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Thread: Rosacea or Seborrheic Dermatitis

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    Default Rosacea or Seborrheic Dermatitis

    Hello,

    I need help figuring out what this is please. I developed this condition about 6 years ago. I had horrible skincare habits...like only washing my face with water and never washing off my makeup (gross I know) :/ and then I began getting this build up of "dry skin" over the central areas of my face. I would just rub it off everyday because any type of moisturizer would break out my skin in tiny itchy whiteheads. I do tend to flush easy and I do have a history of dandruff in and around my ears as well as tinea versicolor that comes and goes. Many topicals just irritate my skin and if my skin gets oily or its humid I break out in itchy burning bumps. When my skin is dry I have this large powdery white build up in like ALL OF MY PORES haha I have attached some pictures. Sometimes my skin looks really good and other days not so much. Over the last couple of years I have tried taking better care of my skin. I have been told seb derm, mild rosacea, and perioral dermatitis at times by dermatologists. I did have a punch biopsy done which showed inflammation of the hair follicle and two demodex mites. But I know we all have the mites so I'm not sure if two mites really means an "overgrowth." I have tried soolantra, ovace, avar, and antifungal creams but seem to have bad reactions about a week after use. I'm wondering if this "build-up" is just from me like never washing my face that well or if this is one of the conditions I mentioned. I currently use Dr. Eddies Happy Cappy Pyrithione zinc wash once a night followed by squalane oil. My derm just started me on ORAL ivermectin for 2 weeks and Ketoconazole 2% shampoo 3 times a week. My skin was actually almost perfect during my third trimester of pregnancy for some reason? Although not sure if this is due to altered immune system or hormones! Your thoughts are immensely appreciated!!
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    Last edited by Capture531; 7th October 2019 at 07:49 PM.

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    Senior Member Brady Barrows's Avatar
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    Quote Originally Posted by Capture531 View Post
    Hello,

    I need help figuring out what this is please. I developed this condition about 6 years ago. I had horrible skincare habits...like only washing my face with water and never washing off my makeup (gross I know) :/ and then I began getting this build up of "dry skin" over the central areas of my face. I would just rub it off everyday because any type of moisturizer would break out my skin in tiny itchy whiteheads. I do tend to flush easy and I do have a history of dandruff in and around my ears as well as tinea versicolor that comes and goes. Many topicals just irritate my skin and if my skin gets oily or its humid I break out in itchy burning bumps. When my skin is dry I have this large powdery white build up in like ALL OF MY PORES haha I have attached some pictures. Sometimes my skin looks really good and other days not so much. Over the last couple of years I have tried taking better care of my skin. I have been told seb derm, mild rosacea, and perioral dermatitis at times by dermatologists. I did have a punch biopsy done which showed inflammation of the hair follicle and two demodex mites. But I know we all have the mites so I'm not sure if two mites really means an "overgrowth." I have tried soolantra, ovace, avar, and antifungal creams but seem to have bad reactions about a week after use. I'm wondering if this "build-up" is just from me like never washing my face that well or if this is one of the conditions I mentioned. I currently use Dr. Eddies Happy Cappy Pyrithione zinc wash once a night followed by squalane oil. My derm just started me on ORAL ivermectin for 2 weeks and Ketoconazole 2% shampoo 3 times a week. My skin was actually almost perfect during my third trimester of pregnancy for some reason? Although not sure if this is due to altered immune system or hormones! Your thoughts are immensely appreciated!!
    Probably your dermatologists are all correct since it is possible to have SD, rosacea and PD at the same time. As for the PD, "One of the most common factors is prolonged use of topical steroid creams and inhaled prescription steroid sprays used in the nose and the mouth. Overuse of heavy face creams and moisturizers are another common factor. Other factors include skin irritations, fluorinated toothpastes, or other dental fluorinated products. Some dermatologists believe it is a form of rosacea or sunlight-worsened seborrheic dermatitis."

    Your dermatologist is quite progressive to give you oral ivermectin, however, there is one paper that shows adding oral metronidazole improves the outcome. How long did he give you the prescription for oral ivermectin (only two weeks)? If you do improve, then you have demodectic rosacea. Please come back in two weeks and post your results.

    As for the count of only two demodex mites, one paper suggests using light microscopy and confocal laser scanning over using scraping:

    "Comparing the results obtained by light microscopy and confocal laser scanning in vivo microscopy in patients with rosacea and healthy people, in more cases Demodex mites are detected by confocal laser scanning in vivo microscopy, whereas scrape in these patients were negative."

    This same paper suggests that the ability of the mites to move may be the reason that mites are not detected in some humans.

    For the SD, recommend you read Tom Busby's thread on SD.
    Last edited by Brady Barrows; 7th October 2019 at 08:22 PM.
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    Thanks for they reply!

    I have never used topical steroids on the face and I do avoid fluoride since it does seem to flare it up more. My thoughts are that I have an overgrowth of yeast and demodex for not cleansing my face properly and a predisposition to them? Pityriasis folliculorum is something that keeps popping into my head. Literally every pore has a keratin plug/flake coming out of it. But I know this is similar in seb derm as well. My forehead is completely unaffected though which I feel like is a common place to be affected by seb derm. I was prescribed Ivermectin 4-3mg tabs on day one and then repeat in 7 days. I think he did this because my skin reacts badly to most topicals. Some of the bumps have flaked off on the side of my chin so far but the small flakes in the pores are still there. I have also read some studies that combination therapy is more effective but I was only prescribed the Ivermectin. I'm wondering how long this actually takes to work though? Some studies for perioral dermatitis and demodex induced rosacea that used 2 doses 7 days apart took about a month to 4 months to heal:

    https://www.jaad.org/article/S0190-9...009-X/fulltext

    and they were not using combined therapy.
    I am familiar with Tom Busby. I have actually been trying to purchase the AquaVive lotion he sells. Wondering if anyone has any experiences with his products? Seems like a knowledgeable guy : )

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    Senior Member Brady Barrows's Avatar
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    Good find on that article of oral and topical ivermectin in a series of 15 cases in children. Yes, Tom is an excellent source of information on SD and the resident RF SD Guru.
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    Senior Member Brady Barrows's Avatar
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    Quote Originally Posted by Capture531 View Post
    Pityriasis folliculorum is something that keeps popping into my head. Literally every pore has a keratin plug/flake coming out of it. But I know this is similar in seb derm as well.
    "Pityriasis folliculorum [PF] is an often over-looked clinical entity” and cases are ‘mostly female.’ Frank Powell, MD explains that there is ‘usually a history of rarely using soap or water to cleanse the facial skin but instead using cleansing creams.’ These individuals often apply moisturizers and complain of a burning or itchy sensation. He also states that the diagnosis of PF is ‘facilitated by use of dermatoscopy, which shows a distinctive picture of the presence of multiple white keratotic material consisting of keratin encrusted demodex mites protruding upwards from the follicular orifices.’ This condition ’seems to be caused by an over population of mites facilitated by the frequent use of creams and the lack of face washing with soap and water.’ "

    "Topical ivermectin has recently been FDA approved as therapy for rosacea. We present the case of a woman with pityriasis folliculorum who showed significant improvement from using topical ivermectin with no adverse events related to treatment."

    Source


    Horse paste is another option to consider.
    Last edited by Brady Barrows; 7th October 2019 at 11:06 PM.
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