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Thread: First time anti-fungal user - advice appreciated

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    Default First time anti-fungal user - advice appreciated

    I've touched on this in another thread (and received some very helpful tips from Tom Busby & Sejon), but thought I'd post this specific query on it's own.

    My GP has agreed to treat me with a topical anti-fungal for a persistent acne-type rash on my chin and nasolabial folds. This is a relatively new symptom for me that flared following (and has been troublesome since) extensive use of soolantra cream, and it seems to be visibly distinct from my longer-standing acne, which predominantly affects my nose, cheeks & forehead rather than the mouth area. The apparent difference has been underscored by the fact that a course of oral antibiotics has cleared my more 'traditional' symptoms, but my mouth area continues to rage...

    However, the GP has prescribed me a combined steroid / anti-fungal cream. At the time I didn't question this, but I've since become concerned at the prospect of using a steroid (even a very mild one) on my face, unless absolutely necessary. So my query is...IS this necessary? Can I not just use the straight-up anti-fungal on it's own, without the steroid? (I've put the query to a pharmacist but they were not at all helpful). The prescription is hydrocortisone/clotrimazole.

    Is clotrimazole even the most appropriate/effective anti-fungal for the job? Another user here suggested Ciclopirox Olamine cream, but that appears to be prescription only here in the UK (my unhelpful pharmacist hadn't even heard of it).

    So, any advice or input that anybody can offer on facial antifungal treatment would be most gratefully received!
    Last edited by davem81; 26th August 2019 at 05:35 PM.

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    The issue with steroids is that they treat the symptoms but not the cause, by suppressing the immune response, but the body has an immune system for a reason. When the immune system is locally suppressed, I believe it can potentially cause other issues -- for instance demodex seems to take advantage of a lowered immune system and proliferate.

    That said, using a mild steroid like hydrocortisone on small areas of the face for a limited time (a week or so) is unlikely to be a problem. It's longer term use that brings risks.

    Clotrimazole is useful against many species of fungus but is rather ineffective against Malassezia, which is implicated in seb derm. Ciclopirox olamine cream is a better bet, but as you said, it's prescription only in the UK but more readily available in Europe -- you might find some online pharmacies in countries like France that will post it to the UK. Alternatively you can try a piroctone olamine cream -- examples are Ducray Kelual, La Roche Posay Kerium, Sebclair, Nutradeica/Nutraseb -- or a ketoconazole cream, although the latter seems to just be available as thick, potentially comedogenic creams intended for use on the feet or body rather than the face.

    Clotrimazole w/ hydrocortisone is the standard go-to seb derm treatment prescribed by GP's in the UK, which shows how poorly understood the condition is. I used such a cream to clear up a fungal rash on my chest which likely involved a completely different species, and it did that amazingly well, but it was useless for the seb derm on the sides of my nose.

  3. #3
    Senior Member Tom Busby's Avatar
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    Like sejon said, the steroid is not going to help. And clotrimazole treats dermatophytes, which is usually called athlete's foot, and doesn't ever occur on the face because dermatophytes require a very humid, wet environment to grow. Clotrimazole is not going to make any difference.

    I suggest you treat the condition as bacterial, and see if you get any results. First, treat your mouth with Paroex, which is 0.12% chlorhexidine gluconate. This is prescription only in the US but is OTC in the EU. It's tricky to use because every surfactant neutralizes it -- therefore, brush your teeth with toothpaste in a normal way, then sip a highly (1 to 6) diluted vodka/water drink over the next half hour, and then re-brush your teeth with Paroex as a mouthwash. This is super easy to do.

    In addition, treat the nasal passages as a likely reservoir for the problem. This is also super easy but the active ingredients are very mild, so the treatment will take about 2 months. Buy some Similisan "Dry eye Relief," which contains silver sulfate and sodium nitrate that immediately (in the bottle) react to form silver nitrate, which is a mild anti-bacterial. Silver nitrate was used for decades in newborn's eyes until better anti-bacterials were invented. This will not treat dry eyes at all, but will drip into the nasal passages to knock out the reservoir of bacteria that has become visible around your mouth. (The eyes, nose and mouth are connected. Look at an anatomy drawing and it will be clear.) You can use the Similisan about twice a day, but you'll get better results if you use it before you brush your teeth, and then again when you use Paroex. One drop in each eye is plenty. I suggest you use it in the morning too, but this might be unnecessary.

    That being said, when you hire a doctor and disregard his or her advice, the doctor should fire you as a patient.

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    Quote Originally Posted by Tom Busby View Post
    Like sejon said, the steroid is not going to help. And clotrimazole treats dermatophytes, which is usually called athlete's foot, and doesn't ever occur on the face because dermatophytes require a very humid, wet environment to grow. Clotrimazole is not going to make any difference.

    I suggest you treat the condition as bacterial, and see if you get any results. First, treat your mouth with Paroex, which is 0.12% chlorhexidine gluconate. This is prescription only in the US but is OTC in the EU. It's tricky to use because every surfactant neutralizes it -- therefore, brush your teeth with toothpaste in a normal way, then sip a highly (1 to 6) diluted vodka/water drink over the next half hour, and then re-brush your teeth with Paroex as a mouthwash. This is super easy to do.

    In addition, treat the nasal passages as a likely reservoir for the problem. This is also super easy but the active ingredients are very mild, so the treatment will take about 2 months. Buy some Similisan "Dry eye Relief," which contains silver sulfate and sodium nitrate that immediately (in the bottle) react to form silver nitrate, which is a mild anti-bacterial. Silver nitrate was used for decades in newborn's eyes until better anti-bacterials were invented. This will not treat dry eyes at all, but will drip into the nasal passages to knock out the reservoir of bacteria that has become visible around your mouth. (The eyes, nose and mouth are connected. Look at an anatomy drawing and it will be clear.) You can use the Similisan about twice a day, but you'll get better results if you use it before you brush your teeth, and then again when you use Paroex. One drop in each eye is plenty. I suggest you use it in the morning too, but this might be unnecessary.

    That being said, when you hire a doctor and disregard his or her advice, the doctor should fire you as a patient.
    Still looking for a good cleanser but Rosewater is saving my skin at the moment x
    I have no ideas how but it is . Must be it’s antibacterial properties.
    I also have a smell in my nose which I think is bacterial. Thinking about having it swabbed .
    Would Ciclopirox Olamine cream work on demodex ?
    I’ve come off all meds’ this week turning to acupuncture only .
    Last edited by Rubydo1; 27th August 2019 at 08:36 AM.

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    Thanks for your responses.

    Sejon, that pretty much confirms my initial thoughts. Are you aware of any reason not to use clotrimazole alone on the face (ie without the hydrocortisone), as I think I'd feel happier going that route? Short-term symptom suppression is not what I'm looking for at this point, even more so if it risks knock-on effects, so I'd prefer not to use hydrocortisone unless there's a legitimate reason for doing so. I'll also look into the options for obtaining either of the olamine creams before deciding which way to go.

    Tom, I've actually gone pretty hard at the bacterial angle already. I've treated my mouth in a similar manner to that which you suggested, and also washed my face (and body) for around 10 days with hibiclens, neither of which had much, or any, apparent effect. I had a nose swab done around the same time, which came back normal. I also treated myself with bactroban cream, which was quite an experience - my face exploded in pustules during the treatment course (>10x worse than 'normal'), which settled within a week or so...and then everything just went back to normal (actually, a little worse, if anything), as if I'd never treated. There was no improvement, not even temporarily, save for the swift recovery from the massive flare that the treatment itself sparked. I never really knew what conclusions to draw from that little episode.

    Additionally to all that I'm currently taking oral erythromycin, which has totally cleared my upper face, while leaving my chin & nasolabial folds no better. For these reasons, I feel it's time I explored the fungal option at this point. & the Dr. agrees, so I am following his advice...in a fashion
    Last edited by davem81; 27th August 2019 at 02:36 PM.

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    Would Ciclopirox Olamine cream work on demodex ?
    Not that I'm aware of. It might reduce the bacterial load from demodex populations, but I'm unaware of it having any effect on the demodex mite itself, and assume it doesn't considering how hardy the mites are.

    Are you aware of any reason not to use clotrimazole alone on the face (ie without the hydrocortisone), as I think I'd feel happier going that route?
    Apart from it just being ineffective, I see no reason why you can't.

    If you're acne-prone, the cream's inactive ingredients might be a concern. As I recall, clotrimazole and ketoconazole creams (both of which are designed for use on athlete's foot and sweat rashes on the body) have a comedogenic thickening agent, isopropyl myristate, which can cause breakouts in a lot of people if used on the face, so that's something to bear in mind.

    Additionally to all that I'm currently taking oral erythromycin, which has totally cleared my upper face, while leaving my chin & nasolabial folds no better.
    It's a bit counter-productive to treat a fungal condition while on oral antibiotics, since the latter exacerbates the former, but one can only assume your doctor is aware of that and knows what are the best options to try.

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    Quote Originally Posted by sejon View Post
    Apart from it just being ineffective, I see no reason why you can't.

    If you're acne-prone, the cream's inactive ingredients might be a concern. As I recall, clotrimazole and ketoconazole creams (both of which are designed for use on athlete's foot and sweat rashes on the body) have a comedogenic thickening agent, isopropyl myristate, which can cause breakouts in a lot of people if used on the face, so that's something to bear in mind.
    That certainly is worth bearing in mind, as I've fallen foul of such things in the past. Does this not apply to ciclopirox olamine?

    Edit: Actually, I don't see it on the ingredient list of the product I have.

    Purified water, 2-octyldodecanol, stearyl alcohol, cetyl alcohol, cetyl palmitate, sorbitan stearate, polysorbate 60, benzyl alcohol.

    Is there anything there you'd be concerned with? I have very little knowledge to draw on in this regard.

    Quote Originally Posted by sejon View Post
    It's a bit counter-productive to treat a fungal condition while on oral antibiotics, since the latter exacerbates the former, but one can only assume your doctor is aware of that and knows what are the best options to try.
    Actually on a related note, I'd taken the exacerbation that has occurred in support of the theory that I have a fungal issue going on. I only have a few weeks left on the antibiotics, I guess I could wait it out and treat after I've finished them.
    Last edited by davem81; 27th August 2019 at 07:43 PM.

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    That certainly is worth bearing in mind, as I've fallen foul of such things in the past. Does this not apply to ciclopirox olamine?
    The ciclopirox olamine creams I came across, Mycoster and a generic, did not contain highly comedogenic ingredients like isopropyl myristate. That said, a formulation's comedogenecity can be highly variable on the individual. I just mention isopropyl myristate (or palmitate) in particular because it's a well-known acne trigger, and it's common in body and foot creams.

    The ingredients you listed for your cream are unlikely to cause such problems.

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    Quote Originally Posted by sejon View Post
    The ciclopirox olamine creams I came across, Mycoster and a generic, did not contain highly comedogenic ingredients like isopropyl myristate. That said, a formulation's comedogenecity can be highly variable on the individual. I just mention isopropyl myristate (or palmitate) in particular because it's a well-known acne trigger, and it's common in body and foot creams.

    The ingredients you listed for your cream are unlikely to cause such problems.
    It beggars belief that proper creams for the face havenít been developed over than
    Smearing athletes foot cream on your face .

    Iíve blown the remainder of my savings on seeing a skin specialist as I need a proper diagnosis.
    Iím just hoping heís good and not a waste of money.
    Whatís the best cream you have used for SD ?
    My last doctor told me to wash my face with Selsun. I tried and it split my skin.

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    My sentiments exactly. People resort to athlete's foot creams and doctors are prescribing harsh shampoos for the face -- a testament to how seb derm research and treatments are horrendously lacking as compared to other common skin conditions like acne, rosacea, and eczema.

    Out of the commercially available creams I've tried, I found that the only ones that made a discernible difference were the Ducray Kelual DS and the Bioderma Sensibio DS creams. Using these creams caused my entire face to turn red like a sunburn, which appeared to be a fungal die-off reaction, and then the redness faded over the course of two months with continuous use, and the stubborn seb derm rashes on the sides of my nose and between my eyebrows cleared.

    There are quite a few European, and especially French, brands that have ranges for seb derm, so it seems, to a certain extent, big "cosmeceutical" companies have recently stepped in where pharmaceutical treatments are lacking, having discovered that there's a considerable market for it.

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