrithione zinc on my face. I started getting burning sensations in mustache then chin and then side of nose. Oddly my facial sweating stopped. The burning would intensified in any temp above 72F.

So off to a local dermatologist who said rosacea. I didn’t want to believe her. Brought up the facial sweating and she had nothing to offer. But the burning wouldn’t stop. Cool water relieved it. I didn’t know how to prevent seb derm from coming back.

A month later new derm gave me oral steroids for about 3 weeks. Still burning. He thought irritant contact dermatitis.

3rd dermatologist said irratant contact dermatitis and wanted me to use topical steroids I said no because I thought it was perioral or perioccular Dermatitis and she prescribed Elidel. Elidel for a month didn’t help. I contacted her and she said steriod induced Rosacea and put me on Oreacea.

The lack of sweating from heat coupled with the burning I saw a neurologist. Had an MRI of brain. Normal. I begged for medication. I received low dose amatripyline. After a month the burning reduced. As sweating slowly came back my whole face would sting and pin prick. I also felt this pin prick in my arms. I asked neurologist if this could be a side effect of amatripyline and she said she didn’t know an to continue taking it.

When I would sweat I could see a gooey slim in my mustache and chin. Is this the biofilm? Is it dead skin mixed with moisturizer? I read the paper on PubMed about TV or PV malassezia biofim and made an appointment with the Derm at Drexel University in Philadelphia. I hoped he had insight because most dermatologist don’t think Seb Derm on the face has a biofilm. He said any heavy metal will disperse the the biofilm. Selenium Sulfide and Pyrithione zinc work because they are anti biofim and anti malassezia. Overall I was happy I made the trip to Drexel in Philadelphia.

I hoped that would help my ability to sweat and surpress the malassezia Seb Derm. I had patch testing done to see if pyrithione zinc was now an allergin or irratant. Test results came back negative.

Went back for second appointment at Drexel and asked if they could write a script for .25% pyrithione zinc compounded into cerave cream. They were reluctant but eventually did write the script as well a recommend Zyrtec for the stinging.

I just started use the compounded med as a cleanser not to leave on. Then I moisture with plain cerave cream.

I hope this works.

I just ordered: Eucerin Milk cleanser with piroctone olamine (as a preservative not as an active ingredient) recommend by Tom Busby.

Nutradeica topical with piroctone olamine that Sejon referenced.