Seborrheic Dermatitis

[Alice S. Fuzzybutt]

Hi Dr. Steve!

I've been suffering from seb derm (of the scalp) since I was 13. I went to a dermatologist once a few years ago about it. I know there is no cure. I was prescribed Nizoral but I wound up buying the OTC formula. It doesn't help much.

Do you know of any NEW treatments? I suppose I should just go to my dermatologist.

Does it get worse with age? I know it gets worse in cold weather.

Any advice would be appreciated!!!


THANKS DR. STEVE!!!

Petrina

[Dr Steve]

Hi Dr. Steve!

I've been suffering from seb derm (of the scalp) since I was 13. I went to a dermatologist once a few years ago about it. I know there is no cure. I was prescribed Nizoral but I wound up buying the OTC formula. It doesn't help much.

Do you know of any NEW treatments? I suppose I should just go to my dermatologist.

Does it get worse with age? I know it gets worse in cold weather.

Any advice would be appreciated!!!


THANKS DR. STEVE!!!

Petrina

Just to get everyone on the same page, Seborrheic Dermatitis causes flaky skin, generally on the face or scalp. It's thought to be caused by a fungus called Malassezia furfur, but it may be related to hormones as well, as it often disappears during puberty.

I'm lazy, so I copped this from "familydoctor.org":
Dandruff is usually treated with a shampoo that contains salicylic acid (some brand names: X-Seb, Scalpicin), the prescription medicine selenium sulfide (brand names: Selsun Blue, Exsel) or zinc pyrithione (some brand names: DHS Zinc, Head & Shoulders). These shampoos can be used 2 times a week. Shampoos with coal tar (some brand names: DHS Tar, Neutrogena T/Gel, Polytar) may be used 3 times a week. If you have dandruff, you might start by using one of these shampoos daily until your dandruff is controlled, and then use it 2 or 3 times a week.

When you use a dandruff shampoo, rub the shampoo into your hair thoroughly and let it stay on your hair and scalp for at least 5 minutes before rinsing. This will give it time to work.

If the shampoo alone doesn't help, your doctor might want you to use a prescription steroid lotion once or twice daily, in addition to the shampoo.

I can't argue with much in that quote...there doesn't seem to be much new on the horizon, unfortunately. It's definitely controllable, though. Just try different things until you find something that works!

[angrymissy]

I have it on my EYELIDS. Nothing new treatment wise, and I go to the dermatologist/eye doctor every year hoping for some fucking miracle cream. Creme de la mer worked for my eyes for a while (it seemed to turn over the skin), but it's about $130/oz. I might actually go that route again because I'm miserable right now, wintertime is awful for it.

Dr. Steve, if it's caused by a fungus, would anti fungal medication work?

[mendyweiss]

I have it on my EYELIDS. Nothing new treatment wise, and I go to the dermatologist/eye doctor every year hoping for some fucking miracle cream. Creme de la mer worked for my eyes for a while (it seemed to turn over the skin), but it's about $130/oz. I might actually go that route again because I'm miserable right now, wintertime is awful for it.

Dr. Steve, if it's caused by a fungus, would anti fungal medication work?

Loprox

[jetdog]

Selsun Blue, all the way. I'll have pretty bad break out on my forehead, especially when I am stressed out (whoch seems like all the time now...). The only thing I've found that works is plain old Selsun Blue. Be careful with the T-gel stuff, it clogs the pores.

[angrymissy]

Selsun Blue, all the way. I'll have pretty bad break out on my forehead, especially when I am stressed out (whoch seems like all the time now...). The only thing I've found that works is plain old Selsun Blue. Be careful with the T-gel stuff, it clogs the pores.

So you've used the shampoo on your face?

[jetdog]

So you've used the shampoo on your face?

Yup, lather it on and leave it for a minute or two. Works great. It contains selenium sulfide, same stuff in the prescription I was given.

[Alice S. Fuzzybutt]

Yes, I was given a steroid scalp lotion but it made my pillow case and pillow greasy, while not helping so much.

I read a statistic that Seborrheic Dermatitis only happens in 1 percent of the population and most of them are male. I guess Missy and I are "lucky."

I've tried every dandruff shampoo under the sun. The ones for seb derm smell HORRIBLE.

I don't mean to be a bad patient. Nixoral smelled nice but I can't afford $15 fir 8oz of shamoo.

Missy-- I'm getting it on my ear lobes. I so feel your pain. I really do suggest you put shampoo on your face. While it doesn't do much for my scalp, Nizoral helps with my ears.

[Bellyfullasnot]

I've had seborrheic Dermatitis every winter for years. This winter it was the worse. Probabaly has something to do with financial stress and the severe weather.

I've used the t-gel shampoo and conditioner and have done "spot treatments" on my ear lobes with 1% hydocortisone from cvs (otc). Once in a while, I use my kid's (for eczema) Alclometasone ointment (prescription). I'm pretty happy with the results but I have very short hair so it's easy to deal with the ointment.

I'm not a medical professional of any type, but try cutting down on beer or bread products. Certain foods trigger reactions with me. Hope some of this helps.

[bentcorner]

I've got psoriasis on my palms and fingers. I feel for ya.

[Dr Steve]

I have it on my EYELIDS. Nothing new treatment wise, and I go to the dermatologist/eye doctor every year hoping for some fucking miracle cream. Creme de la mer worked for my eyes for a while (it seemed to turn over the skin), but it's about $130/oz. I might actually go that route again because I'm miserable right now, wintertime is awful for it.

Dr. Steve, if it's caused by a fungus, would anti fungal medication work?

Absolutely, that's why they recommend the Nizoral shampoo; Nizoral is an antifungal. It doesn't work for everyone, and not everyone who is exposed to the fungus gets seb derm, so there's more to it than that (host immunity, etc.), but I'd say the majority of my patients have had some response to nizoral.

I like the good ol' selsun blue, as well. there's a wacky fungus called "Tinea Versicolor" that responds nicely to Selsun solution too. Just don't get it IN your eye.

your pal,


steve

[Reephdweller]

I have both psoriasis on my face and seborrheic dermatitis on my scalp. I have been using various medications over the years for my face and scalp. For my scalp I was taking Nizoral but every few months or so it would seem like my scalp would get used to it and the effect it would have would wear off. I would end up going from shampoo to shampoo to find a cure that would be temporary at best, from Selsun to Denorex to Nizoral both OTC and prescription and the fixes would always be short lived.

That is until about 4 months ago. Usually when my skin acts up also it tends to happen severely from season to season as the weather changes. It happened that this time both my scalp and face flared up intensely at the same time probably due to stress but it was the absolute worst I ever went through. I tried everything I could think of, reading countless articles, considering getting very expensive creams like Creme De La Mer also, pretty much anything I could to find the relief. Then one day someone told me to give Clinique's facial scrub and their three step system a try. The one I got was Clinique for Men series it was pretty expensive but I decided to give it a try. It's worked wonders for my face since. I used to get god awful flare ups on my skin every once in a while, and now if anything it's in small isolated areas and after applying the treatment to my skin things tend to calm down very quickly, but this happens very rarely now.

I've also managed to resolve my scalp problem since then by switching to Selsun Moisturizing dandruff shampoo. I found the skin on my face and scalp would very quickly get very dry and crack which started the whole itching process. Since using Selsun Moisturizing shampoo the problem on my scalp has gone away.

Everybody is different and different things work for different people but for now this is working for me. I use the Clinique products very sparingly and the results have been amazing for me. I haven't had to use medication since which is unreal for me, it used to be I would have to apply something every few weeks or once a week.

[Radioguy]

Dr Steve, I had heard that many of the dandruff shampoos, like the zinc and coal tar ones can cause or accelerate hair loss to some extent. Is that so?

[angrymissy]

I have both psoriasis on my face and seborrheic dermatitis on my scalp. I have been using various medications over the years for my face and scalp. For my scalp I was taking Nizoral but every few months or so it would seem like my scalp would get used to it and the effect it would have would wear off. I would end up going from shampoo to shampoo to find a cure that would be temporary at best, from Selsun to Denorex to Nizoral both OTC and prescription and the fixes would always be short lived.

That is until about 4 months ago. Usually when my skin acts up also it tends to happen severely from season to season as the weather changes. It happened that this time both my scalp and face flared up intensely at the same time probably due to stress but it was the absolute worst I ever went through. I tried everything I could think of, reading countless articles, considering getting very expensive creams like Creme De La Mer also, pretty much anything I could to find the relief. Then one day someone told me to give Clinique's facial scrub and their three step system a try. The one I got was Clinique for Men series it was pretty expensive but I decided to give it a try. It's worked wonders for my face since. I used to get god awful flare ups on my skin every once in a while, and now if anything it's in small isolated areas and after applying the treatment to my skin things tend to calm down very quickly, but this happens very rarely now.

I've also managed to resolve my scalp problem since then by switching to Selsun Moisturizing dandruff shampoo. I found the skin on my face and scalp would very quickly get very dry and crack which started the whole itching process. Since using Selsun Moisturizing shampoo the problem on my scalp has gone away.

Everybody is different and different things work for different people but for now this is working for me. I use the Clinique products very sparingly and the results have been amazing for me. I haven't had to use medication since which is unreal for me, it used to be I would have to apply something every few weeks or once a week.

Creme de la mer did work for me for a while, the only thing is it's fragranced, which I hate (smells like old lady). It was actually originally designed by someone who wanted something to treat burns. It seems to heavily moisturize, then turn over the skin (the nasty flaky skin rolls off). I might try nizoral then the la mer.

I guess it seems there is no cure, just treatment. I have the eyes of a 50 year old from rubbing/scratching. If I can clear it up, I will be asking a plastic surgeon to fix it.

[Dr Steve]

Dr Steve, I had heard that many of the dandruff shampoos, like the zinc and coal tar ones can cause or accelerate hair loss to some extent. Is that so?

boy is this a hard one to dope out. If you just google coal tar and hair loss, there are a million websites on this. However, if you look at the actual medical literature, all I could find was this:

Int J Toxicol. 2008;27 Suppl 2:1-24.

Final safety assessment of Coal Tar as used in cosmetics.

Cosmetic Ingredient Review Expert Panel.

Cosmetic Ingredient Review, Washington, DC 20036, USA.

Coal Tar is a semisolid by-product obtained in the destructive distillation of
bituminous coal, which functions in cosmetic products as a cosmetic biocide and
denaturant--antidandruff agent is also listed as a function, but this is
considered an over-the-counter (OTC) drug use. Coal Tar is a nearly black,
viscous liquid, heavier than water, with a naphthalene-like odor and a sharp
burning taste, produced in cooking ovens as a by-product in the manufacture of
coke. Crude Coal Tar is composed of 48% hydrocarbons, 42% carbon, and 10% water.
In 2002, Coal Tar was reported to the Food and Drug Administration (FDA) to be
used in four formulations, all of which appear to be OTC drug products. Coal Tar
is monographed by the FDA as Category I (safe and effective) OTC drug ingredient
for use in the treatment of dandruff, seborrhoea, and psoriasis. Coal Tar is
absorbed through the skin of animals and humans and is systemically distributed.
In short-term studies, mice fed a diet containing Coal Tar found it unpalatable,
but no adverse effects were reported other than weight loss; rats injected with
Coal Tar experienced malaise in one study and decreased water intake and
increased liver weights in another; rabbits injected with Coal Tar residue
experienced eating avoidance, respiratory difficulty, sneezing, and weight loss.
In a subchronic neurotoxicity study using mice, a mixture of phenols, cresols,
and xylenols at concentrations approximately equal to those expected in Coal Tar
extracts produced regionally selective effects, with a rank order of corpus
striatum > cerebellum > cerebral cortex. Coal Tar applied to the backs of guinea
pigs increases epidermal thickness. Painting female rabbits with tar decreases
the absolute and relative weights of the ovaries and decreased the number of
interstitial cells in the ovary. Four therapeutic Coal Tar preparations used in
the treatment of psoriasis were mutagenic in the Ames assay. Urine and blood from
patients treated with Coal Tar were genotoxic in bacterial assays. Coal Tar was
genotoxic in a mammalian genotoxicity assay and induced DNA adducts in various
tissue types. Chronic exposure of mice to Coal Tar significantly decreased
survival and liver neoplasms were seen in a significant dose-related trend; in
other studies using mice lung tumors and perianal skin cancers were found. Coal
Tar was comedogenic in three small clinical studies. Folliculitis is associated
with the prolonged use of some tars. Several published reports describe cases of
contact sensitivity to Coal Tar. Polycyclic aromatic hydrocarbons, which make up
Coal Tar, are photosensitizers and cause phototoxicity by an oxygen-dependent
mechanism. A retrospective study of the reproductive toxicity of Coal Tar in
humans compared exposed women to controls and found little difference in
spontaneous abortion and congenital disorders. Cancer epidemiology studies of
patients who have received Coal Tar therapy of one form or other have failed to
link treatment with an increase in the risk of cancer. Although the Cosmetic
Ingredient Review (CIR) Expert Panel believes that Coal Tar use as an
antidandruff ingredient in OTC drug preparations is adequately addressed by the
FDA regulations, the Panel also believes that the appropriate concentration of
use of Coal Tar in cosmetic formulations should be that level that does not have
a biological effect in the user. Additional data needed to make a safety
assessment include product types in which Coal Tar is used (other than as an OTC
drug ingredient), use concentrations, and the maximum concentration that does not
induce a biological effect in users.

So it may be able to cause acne (that's what "comedogenic" means), but probably doesn't cause cancer. It is absorbed through the skin and distributed to every cell in your body, but no one can really find a reason why that's bad. Except it's called "COAL TAR", so it's hard to imagine how it's not bad for you, but apparently it's not. :smile: Doesn't say anything about hair loss. If I find anything else interesting (not that that article was interesting), I'll post it here.