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Thread: Basic SD query

  1. #1
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    Default Basic SD query

    As some regular posters may recall, I had a very bad experience with soolantra cream in 2018. This is elaborated on in the monster soolantra thread, but I have a specific query over one element of the problem that I suspect may relate to SD...

    Basically, after several months of soolantra use (and some initial, fleeting benefits), I ended up having the mother of all flare-ups, which I'm still dealing with now nearly a year later. One specific aspect of this flare-up was irritation around my chin, which prior to using soolantra was the one area of my face that wasn't affected by my skin issues. However, I was specifically directed to apply the product to my chin, even though it wasn't a 'problem' area for me. So that's what I did....

    Well, today, my chin most certainly is a problem area! The visible appearance of the irritation is though quite distinct from the issues I have elsewhere on my face. Elsewhere, I suffer from acne-type, mostly pus-filled spots, but my chin has the appearance much more of a type of red 'rash'/blotchiness, particularly under beard growth (which I'm frightened to shave off, for fear of the extent of what I'll find), rather than the distinct individual blemishes I tend to get elsewhere. It doesn't particularly itch, but there is flakiness, and some pustular eruptions involved in the rash.

    This is an entirely 'new' symptom to me, but I've read several posters raise concerns that soolantra might provoke SD in people who use it, due to the ingredients in it. My query is therefore does this sound like SD, and if so, would nizoral shampoo represent a sensible first treatment attempt?
    Last edited by davem81; 25th June 2019 at 02:46 PM.

  2. #2
    Senior Member Tom Busby's Avatar
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    Hi dave, you could start with Hibiclens (OTC everywhere, even in the US) to determine if you have a bacterial problem. Massage the Hibiclens onto a wet face for 2 minutes, and rinse with water. Towel dry.

    Don't add any other soap or surfactant because it will neutralize the active ingredient, chlorhexidine gluconate. Hibiclens is sold at Walgreens and many other drug stores. Keep it way from your nose and ears, because there are rare events where it penetrates to the ear drum and causes permanent deafness. Hibiclens is designed as a hand scrub, so this is an off-label use.

    I suggest you start with the assumption that the problem is bacterial, because bacteria are much easier to kill than fungi. Your skin should be better in 2 weeks with 2x per day use. It's drying to the skin, so apply a lotion about 20 minutes after your face dries. Don't use it for more than 2 weeks, not because it's bad for you, but because it will nuke all the bacteria, and it's "normal" to have some bacteria on the skin. Plus, 2 weeks is plenty to use it as a diagnostic test.

    Wash your hands before you apply Hibiclens. Wash your towels and pillow cases at least once per week, and more during treatment. Or, use paper towels.

    Or, get a prescription for Bactroban (1% mupirocin) or Fucidin (2% fusidic acid). If none of this works, then try an anti-fungal treatment.

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    Hi Tom,

    Many thanks for your response. Your suggestions are very interesting - quite coincidentally, I tried this very approach (though not, I should add, in relation to the specific problem I'm raising here) earlier this year. The results were somewhat puzzling to me, but it's quite a long story and so perhaps I'll write another post about that, as it doesn't really directly relate to this query.

    I wonder if I could ask your further opinion on another point related to the irritation I have on my chin?

    As stated previously, my chin only became a problem area for me following several months of soolantra use. This may or may not be a coincidence, though my strong personal suspicion is that it is not. The issue surfaced around September of last year however, I have noticed that it appears to have significantly worsened since I grew a full beard in February/March this year. Again, I'm uncertain as to whether this is pure coincidence, or whether the beard growth might in fact be exacerbating the problem. I'm tempted to shave the beard off to investigate, but the risk is that this is something of a double-edged sword - at present, the beard is at least providing me with some level of 'cosmetic' cover for the problem.

    My question therefore is whether SD has any interplay with beard growth that you're aware of, or whether anything that might be termed 'beard rash' could be linked to, or confused with, SD? Also, does SD generally include pustular eruptions?

    Many thanks again for your input, it's very much appreciated.

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    Senior Member Tom Busby's Avatar
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    SD looks very much like a closed comedone, so it doesn't have an acne-like pustule (unless you scratch it too much, which of course will take the top off the red bump, and then it will bleed or at least weep out some plasma). This is the most direct clue as to seb derm. Also, the location of seb derm usually isn't just the chin, but instead, is more prominent around the nose creases and forehead. Of course, seb derm can include the chin, but not usually by itself. Hence, I suggested you look at the problem as if it were bacterial, and treat it as such, and see what happens.

    I don't have beard so I'm not the guy to have an opinion about beard rash. However, shaving is always irritating to the skin if you have any bumps. I doubt that shaving or not shaving is going to change anything. Try it and see though, because if you're right about beard rash, it's fairly easy to shave.

    I'm assuming you wash once per day in the shower, and don't just splash in the sink, because the force of a shower is necessary to rinse off the surfactants, dirt, and sebum. In my correspondence with people on this forum, I've learned there is a small minority of people who rarely take a shower, and their problems tend to resolve with what I think is a more "ordinary" cleaning schedule. Also, wash your hands completely, if you apply lotion more than once per day. This paragraph isn't directed at you, but it's good to cover the basics, because of the format of this forum.

    As for Soolantra, the saying is, "There are no coincidences," so you're probably right that your problem is probably related to something about your use of it. I can't figure out what it might be though.

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    Quote Originally Posted by davem81 View Post
    As stated previously, my chin only became a problem area for me following several months of soolantra use. This may or may not be a coincidence, though my strong personal suspicion is that it is not. The issue surfaced around September of last year however, I have noticed that it appears to have significantly worsened since I grew a full beard in February/March this year. Again, I'm uncertain as to whether this is pure coincidence, or whether the beard growth might in fact be exacerbating the problem. I'm tempted to shave the beard off to investigate, but the risk is that this is something of a double-edged sword - at present, the beard is at least providing me with some level of 'cosmetic' cover for the problem.

    My question therefore is whether SD has any interplay with beard growth that you're aware of, or whether anything that might be termed 'beard rash' could be linked to, or confused with, SD? Also, does SD generally include pustular eruptions?
    For what it's worth, I sometimes develop beard rashes also, and if I shave, the area of the rash will flake off after a few days and heal, so in my case there is definitely a correlation between having a beard and developing rashes. I don't experience them nearly as often these days, but I remember one instance a couple years ago where I had developed symmetrical bright red rashes in my moustache, above the corners of my mouth, and when I shaved I looked like I had smeared clown makeup on my face -- it was that vibrantly red and obvious -- but the act of shaving (and possibly staying out in the sun for a bit after doing so) caused them to flake off and heal to the point that they were barely noticeable anymore within less than a week.

    I used to think it was Malassezia dermatitis, but since it didn't improve even after a year and a half of applying anti-fungals (climbazole, piroctone olamine, ciclopirox olamine) regularly I abandoned that idea.

    I still have a beard a lot of the time, but I don't grow it out as much, and I think occasionally applying topical sulphur has also helped in warding them off.

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    Thank you both for your input.

    Sejon, I also have experienced beard rash before, so I'm certainly not ruling that out. Like yourself, mine have also previously resolved upon/after shaving, however this current issue seems quite different from what I have experienced before. I've never previously had it on my chin, it has always been on my cheeks previously and has itched intensely. This one doesn't really itch, and the visible appearance is quite different. That said, I've never previously retained facial hair for more than about two weeks at a time prior to this (I've had the beard for about 4 months at this point), so I guess that could account for some of the difference. I'm not feeling brave enough right now to shave it off but it will eventually come to that, so I'll find out one way or the other at some point...

    Tom, I think I can probably begin to move away from the SD theory based on your comments, due to the presence of pustules in the rash. After a little bit more reading, I'm now wondering if it might be Perioral Dermatitis. One source I read stated that this is almost exclusively caused by steroid cream application, but another seemed to contradict this by stating that heavy cosmetic/moisturiser use could also be a cause - which would fit my circumstances in theory. The area of the irritation meanwhile certainly fits (chin & also a bit in & around the nasolabial folds). Coincidentally I was recently prescribed oral erythromycin in an attempt to bring my acne-type symptoms back under control. I really didn't want to take them, but I now see that they are also the treatment for PD...so I will perhaps have to give that a little more thought.
    Last edited by davem81; 27th June 2019 at 08:10 PM.

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    Last year my sister came down with a stubborn case of perioral dermatitis -- red rashes of little pimples around her mouth -- and was prescribed antibiotic and steroid creams which had no effect and it continued to worsen. On a whim I suggested she try a tube of 1% ciclopirox olamine cream that I had lying about because I had used it unsuccessfully to treat what at the time I thought was seb derm. After applying that twice a day her PD cleared up completely in just 2-3 days. I made a mental note of it in case I ever come down with a similar affliction -- now I know precisely what to use.

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    Quote Originally Posted by sejon View Post
    Last year my sister came down with a stubborn case of perioral dermatitis -- red rashes of little pimples around her mouth -- and was prescribed antibiotic and steroid creams which had no effect and it continued to worsen. On a whim I suggested she try a tube of 1% ciclopirox olamine cream that I had lying about because I had used it unsuccessfully to treat what at the time I thought was seb derm. After applying that twice a day her PD cleared up completely in just 2-3 days. I made a mental note of it in case I ever come down with a similar affliction -- now I know precisely what to use.
    Sejon, is ciclopirox olamine cream prescription only, do you know? I have a GP appt. on Friday at which I'm going to bring this up.

    I'm about 7 weeks now into a course of oral erythromycin. This was a desperate attempt bring me some respite from the symptoms of what has been the worst (and most sustained) flare of my life - which directly followed months of soolantra use. The antibiotics started to work almost instantly (improvement was visible by the next day, everything but scars/marks had disappeared within maybe 4 or 5) and entirely cleared all of my symptoms, both facial 'acne' and the distinct perioral issue. However, the first signs of the magic effects wearing off came only 3 weeks later, and my chin & mouth area under my beard has since re-flared significantly - though not the rest of my face. This would seem to support my thinking that the chin/mouth issue is something distinct from my 'wider' problem, though whether the GP will be persuaded of this is another matter...

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    Senior Member Tom Busby's Avatar
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    Ciclopirox olamine is available as a shampoo and a cream. Here's more information: https://ca.gsk.com/media/1187424/stieprox.pdf https://www.wellrx.com/ciclopirox/monographs

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    So, my GP agreed that there is a good possibility that the symptoms around my chin and mouth are distinct from my longer standing acne-type symptoms (and didn't disagree with my suggestion/query over whether it could be perioral dermatitis sparked by soolantra use).

    However, he has prescribed a combined anti-fungal/steriod cream. Hydrocortisone & Clotrimazole 1% each.

    I'm personally unfamiliar with both steriod, and anti-fungal category treatments, having never used either. I am though vaguely aware of the need for caution with steriods. Can anybody comment on the pro's/cons of this treatment, and whether I should use this or seek out the ciclaprox olamine as already suggested?
    Last edited by davem81; 25th August 2019 at 09:07 AM.

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