What works?

[lostintheforest]

Problem with these forums is that after a while they lose cohesiveness. I have been reading everything posted since I was diagnosed with SD because my treatments haven't worked very well. Because of that, I was hoping we could get a topic on what has worked for folks.

If some treatment has worked at controlling your SD then let the rest of us know.

[lostintheforest]

For example, until I was diagnosed with SD I used to think I had acne and dry skin on mid forhead, upper cheeks, eyebrows and side of nose and I would use a cotton ball with alcohol on it 1 or 2x daily to rub off oily area. I did this for years and while it didn't ever stop, I have to say it seemed to have worked better than the crap my derm has had me on and the hell I have been through this last year. I have not gone back to the alcohol because since the diagnosis I have read that it is not a good idea and that it aggravates the SD.

[Jordan]

Each seb derm sufferer is different. Different solutions for different people. What does your derm have you on currently? Hopefully it's not topical steroids. (hydrocortisone)

I would recommend, if you havent tried already, low dose accutane, protopic or elidel, the acvwm diet and routine(http://health.groups.yahoo.com/group/seborrheic-dermatitis-support/), or oral anti-fungals such as nizoral or diflucan. Also, reading up on the causes and treatment of seb derm is a good thing to do. Check out books such as "The Yeast Connection" by William G. Crook.

Also, diet and food allergies play a major role in seb derm.

[lostintheforest]

Thanks Jordan, I have always enjoyed your posts. They are particularly helpful.

Here is a weird treatment idea. I had a friend over last night. He told me about Athlete's Foot he had really bad after returning from the first gulf war. After trying all the fungal treatments prescribed by doctors and failing, he used a country home remedy his mother used when he was a kid and soaked his feet in a mixture of bleach and water. It was cured after 1 treatment of about 20 minutes.

Has anybody ever heard of or tried this approach?

[Bradley]

The active ingredient in bleach is Hydrogen Peroxide and this is the likely reason as to why your friend's athelete's foot problem went away. The fungus cannot live in an oxygenated environment and thus dies. However, I would definitely urge extra caution with using this on your face is your have Seb Derm there because it can cause extreme irritation as once happened to me when I attempted it hoping that it would end all my problems.

Moreover, if you do use H2O2 make sure it is food-grade!!!

[Jordan]

Yes, the already inflamed seb derm area of the face can react severely to a solution like that.

[Brady Barrows]

Rosacea and SD is a controversial subject due to the number of rosaceans who are supposed to have SD with their rosacea. I have a page dedicated to this subject at this url >

http://www.rosaceans.com/html/sd.html

I have one support group listed on this subject at this url >

http://groups.yahoo.com/group/seborrheic-dermatitis-support/

If anyone knows of some other support groups on SD please let me know so I can list them.

Researching SD and rosacea is obviously a subject that needs to be investigated. Who do you think will do this? Is SD a variant or subtype of rosacea? Why does it keep coming up in all the ROSACEA forums and support groups if it has no relationship to rosacea?

[JR]

Brady,

There are many different diseases that are correlated in the sense that sufferers from one are more prone to develop the other etc. However, this does not mean that these diseases are the same. Moreover, they need different treatment.

You are right about the fact that SD keeps appearing on rosacea ground, but that does not make SD a variant or subtype of rosacea. Each disease is caracterized by etiology, pathology and symptoms. If these differ substantialy you have two different diseases, by definition.

Rosacea is one disorder, SD another. End of story. However, some information about occurence relation would be interesting.

/JR

[lostintheforest]

Brady, I agree that SD doesn't have the attention that rosacea does. I am not exactly sure why that is since the prevalence of SD is greater than that of rosacea--I think.

By the way, I have sent an email to Dr. Darm asking him if laser treatments now available can help SD. If so, I am on my way to see him. I will post a reply if I get one.

[Brady Barrows]

Brady,

There are many different diseases that are correlated in the sense that sufferers from one are more prone to develop the other etc. However, this does not mean that these diseases are the same. Moreover, they need different treatment.

You are right about the fact that SD keeps appearing on rosacea ground, but that does not make SD a variant or subtype of rosacea. Each disease is caracterized by etiology, pathology and symptoms. If these differ substantialy you have two different diseases, by definition.

Rosacea is one disorder, SD another. End of story. However, some information about occurence relation would be interesting.

/JR

JR,
What is the difference between SD and Rosacea? What is that makes a dermatologist decide the difference between these two diseases? Do you have some authority on the subject that explains this in layman's terms?

[JR]

What is the difference between SD and Rosacea? What is that makes a dermatologist decide the difference between these two diseases? Do you have some authority on the subject that explains this in layman's terms?


Brady,

I understand the confusion, because many dermatological diseases are sometimes hard to distinguish from one another (simply because they share many obvious symptoms). For one, rosacea and SD both involve erythema (inflammation of some grade), and they can affect the same part of the body. However, there are also well-known differences. Rosacea is primarily a vascular disease that causes blood vessel hypersensitivity (flushings e.g.) which can lead to a state of cronic inflammation (erythema). SD is not primarily a vascular disease (vascular abnormality is not the cause). Dermatitis (skin inflammation) is simply the symptom (not the cause). Like rosacea, the exact pathogenesis of SD is still unknown but an abnormal reaction to fungus (pityrosporum ovale) is generally supposed to be involved. This explains why SD is primarily treated with antifungal medication (ketoconazole, miconazole etc.).

Based on the history of the disease and the clinical symptoms, a well trained dermatologist should be able to distinguish between rosacea and SD in almost every case (however, possible coexisting conditions can make the diagnosis tricky)

I hope this cleared up some thoughts...

/JR

[Brady Barrows]

JR,

I like your style. What is your background since you seem quite educated in this?

I have written an old editorial on this at this url >

http://www.rosaceans.com/html/sd.html

I need to re-write my editorial on misdiagnosing rosacea and would like some criticism on it from you so I can get jazzed to update it >

http://www.rosaceans.com/html/misdiagnosed.html

If they don't know what causes SD and it is theoretically caused by some fungus or whatever and isn't vascular, how do they know that? The confusion is also over how many rosaceans have concurrent SD with rosacea. There really is so much of a lack of knowledge on these diseases that it is pitiful, isn't it?

And having a dermatologist make the distinction between SD and rosacea is just great, but I was wanting some idea how they determine it in layman's language. It sounds like you have to be trained in art in order to classify rosacea-like skin conditions.

[lostintheforest]

JR, I also agree that you seem to be keenly aware of the SD problem. You and Jordan sound more like dermatologists than lay posters. I have a question about your last post. You write that treating with anti-fungals is the mainstay of SD treatment. Are you concerned that the use of these drugs may train our body to become immune and eventually overcome their effectiveness? If so, then what? Nobody seems to be able to answer the question of whether lasers or some other treatment may be effective. Which leads me back to the original intent I had when I started this post--what works? The better question may be--what will always work.

When I started this process my derm said I had rosacea. 6 months of treatments made me worse. 2nd derm said it probably isn't rosacea since these clues existed after treatment: worse redness, more paps and pusts, more dryness and scaling. After discontinuing the rosacea treatments and turning to nizoral shampoo and now nizoral topical cream, redness is much less and paps and pusts reduced...but, when I stop using the anti-fungal cream (as I did last week when I went out of town and forgot my tube for 6 days) it seems the area of SD is larger--now along nose, in laugh lines, eyebrows and forehead. This may also be a product of the weather though.

What do you do to control your SD? I assume from your posts that you are also on the topical anti-fungal program, but I would like to be sure.

[JR]

Hi Brady

I like your style. What is your background since you seem quite educated in this?

I'm a biotech engineering student (specializing in molecular biology). I'm not an expert in diseases, but I have read alot about some dermatological disorders. I have had rosacea (subtype 1) for about 5 years and after a couple of really bad years all the reading and effort has finally paid off. My skin is still not completely normal, but it is much better than it used to be.

I need to re-write my editorial on misdiagnosing rosacea and would like some criticism on it from you so I can get jazzed to update it

This sounds like a nice idea... I have already looked at it (quickly) and overall it seemed ok. I'll take a closer look at it when I have more time (I hope this will generate some meaningful feedback)

If they don't know what causes SD and it is theoretically caused by some fungus or whatever and isn't vascular, how do they know that?

The main characteristic of rosacea is vascular abnormality and hypersensitivity (of some form). Since SD does not involve that it is quite safe to say that SD is not a rosacea subtype or variant.

The good news is that the pathogenesis of many states (dermatitis and vascular hypersensitivity e.g.) will be elucidated in the near future. This in turn will open doors for powerful medication that directly targets the cause of diseases like rosacea and SD.

There really is so much of a lack of knowledge on these diseases that it is pitiful, isn't it?

Yeah, especially rosacea has definately not received the attention it deserves considering the number of sufferers and the effect it has on peoples lives. I think this is beginning to take a turn though, so keep your head up :).

/JR

[JR]

Hi lostintheforest

You write that treating with anti-fungals is the mainstay of SD treatment. Are you concerned that the use of these drugs may train our body to become immune and eventually overcome their effectiveness?

This is mostly a concern for those who take antibiotic medication (e.g. macrolides such as tetracycline to treat acne). There is a growing number of resistant or semi resistant bacteria, due to the increase in use of antibiotics. I should add though, that antibiotics such as tetracyclines can be useful to treat some rosacea symptoms because of their nonspecific anti-inflammatory effects (not the antibiotic property). Obviously, for rosacea patients therapy resistant bacteria is not a big concern.

Antifungal resistance and resistance development is a growing problem, but it is still not as widespread as therapy resistant bacteria. I would recommend you to keep using nizoral (ketoconazole) as it seems to reduce your symptoms. If you are not sure about rosacea (you might have coexisting rosacea), be very careful to use steroids (hydrocortisone) of any strength on your face (some antifungal creams also contain low dose hydrocortisone). Rosacea skin does not tolerate steroids.

Nobody seems to be able to answer the question of whether lasers or some other treatment may be effective

This is still being investigated. My guess would be that conventional medication is a better alternative for SD. Laser certainly plays an irreplaceable role (for the time being) in rosacea treatment, but I'm not so sure that the same will hold for SD.

What do you do to control your SD? I assume from your posts that you are also on the topical anti-fungal program, but I would like to be sure.

I don't have SD, luckily. I do have a condition that could be referred to as rosacea dermatitis, which e.g. causes my epidermis to scale in the erythematous parts. Just to make sure that I do not have coexisting SD, I have tried almost every prescription or nonprescription medication available (including oral broad spectrum antimycotics).

There are no garantees that medications will always work (neither for rosacea nor SD) but I can give you some tips on possible treatments:

*topical broad spectrum antimycotics (ketoconazole, miconazole)
*other topical antimycotics (selenium sulfide, sodium sulfacetamide)
*oral broad spectrum antimycotics (itraconazole, ketonazole, fluconazole)
*salicylic acid
*mild topical steroid (hydrocortisone)
*propylene glycol

Salicylic acid is used to remove scale and may cause skin irritation in rosacea patients, as might high concentration sulfur topicals. Propylene glycole is a moisturizing substance with antimycotic propertis. It can cause irritation on rosacea skin, but SD patients usually tolerate it.

Hydrocortisone should not be used to treat SD unless you are certain that you don't have rosacea. In fact, long term use of topical steroids have considerable adverse effects on any skin type, but there is a place for topical steroids under a short period of time.

I hope this information helped a little bit...

/JR

[francois]

I remember Dr. Nase telling about a new tech machine that can show each layer of the skin. So isnt it possible to diagnose disorders without being mistaken and examining the exact location and severity of the inflammation?

[Bradley]

Is SD a variant or subtype of rosacea? Why does it keep coming up in all the ROSACEA forums and support groups if it has no relationship to rosacea?

To find the answer you just need to look at the treatments for these skin disorders. The rosacea disorder itself does not cause seb derm and the same can be said in reverse. But it is now more and more common to find people, who already have rosacea or acne, developing seb derm. And it is also common to find people developing rosacea/flushing skin that already have seb derm.

The main reason being that the initial disorder is attacked with treatments that bring about an environment for the second disorder.

Seb derm sufferers use steroid creams to clear them of their disorder. But in doing so they cause their blood vessels to become increasingly sensitive and eventually begin to suffer early symptoms of rosacea. This is almost always the case with seb derm sufferers because they have to use the steroid cream on an on-going basis.

Rosacea or acne sufferers often use multiple courses of antibiotics so as to exploit the highly effective anti-inflammatory properties of these drugs which in most cases supress the disorder. The problem, of course, with continued use of antibiotics is not only do you destroy the bad bacteria in the gut but the good bacteria is also wiped out. Since seb derm is caused by the yeast called Pityrosporum ovale, the environment is created in which this yeast can effectively repopulate.

I, myself, noticed that my skin around the nose became increasingly flakey and red after several courses of antibiotics and was eventually diagnosed with seb derm.

But I do experience a great improvement in this area when I try to repopulate my gut with good bacteria however it is hard to be consistent as my living conditions constantly alter. Although, in my opinion I would say one of the most effective methods of treating seb derm is by giving up foods containing yeast and filling your system up with good bacteria and definitely stay away from antibiotics!

I would urge caution over following the traditional western medical view of treating seb derm with anti-fungal chemicals over the long term because your skin will increasingly become more and more sensitive. And what's more your seb derm will eventually become comfortable and adapt to the anti-fungals if consistently used thus rendering them useless. This has been my case in the past.

[Jordan]

Excellent post Bradley, I couldn't have said it better.

[Bradley]

Thanks Jordan, no probs :) just a shame we can't cure both!

[fanta]

gut involved in seb derm? :o

[Tricia]

Just to shed some light here about lasers and seb derm. I've gone through multiple treatments with Darm that have helped tremendously with redness/flushing and skin texture.

My seb derm I managed to get under control by going on a one month course of an oral anti-fungal (Nizoral?) combined with a strict no sugar and yeast diet. This helped the lasers do their job better and now with my skin being much cooler I don't have as many flares. I think one of the main reasons so many people with rosacea end up with seb derm is due to the high temperature of the skin, it's just an open door for all sorts of nasty things to sewt up shop.

The holiday season has officially started though and I've had a set back with SD which I contribute to the increased sweets and copious amounts of wine I seem to be drinking lately. Hey, it's the holidays, give me a break! I'm hoping I can ward off a full blown attack by using the Ovace scrub and Elidel when needed plus I'm taking Caprylic Acid and Paul D'arco supplements. I also use the red acne lamp to control inflammation. So far so good.
It's frustrating though. I was at a dinner party earlier where everything on the table was a bad for my skin (pasta, creamy dressing, bread, wine and chocolate cake!). There was no way I was going to go in to my litany of problems and why I couldn't e,at so I just dug in and am praying I won't pay for it tomorrow. I'm so sick of tip toeing through life!

Tricia

[Jordan]

What was the dosage of Oral Nizoral that you took?

[Tricia]

200 mg/day. Just make sure you get blood work done to see if your liver is okay and if you go neyond one month keep getting the labs. Also, don't drink alcohol.

It's not for everyone but if you r topical resistant it may be an option to go with the oral meds.

Tricia

[Tricia]

Oops, I meant 200mg twice a day.

[fanta]

wasnt it oral itraconazole you took, Sporanox in freaky colors?

[JR]

Blue and pink, not exactly an appetizer ;)

/JR

[Tricia]

Yes, it was Sporanox, thank you for reminding me! Does rosacea make you lose your mind too? ;)

[lostintheforest]

Tricia,

I've sent Dr. Darm two email requests asking simply if he treats seb derm with lasers. No response. Do you know if he or anyone does and what kind of success can be expected.

[fanta]

I think he did answer your question :wink: I have myself asked some of the doctors at rosacea support different things under different usernames (they didnt have a clue who I was)..no answers whatsoever. Only if you are easy to treat and dont pose too many question they want you, seb derm, rhinophyma, severe flushings and ocular rosacea are not what they are happy with. They want some mild rosacean with shiny skin cause they pay the same and respond perfectly.

[francois]

I can never forget what Dr. Soldo did to Natalja. Natalja has talked to Dr. Soldo about her condition and he gave her appointment. Then Natalja arranged EVERYTHING ( the flight from holland to USA), her visa, a place to stay and she was also ready mentally for this treatment. But all of a sudden, Dr. Soldo changed his mind and told Natalja that he cant treat her because of
what she said on the forum. We all feel depressed most of the time and therefore Dr. Soldo's excuse was not acceptable.

But if you put yourself in doctor's shoes, you would probably treat patients that are easier to treat since you get the same price from both treatments. So why treat the harder case? People always tend to do less riskier things, if the outcome(return) is same.

[fanta]

Well, perhaps he did her a favor :|

[Tricia]

Hey Forest,

I'm surprised Dr. Darm did not respond as he is usally very good with that. Seb derm is hard because (I believe anyway) it has more to do with an internal buildup of yeast that can manifest in areas like the face and scalp. Darm's treatment has helpe' me in that there is less heat arising from diseased blood vessels but I"m also using Ovace a couple of times a week and taking over the counter supplements like Caprylic Acid and Paul D'arco. Also, the less sugar I eat the better but it's sure tough this time of year!

So......I think lasers can help but seb derm really has to combatted internally as well, for tough cases anyway.

Tricia

[fanta]

often you have a few spots or big pores where seb derm seems to thrive..you probably just need to destroy the sebaceous glands in these areas. New sebaceous glands will most likely appear in these areas, same thing happen with scars, nothing really dies without new life.

[natalja]

Sorry Francois, I understand you are trying to back me up here, but mentioning this without even discussing it with me is not appreciated. in fact, things are very different then what you write: Dr. Soldo has been very helpful with my case and we agreed between us that concidering the circumstances it would be easier and better for my own wellbeeing that I got treatment nearer home, then travelling to the US. Dr. Soldo is still concerned about my condition and willing to help, but at the moment we are just keeping in contact so I can update him with my progress and also ask for advice when needed.

Natalja

[francois]

Hey Natalja,

Excuse me about my post. I just heard somewhere that you canceled your trip to USA because of doctor's hesitation to treat you. I know that you and me never talked about Dr. Soldo or anything about your trip personally but this was the impression I got from what I read from some posts.

I think I have become quite prejudious about derms and I applied this to your case with some improper knowledge. But I still think that most derms work with little job ethics.

The last derm I have visited wanted to treat me with her machine which I finally found out that was completely dangerous for rosacea. For money people do everything.

I apologise again for talking about something that I've never talked to you before.

Best wishes.

[Callien]

Natalja,

I wondered what had happened to you. I was looking forward to hearing about your trip (and success, I hoped) in the US. I know you've seen Dr. P. in the UK and I've read somewhere that Dr. Crouch is very good but I can understand your possible hesitation at having more IPL. It was moderately successful for me but unless I win the lotto I'm afraid it is out of my league financially besides the fact that being on accutane right now rules it out also. Take care and keep us posted.
Best,
Callien

[natalja]

Apology accepted Francois. I just felt I needed to set the record straight, because it is not fair on anyone if they didn't know the full facts of my case to criticize Dr. Soldo.

Thanks for asking Callien, I'm doing a bit better lately. I am currently taking an antidepressant, but will later post about it, if things keep going a bit better. Not sure yet, because I've only been on them for 2 weeks now. I am looking for laser treatments and other treatment options in the UK at the moment. Again here: not sure yet what route will be best, so as soon as I do see some improvement I will post about it.

Bye for now,
Natalja