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Thread: My skin is so f'ed

  1. #11
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    I don't think I have demodicosis, but I do think I have a malassezia proliferation and a terrible bodily immune response to it; i.e., seborrheic dermatitis
    Is there a specific reason why you've discarded demodex as a causative factor and believe it's Malassezia? I ask because the symptoms that you describe could just as easily be caused by demodex proliferation, so I'm having difficulty understanding why you've ruled it out.

  2. #12
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    Well I got another 2% ketoconazole shampoo script and after just two uses my skin is flaking off excessively. On the left side of my face at the edge of my cheek in the beard it looks like the Atacama desert this morning with raised flakes that looked like dried cracked skin. I had to use my fingers and just brisk over it over and over to get it off before going into work... my forehead is extremely flaky and eyebrows too. I know I have seb derm, but does ketoconazole even doing anything? Will the flaking stop? I am one of the lucky ones with this and rosacea.

    I also happen to be on a course of fluconazole for paronychia wonder if this does anything to seb derm.

  3. #13
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    When I pick off the flakes the underlying pores are so huge... and picking just exacerbates the erythema. I have been shaving my beard down to a 1 or 2 guard now and not going to let it grow. Seems to help with the patches in my beard by keeping it a lot shorter. I have a patch on my mustache that is very small but very obviously seb derm as it's reddish and flaking. And I have it fairly bad on my glabella and at the ends of my eyebrows closest to the center of my face/T-zone. I am only taking fluconazole right now and seldom using my ketoconazole shampoo. The fluconazole was actually for paronychia of my left big toenail... I have been taking 400 mg once weekly and have a 30 qty supply.

    Of course I am about 95% certain I also have rosacea. Nothing has really helped. My nose constantly crusts over every day if I pick off the scales, and it just makes everything way more red and oozes. I guess I am going through a LONG bout of this, but I can't remember the last time my nose felt smooth to the touch.

  4. #14
    Senior Member Brady Barrows's Avatar
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    aafdup, you think you are 95% certain you have rosacea, and you have ruled out demodectic rosacea since you said you tried ivermectin. Have you considered the oral ivermectin/metronidazole? Have you read when rosacea doesn't respond to standard therapies.

    The flaking you describe is more SD than rosacea. Have you gone through the Tom Busby's SD Treatment Protocol thread or the RRDi page on SD? You might have missed something or find something to help.
    Last edited by Brady Barrows; 13th June 2019 at 05:12 PM.
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  5. #15
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    I have been trying ketoconazole 2% prescription shampoo as a face wash (lathered and leave on 5 mins) to no avail. I will continue using it, and I am also taking 400mg/weekly fluconazole for something else that I hope has an effect on the seb derm by proxy. I don't remember the last time my seb derm waned.. it's essentially always all over my nose. It's on both sides of my face in my beard closest to my side burns in two small areas (it's actually the outer edge of the cheek really just extending into the beard), a small area on one side of my mustache and in both lower eyebrows and glabella area. I am sick of all of this stuff and tired of not going out on social outings and ignoring texts from people wanting to hang out.

    This isn't living... this is just getting through each day one day at a time without killing myself. What a miserable existence.
    Last edited by aafdup; 13th June 2019 at 08:22 PM.

  6. #16
    Senior Member Tom Busby's Avatar
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    Flaking skin after using a topical -azole is a sign of healing. Visualize it as a good thing -- conceal the flakes with a malassezia-safe moisturizer, applied with wet fingers so as to soak into the dead skin better. Concealing is much more effective than picking, scratching, or srcaping.

    Picking at the flakes will only irritate your skin, and accomplishes nothing. The cause of seb derm is much deeper than whatever you can see on the surface -- it's basically an allergic reaction to malassezia.

    Anyway, you can remove the most superficial flakes by gently rubbing with wet fingertips, or using the back of your fingernails (going backwards instead of forwards with your nails). Re-apply the moisturizer after rubbing.

    I started a thread about 4 years ago, on this forum, titled, "Moisturizers that do no Harm," which may provide some help in selecting a moisturizer. Please keep in mind that formulas have changed over the interval. CeraVe PM for example is not the same now as when I reviewed it.

    When using a commercial ketoconazole shampoo, you need to rinse completely because they all have sodium lauroyl sulfate, or some similar sulfate-based surfactant. Sulfate-surfactants will irritate your skin, at least a little, and must be washed off completely in the shower. To "rinse completely," rinse in the shower about twice as long as you normally would think is "enough." Don't use them in the sink, because splashing in the sink will not rinse completely.

  7. #17
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    Quote Originally Posted by Tom Busby View Post
    Flaking skin after using a topical -azole is a sign of healing. Visualize it as a good thing -- conceal the flakes with a malassezia-safe moisturizer, applied with wet fingers so as to soak into the dead skin better. Concealing is much more effective than picking, scratching, or srcaping.

    Picking at the flakes will only irritate your skin, and accomplishes nothing. The cause of seb derm is much deeper than whatever you can see on the surface -- it's basically an allergic reaction to malassezia.

    Anyway, you can remove the most superficial flakes by gently rubbing with wet fingertips, or using the back of your fingernails (going backwards instead of forwards with your nails). Re-apply the moisturizer after rubbing.

    I started a thread about 4 years ago, on this forum, titled, "Moisturizers that do no Harm," which may provide some help in selecting a moisturizer. Please keep in mind that formulas have changed over the interval. CeraVe PM for example is not the same now as when I reviewed it.

    When using a commercial ketoconazole shampoo, you need to rinse completely because they all have sodium lauroyl sulfate, or some similar sulfate-based surfactant. Sulfate-surfactants will irritate your skin, at least a little, and must be washed off completely in the shower. To "rinse completely," rinse in the shower about twice as long as you normally would think is "enough." Don't use them in the sink, because splashing in the sink will not rinse completely.
    I get into a cold shower, lather on the 2% prescription ketoconazole. Get out of the shower and let it sit for 5 mins, then get back into a cold shower to rinse off. This is what I did last night and what I am going to start doing every night. Sucks because I used to love hot showers. ****ing rosacea and seb derm ruined that. I don't even know what moisturizer would be good, the last time I used the big bottle of Cetaphil I still have it burned when I applied it. My nose is constantly caked in flakes. If I pick at it they can be very large and underneath is very irritated inflamed skin. How can the ketoconazole even penetrate this? It's like a protective covering over my enlarged pores which this has also caused..

    The seb derm literally covers my entire nose. I don't see how anything could penetrate it.. but picking at it does no good either.

  8. #18
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    I keep picking at the sides of my nose while I'm at work and it's just completely inflamed/red and even bleeding. How does ketoconazole penetrate this at all? It's so stubborn and just keeps coming back.

  9. #19
    Senior Member Tom Busby's Avatar
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    Ketoconazole barely works in my experience -- that's why I tried climbazole and found it to be reasonably effective.

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