29 May, 2013

Seborrhoeic dermatitis (seb derm) - in combination with rosacea

A lot of patients with rosacea, also have to deal with a coinciding skin condition called Seborrhoeic dermatitis, in short seb derm. I also have this annoying ailment and it primarily raises it's ugly head in winter for me. I'd say I have no issues with it at all for 3/4 of the year and only in very cold periods, which are - let's be honest- quite long lasting in Holland, the seb derm tends to appear. 

Seb derm is a common skin disorder

that mainly manifests itself on the scalp and facial T-zone (forehead, eyebrows very often, sides of nose and mouth), causing scaly, itchy, red skin and stubborn dandruff. It can also go to the scalp. Seborrheic dermatitis can also affect the upper chest, back and other areas of your body that have many oil (sebaceous) glands. On the scalp, seborrhoeic dermatitis usually causes roughly defined, dry pink or skin colored patches with yellowish or white bran-like scales. In winter, I can bend my head forwards, rub through my hair and over my scalp with my fingers and nails and it causes a lot of fine, white-grayish flakes to rain down.In the eyebrows and the creases beside the nose, seb derm can cause greasy textured, often yellowish flakes to build up. For me, these flakes start to look fatty and scaly when I don´t rub them off within a certain amount of time (usually a few weeks). In summer, this isn´t a big deal and I just need to rub these facial areas a bit harder when I clean my face. But in winter the seb derm causes my (rosacea) skin to turn scaly and rough and red. This makes the skin around my mouth and on the inner cheeks and in the eyebrows stand out in color, and looks quite sickly if you ask me.

The cause isn´t fully understood yet, as far as I can tell from the information that´s out there online and from the dermatologists I´ve seen. What I understand, is that seb derm might have an underlying autoimmune component to it. The skin responds badly to a common yeast that lives on it. This normal skin inhabitant is called Malassezia (formerly known as Pityrosporum ovale). Patients with seborrhoeic dermatitis appear to have a reduced resistance to the yeast and the toxic substances that it produces. Unlike in healthy people, it creates inflammation and skin irritation in us seb derm patients. An overproduction of sebum is also mentioned as a cause and there is an increased turnover of shedded skin (hence the flaking). In some cases, the seb derm is actually a precursor of psoriasis...
3-5% of the population has seb derm and it occurs more often in men than in women. Low immunity, stress, cold and dry weather and some foods (amongst some other triggers that I probably missed here) can exacerbate the seb derm. It often runs in families.

Treatment options
  • Ketoconazole cream or shampoo (1 or 2%)
  • Nizoral cream or shampoo
  • Zinc pyrithione shampoo
  • 5% sulfur / 10% sulfacetamide lotion and or wash
  • Lamisil cream
  • Salicylic acid
  • Ciclopirox cream / ciclopiroxolamine
  • Elidel or Protopic cream (pimecrolimus cream or tacrolimus ointment).  
  • Hydrocortisone or steroid creams (Note: I would absolutely warn against this in case you also have rosacea, as it might stir up or worsen the rosacea).
  • Tar cream can be applied to scaling areas and removed several hours later by shampooing.
  • Severe cases may receive a course of tetracycline antibiotics, oral antifungal medication, or sometimes, ultraviolet radiation

selenium disulfide
Piroctone olamine

sodium sulfacetamide

There are also more natural treatment options, including raw honey and virgin coconut oil. Some people use apple cider vinegar or tea tree oil on their seb derm and find it helpful. Watching your diet and avoiding foods with a lot of yeast (certain breads), high levels of simple sugars and certain fermented foods also helps some patients. Dairy products might also add to the problem for some. On the other hand, some other foods have been mentioned to help combat the seb derm, including garlic (anti fungal and anti inflammatory actions), coconut oil (idem) and probiotics. I would personally forget about steroid creams and focus on antifungal creams. They are both available OCD and on prescription. But steroids can cause rosacea, thin your skin and on top of all that don't tackle the yeast issue. The steroid cream set off my rosacea out of nowhere so I wouldn't even touch it again personally. Also, the steroid cream might clear your seb derm initially, because the steroid is stopping your immune system from attacking the fungus that causes seb derm plus it works as a strong anti-inflammatory. But once you stop the steroid, your immune system goes right back to work, creating inflammation to protect the body from further injury caused by pathogens so you are back to square one.

Selsun Blue

Some people with rosacea, especially with redness and skin outbreaks and pimples, but also those with seb derm, mentioned that washing their face with Selsun Blue shampoo (and then rinsing it off again) helped them control their skin. Selsun Blue is a line of shampoos used to treat dandruff and other skin conditions. It is available over the counter and in a prescription-strength version as well. It contains selenium sulfide as the active ingredient. Selenium sulfide is an anti-fungal agent which may be helpful in treating the skin yeast infection tinea versicolor, scalp ringworm (tinea capitis) and athlete's foot (tinea pedis). Selenium sulfide also is effective at treating seborrheic dermatitis because it slows the overgrowth of skin cells involved in this condition. Selsun Blue is also available in a medicated formula, containing selenium sulfide along with menthol, the main active ingredient in peppermint. Menthol has cooling, calming and numbing effects and may soothe irritated skin and stop itching, unless of course your skin is too sensitive for it (then it can irritate in fact). Trial and error..

Selsun Blue Naturals
Selsun Blue is available in a moisturizing formula as well as a shampoo called Selsun Blue Naturals, both of which contain botanical ingredients to moisturize hair. Selsun Blue Naturals contains the active ingredient salicylic acid rather than selenium sulfide. Salicylic acid promotes shedding of the skin's top layer, so the shampoo can wash away the dead skin cells making up dandruff. Botanical ingredients for moisturizing include aloe, and chamomile and lavender extracts.

Selsun Salon
Salsun Salon is another dandruff shampoo, this one containing the active ingredient pyrithione zinc. This ingredient slows the excess production of skin cells, thus relieving and preventing flaking and scaling of the scalp caused by dandruff or seborrhea.
Active Ingredient - Selenium Sulfide 1% - Purpose - Antidandruff.
Inactive Ingredients: Water, Ammonium Lauryl Sulfate, Distearyl Phthalic Acid Amide, Ammonium Laureth Sulfate, Sodium Chloride, Cocamide MEA, Dimethicone, Aloe Barbadensis Leaf Juice, Hydroxypropyl Methylcellulose, Sodium Isostearoyl Lactylate, DMDM Hydantoin, Fragrance, Citric Acid, Sodium Citrate, Titanium Dioxide, Blue 1.

For me, ketoconazole cream does the job very well

I use ketoconazole 2% and find it very effective in controlling (and in winter limiting) my seb derm rashes nowadays. Because of my very delicate and sensitive, flushing prone rosacea skin, I normally can´t even tolerate a neutral base cream (use nothing on my skin). However, my cheeks are the most sensitive and affected and the seb derm usually shows up around my nose and mouth folds, where my skin can handle the ketoconazole 2% cream. My pharmacist makes a special cream however. Regular ketoconazole cream has alcohol and a preservative which both seem to irritate my skin, so he makes a special cream with 2% ketoconazole in a cetomacrogol base cream (almost like a wax) without preservative. Also no alcohols in it. I can store it in the fridge and get a new one every month. My cream contains the following ingredients (30 gram tube):

-Ketoconazolum 0,600 gram
-cera cetomagrogolis emulsion 4,500 g.
-decylis oleas (cetiol V) 6,000 ML
-aqua purificata bag in box 17,700 ML
-Sorbitolum 70% crist 1,200 ML

I only get the seb derm in the T-zone. I usually get flakes that look a bit greasy and that I can 'scrape out' of my eyebrows easily (yes, yuck!). They can also come on the bridge of my nose and in the folds next to nose and mouth. I can usually remove it with a cotton pad and see a very light yellowish tone and greasy substance. I use this cream for most of the winter and it limits the seb derm for me once I start using it and it doesn't set off my rosacea either. I get no stinging from it. For those with both rosacea and seb derm, perhaps your pharmacy wants to make this cream as well, if only to help you try it out for a bit.I use the cream every night or when needed in the skin folds near the nose and above and in between the eye brows. I know that, like steroids, the ketoconazole won´t entirely address the cause of the seb derm, but it is a lot less harmful for our sensitive skin and it will limit the existing yeast in the treated areas, thereby limiting the subsequent skin response and stopping the vicious cycle. By doing this, I am able to be symptom free for part of the year (except for very stubborn eyebrow flakes) and I limited the seb derm outbreaks to the harsher months of winter now.The following pictures were taken in a bad seb derm year, was winter of 2010 when I didn't use the ketoconazole cream yet. The white dots are metronidazole cream and zinc cream; I was silly enough by then to think the metrocream would work for everything rosacea related. But it never worked for my rosacea and has the opposite effect of what we need in seb derm (we need an antifungal and this one does the opposite and kills certain bacteria, which will only make the yeast issue a bigger one lol).

Eyebrows versus seb derm

Ever since I developed rosacea and seb derm, I have slowly but surely lost a good part of my eyebrows. Mine got thinner and thinner over the years, and when I clean my eyebrows thoroughly with a cotton pad, I always see loose hairs from the eyebrow coming off with it. But it's not as if they fall out with the slightest touch. I got my thyroid tested several times, but it is fine and the eyebrow loss is not related to this. In fact, they found nothing else in blood tests to explain it, and blame it merely on the rosacea and seb derm (and possibly to some other auto immune issues I have). Right now the outer parts of my brows are almost invisible. There are hairs there, but not enough to make the brow look normal and continuing. I also lost a great amount of eye lashes. I don´t use any make up normally, but the past years I really started to get annoyed (and sad) with the bloated, red cheeks (from rosacea and medication) and the sickly looking bare eyes and half decent eyebrows. Mascara makes me flush badly (I know this sounds ridiculous, as the mascara doesn't even touch my skin, but believe me, I loved my mascara as a teenager and there is no way anything but bad flushing and burning would keep me from it). But I found a great solution. I now grind charcoal into a fine dusty substance, dip my finger into it, make sure I have a little bit left on the top of the finger. Then I bend forwards (so that the dust doesn't powder all over my cheeks), have a hand pocket mirror and use the black powder to make an eyeliner type of line on the eyelid and to fill in the eyebrows. Looks great!! And a great color too, black but more natural than the synthetic shiny black from regular make up. No flushing, no burning and I leave it on for a week, then remove what´s left (rub my ketoconazole cream in my now bare eyebrows and let it sink in all night), then redo the make up the next morning. Make sure to whisk over your eyelashes with a tissue first, to remove any left particles.

I think it´s important to keep your skin clean when you have seb derm, but I am unable to tolerate any facial cleansers. So I wash my skin with bottled water (low in chloride), with cotton pads and not even every evening, since my skin is very dry. I really wondered how it is possible to have a skin as dry as mine, yet to suffer from (local) sebum overproduction :/ I read that it happens to more people though.I have a very strange thing happening after some time, where the flushing threshold seems to go up when my skin gets a bit thicker, but I can see dead skin piling up on my face. When you look close I mean. At some point I need to clean it with some more force than the usual soft kitten petting strokes and by then you can see the excess skin flaking off. I´ll try to add some pictures to illustrate this, as it is an odd thing to explain. It feels like a face scrub by then, and the dead flakes act as an exfoliate. This is horror for my rosacea and I always end up with shiny, red, swollen cheeks for days on end. Just like when you have a bad sandpaper rub treatment on delicate rosacea skin done. So I try to limit this to once every month or even longer when possible. I am still unsure if this extra layer of dead skin is a good thing or not for me. I look less red, as it hides and protects (I assume) the underlying red baby skin. But after a longer time. I get red paps and dots (which I usually virtually never have), simply from the dirt on it. I never read anything about this on the Rosacea Forum and neither posed the question (yet).

Differentiating rosacea from seb derm

Differentiating rosacea from seb derm can be tough. Both deal with red skin and rough skin texture.  One of the real differentiating aspects of rosacea is the on and off redness. Rosacea tends to flare easily and when you feel flushed and hot from specific triggers (alcohol for instance, certain foods or hot rooms) then it is likely that rosacea is at play. Rosacea tends to flare in the sun, whereas seb derm might benefit from it. The scaling, flaking and more persistant redness (that can't be cooled down with cold temperatures withing hours) might indicate seb derm. When you have a fatty like substance (dead skin, sebum) that you can rub off your skin with a cotton pad, then that's another symptom of seb derm. Some doctors are quick to rule out rosacea in favor of seb derm, because of young age of a patient. can also make you feel flushed though, to make matters more complex. Seb derm can cause burning in the skin, but it's not common for that to happen, whereas rosacea definitely makes the skin feel sore and painful and hot and burning when it flares. Seb derm might itch (but not necessarily) and will feel and look irritated. For me, the seb derm also brings on some paps and little acne like bumps often. For me, this makes it stand out from the rosacea (only see them in the flaky seb derm areas when that one is flaring) but for those with subtype 2 rosacea (papular), this might make matters even more difficult to distinguish one from the other.

It's a misconception however that rosacea doesn't affect youngsters. Mine started age 19 and I know lots of youngsters with rosacea. One way to find out if you have active or underlying seb derm, is to apply ketconazole cream to a small area of the affected skin for some time, and to see if it clears up. Seb derm can aggrevate rosacea when you have to deal with both of these charmers, so it might be a real catch 22 to sort the one out from the other. But rule of thumb is that rosacea has a tendency to flush and flare for shorter periods of time and seb derm is more persistant redness, roughness, scaliness and seb derm also has a preferance for the T-zone; forehead, eyebrows, nose, mouth and inner cheeks. Whereas rosacea usually manifests itself on the cheeks, sometimes nose and chin. It also takes quite a lot of years usually for rosacea to cause the skin to become rough, red, raised and swollen, whereas seb derm can cause that very soon onwards. Both with seb derm and rosacea, you should look into very gentle skin care products. Harsh ingredients and fragrances can irritate the skin even more and worsen both. Try to find something hypoallergic and oil free (oily products tend to make both seb derm and rosacea worse). Oral or topical antibiotics help some rosacea patients (as they act as anti inflammatory meds) but usually make seb derm worse. The killing of bacteria will make the yeast population more powerfull and the yeast is the culprit in seb derm. Both seb derm and rosacea usually benefit from a diet low in sugar, processed foods, fast food and pro inflammatory foods.

Here are some of the quite disgusting looking close ups of the sebum/skin flake build up I was talking about earlier

My skin doesn't shed dead skin cells normally. Dr. Chu (my derm.) also explained me this the last time I saw him; some rosaceans have compromised skin function, meaning the dead skin cells don't just naturally fall off, but instead keep building up and up. For a while, this seems to make my rosacea less reactive; gives some sort of protective layer of you like. But after a certain time, and I only wash my skin mildly with cotton pads and water, I can notice the build up gets too much. It still looks kind of normal, but at close look you see there is too much of dead skin layer. And usually by then my skin starts to feel tight, starts to itch and mostly; p&p's form all over my cheeks. Dr Chu said I need to scrub my skin, or clean it very thoroughly, because this dead skin cell build up can act as a breeding ground for inflammation. I do this, but I kind of like the initial dead skin build up. It won't show as detailed as in these pictures, in fact, most of the time it looks a lot better and more normal with some dead skin build up. It masks the redness and seems to protect the skin. But after a given time, usually a week or 3, maximum 4, I notice p&p's and my skin feels tight and it needs a good scrubbing. I don't think normal skin gets that like this. This extreme I mean. So these pictures are high definition and right during that scrubbing process; when I am rubbing the top skin layer off. Halfways I paused to picture it, which is the (pretty unappealing) close up you now see here. As I said, normally you don't see it like this on the skin, but here I did some firm rubbing with a cotton pad, where the flakes would roll down and stick together, merely to show you guys what it looks like then. Underneath you see how red my skin turns when I scrub it. Can't believe I'm posting this tbh :) So, at the end its me on a good day, recently (sorry, need to pretty the other pics out a little bit, although it was shot in vĂ©ry favorable light). So this is only happening when I DON'T scrub, am too gentle and feeble with the face cleaning and when I use an ultra sharp lens and zoom on my camera :) You don't see it like this when you just stand in front of me and talk to me. At the bottom of this blog post I added another set of such scrubbing photos of mine. See more pictures of my (seb derm/rosacea) skin in winter in this blog post about winter. 







Patient testimonies on seb derm (versus rosacea).

Panasonic wrote: "I have very weak Seb Derm since one year now (I am 22 now). You can see nearly nothing from the outside. I have only very small scales around my nose, overlip beard (sry I'm from germany, don't know every word) and in my eyebrows. But they are really small and not many. Only rarely some small parts of my skin get red. But most of the time, my skin looks totally normal. I am very thankfull that my Seb Derm (two dermatologists diagnosed it) is so weak. BUT!!!! My hairs are falling out although it is so weak. My eybrow hairs are falling out regularly which makes me sad and angry because I love my eyebrows. And my mustache also started falling out this winter. The hair grow back but I desperatly want to stop them falling out because I'm terrified that the bald parts get bigger. I don't understand that. Why is my Seb Derm so weak but my hairs are still falling out? I hate this so much because creams and cider vinegar only help for a short time. Then they start falling out again. I read that this virgin coconut oil and raw honey therapy works good?! Do you think it can stop my hair loss or do you have any other tips?"

Desperado wrote: "I have had this from 6yrs now ... What have the docs prescribed for you ... hydrocortisone 1% or a more powerful steroid ?Do you have white sebum plugs in the eyebrow pores as well ??? When it first began for me I didnt have visible plugs just little scaling as you mention but with time the disease modified its form to thicker and dryer scaling from being oily scales initially. Also the plugs now are harder and dryer like rice grains and nearly all the pores of both the eyebrows are affected. This year I also notice its spreading to the forehead where am getting bits of scales and the plugs. I have tried Zinc pyrithione ...controls a bit by delaying the scaling ... but does not touch the plugs!!! [...] I have tried oral anti fungals and they have not helped. Selenium sulphide and ZNP just make the condition dryer and minimal difference if any. Doctor did a skin scraping of the brow area and did not find demodex." 

And:  "There are many theories behind why it does what it does ... from it being an autoimmune disease and attacking healthy cells just as it would attack foreign anything owing to wrong body signals being sent with possible links to high stress or anxiety levels to genetic predisposition etc etc. Lot of skin diseases look alike and very often can get misdiagnosed. Even all derms do not concur on their diagnosis. Ex: sebopsoriasis and psoriasis are close cousins yet different. Not to scare anyone but there is theory that if seb is left untreated for long it has the potential to turn into sebopsoriasis."[...] "Focus on improving your diet so that your eyebrow roots can regain some strength or have possible regrowth. Lower your carbs intake and increase your green vegetable intake. Do you eat a lot of sweets?? Drink lotsa water and since you are prone to Chrons ... definitely add probiotics to your daily routine. 80% of the immune system is controlled by the condition of the gut. Unfortunately there is no quick remedy for seb derm hair loss but doing the above things will control the condition much better."

Breanne wrote: "I was diagnosed with Crohn's Disease in August 2012. As of October 2012 my hair started to fall out, then in Decemeber my eyebrows and lashes began to fall out. I had blood work done and was diagnosed with a zinc deficiency so I have been taking supplemetns for that. I recenetly went to the dermatologist due to the hair loss and the severe dandruff i have in my hair and eyebrows. She diagnosed me with dermatitis. I am just wondering, can dermatitis make your hair, eyebrows and lashes fall out? My scalp hair loss has slowed down since starting the zinc supplements but not my eyebrows or lashes. When the brows and lashes fall out there is white on the tip of the hair. Is this permanent? The dermatologist prescribed me cream to put on my eyebrows twice a day. The dandruff in my eyebrows is very thick and yellowish. I read that coconut oil can help regrow eyebrows. I am so worried I'm going to lose all of my eyebrows!!"

And: "I am having the exact same problem!!! I was just diagnosed with seb derm. I get thick yellowish dandruff in my eyebrows and scalp. Eyebrows are drastically falling out when I wipe away the dandruff,, they even fall out with out touching them. The root of the eyebrow has white on it. Dermatologist prescribed me the cortisone cream but I find it makes my brows even more itchy. Why does the seb derm cause the eyebrows to fall out???? I am so scared I'm going to lose all of mine as they have become so thin :( Has anyone tried the coconut oil? I am willing to try ANYTHING at this point. The hair on my scalp was also falling out really bad for months, it has seemed to slow down quite a bit but now I am left with only about 1/3 of the hair i used to have :( I am only 25 so this is taking quite a toll on me. Any help would be greatly appreciated!!"

I replied: "I have a similar problem. The hair on my head is not falling out and is normal, but over the years I have lost at least half of my eyebrows (only inner half is there, the rest I fill up with charcoal now which looks pretty natural from a distance). Eye lashes have become much much less as well. And I also get the dandruff like issue on my eye brows. In my case its seborrheic dermatitis. I use a cream (ketoconazol) for it and it's probably also the rosacea and facial inflammation that plays a role for me. I have found no way yet to make the eyebrows grow back :( Have been tested many times for thyroid issues (as they can cause the same symptoms) but no. Don't have lupus either but I do have a bowel inflammatory disease, but not Crohn's (I have lymphocytic colitis)." 
And: "If you have seb derm, you usually get flakes that look a bit greasy and that you can 'scrape out' of your eyebrows easily. They can also come on the bridge of your nose and next to your nose. You can usually remove it with a cotton pad and see a very light yellowish tone and greasy substance. If that's what you have, then hydrocortisone is not the right cream. The problem of seb derm is more of a yeast/fungal type of microbe and what helps is a cream called Nizoral or ketoconazol or Lamisil; all the same type of cream by the way, but slightly different. Hydrocortisone is a anti inflammatory and lowers the immune response of the skin. Although seb derm does have an auto immune component, it is the yeast aspect that you need to tackle. No, mine got thinner and thinner over the years, but when I clean my eyebrows thoroughly with a cotton pas, I always see loose hairs from the eyebrow coming with it. But it's not that they fall out with the slightest touch.Have you been tested yet on your thyroid? It's a simple blood test and they actually should always test you on this once you are losing eyebrows. Yep, I have dandruff on the scalp too. Not too bad but when I scratch my forehead or scalp, there are lots of white dry skin cells coming lose, lol it can look like snowy powdery like sugar :) I don't have a problem with this and wash my hair every 3rd day with neutral anti allergy shampoo. Overwashing (every day) usually worsens matters, oddly. There is special shampoo for this, called nizoral shampoo, but I don't use it because I get flushed easily from it. But I have pretty bad rosacea. If you don't, I would definitely give it a try. I don't know about supplements, but the ketoconazol or nizoral cream is really the thing to try when you have seb derm. NOT hydrocortisone. And I wouldn't rely on supplements just yet, and first try the special creams for this problem. Also try to limit your sugar intake and try to avoid yeast products (bread for instance) for a while perhaps as they can worsen the seb derm."

Breanne later wrote: "Thank you for your reply Nat. I believe it is seborrheic dermatitis i have as well. The cream the dermatologist prescribed me is hydrocortisone, not sure on the spelling. My outer eyebrows are definitely falling out worse then my inner brows. I just touch them and they fall out. Some times they fall out with out even touching them. Are yours like that? I am so scared I'm going to lose them all  :( I read online that seborrheic dermatitis can cause thinning. Do you have the dandruff on your scalp too? Mine is like a thick yellowish dandruff, its gross! I just had more blood work done last week to check my thyroid. I do have a zinc deficiency which can cause dandruff and hair loss. I've been taking supplements for over 2 months now but its still happening. Dermatologist said supplements can take up to 6 months to work, so fingers crossed! I don't think I have been tested for lupus.. is that done through blood work? I am paranoid I have alopecia and its really scaring me: ("

Johnabetts replied: "There is a very common form of seborrhoeic dermatitis in infants colloquially called cradle cap. It can look quite severe and distressing to the child but it does not seem to affect them much. The point of this post is to direct sufferers to the Wikipedia entry for Cradle Cap: http://en.wikipedia.org/wiki/Cradle_cap where you can find a number of remedies for the condition. An old fashioned but effective anti-seborrhoea/antifungal composition is Whitfield's Ointment (Compound Benzoic Acid Ointment) still available (at least in the UK) at very low cost. It does contain salicylic acid which will get the "anti-salicylists" here in a tizzy but it must be remembered that adverse reactions to salicylates are relatively unusual."

Judworth warned about the possibility of underlying thyroid problems: "I have hyperthyroidism and my partner has hypothyroidism, hair thinning (especially at the front) is very usual for hypothyroisdism as is losing the outer third of brows. You mention hoarsness (another symptom) do you feel as though you are 'wading through mud' emotionally & physically too? Extreme tiredness despite sleeping for hours on end is another."

Kelemvor replied: "I think I had a seb derm component and remember losing some eyebrow hair. Pyrithione zinc helps the seb derm component, but worsens my rosacea symptoms. I think it pretty much cleared up the seb derm component without worsening my rosacea (improving slightly) when I started using coal tar 2% ointment. I lather it on my face for a few minutes and wash it off twice about every 1.5 weeks. Skin is slightly pink the next day but helps put everything into remission and helps texture of skin. I'm pretty sure I stopped losing hair when I started that routine. I also use a coal tar shampoo on my scalp. Everybody is different but see if it helps."

Angelstar also has seb derm that makes her eyebrows fall out and writes about it here 

Seb derm and having a burning face and red rashes at inner cheeks

Sparrow-legs suffered from seb derm and rosacea issues this winter and wrote: "Hi. I have had rosacea and seborrhoeic dermatitis for several years now (I'm 26) and it has been pretty well controlled with diet, antibiotics, occasional ipl and red light. However for the past 10 days or so I have woken up with really red, BURNING cheeks despite not having changed anything. I am getting really distraught. I am having a lot of trouble sleeping because I am so anxious about what is happening with my face. I thought I was finally moving in the right direction, and I was content in life... And now I feel like doing something stupid." 

And: "I thought that this started out as a seb derm flare, because I had the typical itching, burning and flaking down the creases by my nose, eyebrows, mouth, chin etc. clotrimazole didnt do anything so I put a little hydrocortisone on, and the flaking and rawness cleared up, but every morning for the past 10 days or so I have been burning quite badly on both of my upper cheeks. I wondered if I was allergic to something in the clotrimazole cream, but I haven't used that for a week and no improvement. I tried sleeping with a fan, I think it just kept me awake and made it worse. I think the cold weather is the factor that started all this." 

Phlika also experienced worsened seb derm during the cold and wrote: "Sorry things have taken a down turn but you aren't alone. My skin turned really bad a few weeks ago which I have put down to dreadful cold weather and too much sugar. For me the flair was seb derm related and it made me burn every afternoon at work for about two weeks. Could it be a seb derm flair for you too.? It has been such a long cold winter/spring. But it will pass and it really shouldn't leave any permanent damage." 

Melissa W also experiences seb derm flares in winter and wrote: "Hi there Sparrow, so sorry you are experiencing a flare. It has been a rough winter/spring-so dry and cold. Hang in there and your flare in symptoms surely will pass. Try to take things one day at a time, be gentle with your skin and kind to yourself and I know your symptoms will ease. I know how you are feeling and sometimes our thoughts get away from us and go to scary dark places... don't be afraid to lean on your bf (and ofc us) at this difficult time. [..] Sparrow, forgive me because I cannot remember the details of what you might have tried in the past but have you ever tried Auburn's raw honey/virgin coconut oil treatment for seb derm? If not perhaps you can read her sticky here and see what you think."

Patient testimonials and tips to treat the seb derm

Jeff  found that a combination of Butenafine, pro-biotics, garlicCaprylic acid and Sovereign Silver helped with his deb derm. (Note, be aware with Colloidal silver). Johny battled his seb derm with an anti-candida, low carb diet. Dryfairskin also posted about his/her seb derm problems. There is a referance in this post to the Warm Room Flush (see pdf on this weblink). A very interesting read on how being in a room that's too cold, might stir up your flushing and lower your flushing threshold. Australian research.

These are such pictures where you can see a little bit how I had these discolorations around my mouth from the seb derm. I didn't want to make pictures at the time, when it was a lot worse, but people actually commented on how yellow my mouth and chin area was :( In this picture you only see it slightly, and I also used to put a bit of pale powder on the chin and upper lip at the time (but no make up on the rest of my face/cheeks). I remember also having very scaly, yellowish flakes and at some point I thought I would only damage my skin by stripping them off and I left them alone. I was waiting at the bus stop and a nice older man started talking to me and said I really had some skin problem going on. I was so shocked he said that and acted all laid back, as if I heard that all the time. But back home I did clean my skin again and tried to get rid of the layer of dead yellow scaly cells. I also was asked by people about the orange/yellow skin discolorations. Felt really ashamed about it at the time.



Update May 21st 2014

Redfacegirl wrote on the Rosacea Forum: "Completely agree, it's a lot easier for me to stay inside as well. I started online school for my 10th grade year in high school this year so I wouldn't have to deal with people seeing my skin. I hate going out outside, I always feel like people are staring at me and it just makes my anxiety so much worse. Do you use anything for your eyes? I also have light sensitivity, my computer screen/tv screen bothers my skin too. A couple months ago, every time I went on my computer the screen would make my face flare up so bad that I felt so sick and it was on a low setting of brightness. I went to the eye doctor last month and she told me my eyes are very dry. I have a heat intolerance too which sucks because the weather is getting hot now. I would love to go back to school and be a normal teenager but my skin keeps getting worse. I never thought skin would have this big of a impact on my life and become my worst enemy. I have rosacea and seb derm but I can't find anything that helps really. My brother told me today my skin looks red, brown and yellow and I wanted to throw up just thinking about how disgusting I look all the time. I feel so embarrassed that I look like this and I don't feel like there's much hope. Even the tiniest bit of improvement would make me so happy and grateful."

I replied: "Poor Redfacegirl :( Just on a side note, have you ever tried ketaconazole for your seb derm? I have pretty severe rosacea on top (and only have seb derm issues in the cold winter months mostly), but my pharmacist makes an ultra neutral soft cream base for me, of cetamacrogol (a neutral pharmaceutical wax like substance) and they leave out any preservatives, so I can store it in the fridge for one month. They add 2% ketoconazole to it. The normal ketoconazole (for seb derm) has alcohols etc to preserve it and make it penetrate the skin easier, but I find my cream to be just as effective and it won't burn my skin. I only use it on the T-zone when needed, which is less sensitive than the cheeks anyway. If you want to try some let me know, I can spare one tube I think (it's sealed and the one month expiry date starts as soon as you puncture the sealing). Maybe it helps you to control the seb derm, which in turn might control the rosacea. And if so, maybe you can find a pharmacist who can follow this example? I remember being 22-25 and having the same issues as you describe; discolorations, brownish, yellow, orange even, around my entire mouth and T-zone. It looked bad and it burned. Now that I treat the seb derm my skin tone is even (albeit sometimes red, but when flush has stopped my skin looks fairly normal). Let me know if I can help. Also, please try to cut down on sugars and yeast, at least for a trial period? I find they really worsen my seb derm.
On topic; I'm so sorry for each and everyone here who has to sit inside so much and often unwantedly :( It's fantastic that this forum exists and we can find people in a similar predicament.
Best wishes Nat"

I found a good suggestion on The Rosacea Forum for the red rashes and falling out of eyebrows
I went to my GP about it again last month and all we thought it could be was thyroid disease. I had been tested on them in the past already twice, always normal blood results, but we tested it again some weeks ago and again, all was normal. I still have about half my eye brows missing and what I find most typical about it is that the place where the eyebrows are supposed to be, there is a vague red rash. A red hue almost. The suggestion was made here that it can be Ulerythema ophryogene. Its other name is Keratosis pilaris atrophicans faciei. I knew about that one as a friend of mine has it on his arms, little small red dots, rashes, especially in summer. And there are a couple of long term members on the forum who have it as well, it gives a more constant redness to the cheeks. I discussed it in this blog post (or look below, I'll copy paste the part about KPRF).

So this is what eyebrows of such patients can look like. 

I am not sure if I could have KPRF... I have seen many good dermatologists and my symptoms are always attributed to rosacea. My skin can look pale, until a flush comes up, it's typical rosacea in many ways, but the eyebrows look identical to mine! Which make me doubt again now, whether there might be a little overlap perhaps in those specific eyebrow symptoms. Both are inflammatory skin diseases, both might even have an autoimmune component to them, we don't know that yet but I personally suspect they can, in some cases. 

Keratosis Pilaris Rubra faceii

Keratosis pilaris (KP, also follicular keratosis, lichen pilaris) is a common genetic follicular condition, that produces  rough, slightly red, bumps on the skin. It most often appears on the arms, but can also occur on the thighs, hands, and tops of legs, sides, buttocks, or on any body part except for the palms of the hands or the soles of the feet. Often the lesions will appear on the face, which may be mistaken for acne. Keratosis pilaris results in small bumps on the skin that feel like rough sandpaper. They are skin-colored bumps the size of a grain of sand, many of which are surrounded by a slight pink color. They are seldom sore or itchy. They occur when the human body produces excess keratin, a natural protein in the skin which is cream colored. It surrounds and entraps the hair follicles in the pore. This causes the formation of hard plugs. Doctors can often diagnose keratosis pilaris simply by examining the skin; tests are usually not needed. According to wikiKP affects worldwide an estimated 40-50% of the adult population and approximately 50-80% of all adolescents. It is more common in women than in men, and is often present in otherwise healthy individuals. The skin condition is prevalent in persons of all races. No particular race is at higher risk for contracting keratosis pilaris. Although keratosis pilaris may manifest in persons of any age, it usually appears within the first decade of life and is more common in young children. In most cases, the condition gradually improves before age 30, however it can persist longer.

There are several different types of keratosis pilaris, including keratosis pilaris rubra (red, inflamed bumps which can be on arms, head, legs), keratosis pilaris alba (rough, bumpy skin with no irritation), keratosis pilaris rubra faceii (reddish rash on the cheeks), and related disorders. Because of the resemblence with rosacea, I will focus on this last subtype. 


Wiki states that keratosis pilaris is harmless and that medical treatment is not necessary. Many patients do however look for treatment because of the cosmetic apearance of KP. Topical creams and lotions are currently the most commonly used treatment for keratosis pilaris, specifically those consisting of moisturizing or keratolytic treatments, including: urea, lactic acid, glycolic acid, salicylic acid, tretinoin, Vitamin D, or topical retinoids. Steroid creams can also be used to reduce redness. (NOT to be used when you have rosacea though!). However, the effectiveness of these treatments is limited and research to discover more effective treatments is ongoing. Improvement of the skin often takes months and the bumps are likely to return. Taking long, hot baths followed by exfoliating the affected areas with a coarse washcloth or stiff brush may help unplug pores and therefore can also be used as a treatment method. Some cases of keratosis pilaris have been successfully treated with laser therapy, which involves passing intense bursts of light into targeted areas of the skin. Depending on the body's response to the treatment, multiple sessions over the course of a few months may be necessary. Note that most of these treatments can be detrimental to underlying rosacea, in case you suffer from both conditions. Steroid creams are not recommended when you have rosacea and long hot baths neither. Some of the suggested creams here can worsen rosacea as well.

This blogger with KP suggests for treatment: "For the majority of cases of Keratosis Pilaris, one can use moisturizers along with basic lubes that can be bought which are non-prescription such as Cetaphil and also Lubriderm and lactic acid lotions for instance AmLactin and Lac-Hydrin. Your affected area ought to be washed that has a mild moisturising soap or even facial bathe twice a day. By no means use unpleasant ingredients that can dry up your skin layer since this is only able to worsen the problem. Your skin specialist may also prescribe creams using alpha hydroxy acids, vitamin A lotions and immunomodulators. Even though not that effective in completely smoothing out Keratosis Pilaris, you can also use gentle exfoliant soaps and also facial scrubs to improve the disorder of the skin."

KP or rosacea?

People with keratosis pilaris rubra faceii (KPRF) can have very red faces. The excess Keratin that KP patients have, here aggrevates the blood vessels in the cheeks and causes them to be more visible from the surface. People with fair skin are more likely to suffer with this as it would be harder to see the blood vessels with people with darker skin. It can be very difficult to distuinguish these red cheeks from rosacea. Especially when you read that KP is so common and widespread. I can hardly believe to be honest that about 60 to 80 % of youth are afflicted by the item, whereas just 40 per cent of grownups manifest some degree of the condition (source). Wiki estimates these percentage even higher as you could just read. I doubt these massive numbers of people have the keratosis pilaris rubra faceii, if so I hardly see them! I assume the majority of these people have the small red bumps on their arms and legs instead, at times.Update; KPRF is a lot more rare than regular KP. On this forum a member writes: "As keritin disorders affecting the face are rarer than rosacea it would be good to see a derm who is familiar with these to rule out KPRF or KPAF."

Keratosis pilaris rubra faceii (KPRF) is often misdiagnosed as rosacea (source), as it primarily affects the face and makes the cheeks also red and ruddy looking. However, KP can be accompanied by itching in the affected area, whereas rosacea rarely itches, and often burns instead. Also, KP not only gives a bright rosy color, but this color can be very clearly marked from normal looking skin (and rosacea rarely has such a clear cut division line), and KPRF can also look very smoothly red/rosy coloured, whereas rosacea rarely is as evenly red or pink (but again, there are exceptions for all this).  KP can come with the typical KP bumps. However, to make matters more difficult: KPRF doesn't even have to have the chicken skin feel of normal KP. Also people who have Rubra Faceii usually also have a small bit of Keratosis Pilaris on other body parts, like the backs of their upper arms (however as 1/2 population has KP this is probably not that great a test). Another difference is that rosacea usually also affects your nose, the sides of your nose, your chin and your forehead (this can come gradually. I started of with only redness in the cheek area but by now, 15 years later, my chin and nose are also getting a lot more red). Rubra Faceii affects the cheeks, the area just under the nose and just under the eyes. In addition, as written before,rosacea is usually quite blotchy while Rubra Faceii gives a much more even red skin tone (source). People with KPRF do blush and flush easily, something they share with a lot of rosacea patients. Also KPRF does not affect the eyes, unlike rosacea (causing occular rosacea; dry, gritty, painful eyes). KPRF can also hit at a young age, whereas rosacea usually starts after age 18. Some derms still say rosacea only affects people in their 30's, but this is most definitely incorrect. Mine started age 19 and I know a lot of people from forums who had rosacea from their 20's, but I only heard of people getting affected with it as early as puberty (seldomly) and onwards. KP seems to start in kids already, and also very often or even usually during puberty. Some other KPRF indications are a paler patch right in the middle of the cheek redness area, or roughness or pitted areas (small depressions) in the redness, around the hair follicules on the cheek. Also, both KP and rosacea can run in families, so if any of your family members have one or the other, this can be another indication of which of the 2 you might have when you are dealing with these symptoms that can be both KP or rosacea.

For more information on KP, see this forumHere and here a patient asks if he has KP or rosacea. See also this and this thread.

What does KPRF look like?

Update August 20th 2018

I have written before about how my skin doesn't seem to build up normally. My dermatologists think that the decade + of skin inflammation from the rosacea and flushing have disturbed normal skin barrier function. That my skin lacks a strong skin barrier therefore, making it very sensitive, easily disturbed (redness, burning, flushing) and it does not really handle many topicals, either moisturizers or make-up. So I put nothing on my skin normally, just wash it with bottled water and cotton pads, gently, every evening. No skin care, aside from some diluted jojoba oil around my mouth and eyes maybe once a week. I have worn make-up 4 times in the past decade. Part of this not normal skin barrier function seems to be that dead skin cells just build up and up, without naturally falling off. I also don't rub my face with a towel or scrubs like 'normal' people, but I do wash it and the old dead skin after a while becomes visible on my skin... But it is a delicate balance; after I scrub my skin and have red, flushed, fragile skin, it takes at least a month, maybe two actually, to be back at the stage where a layer of normal looking skin covers my face. Only when you look really carefully close by you can see the dead skin layer (it sounds more yucky than it really is or looks), but I love this stage as even when I feel a flush burning, it is only coming through, visibly, for 25% or so. The layer of dead skin also protects my face from a lot of stimuli it seems and I just flush a lot less. BUT... there comes a point where the layer gets too much and darkens a bit and then I need to start rubbing or plucking again. Once I'm busy with that, it is very tempting to go overboard and keep going on and on, only to find out soon after that my skin is looking way too raw and was scrubbed off its protective layer entirely :( 

In photos: 

The best stage of having some protective layer, but no dead skin cell build up being visible yet

Before scrub:

After scrub:

The day after scrub:

Day or two, three after scrub:

Week after scrub:

Those pictures are all taken with a cooled skin, no flushing. It really takes about a month before my flushing is back to old low levels after scrubbing my face like that. I like to just pluck the odd old skin cell off with something (not too) sharp, instead of roughly scrubbing the whole face, but after a while it just has to happen :( 


  1. This comment has been removed by the author.

  2. I’m not that much of a online reader to be honest but your blogs really nice, keep it up!
    I'll go ahead and bookmark your website to come back in the future.

    Many thanks

  3. This comment has been removed by a blog administrator.

  4. Thanks anonymous, I hope your homepage isn't intended as spam, but will give it the benefit of the doubt. I try to make simple inventories of information out there on rosacea and to add some personal experience to it all, thanks for reading.

    best wishes

  5. you are beautiful. This helped me. I deal w/ seb derm, rosacea and hyperpigmentation as a result - it has come on quite aggressive in the past 3 months. Terrible! Thanks for posting this and knowing I am not alone.

  6. Thank you Trish, that's really nice to hear. I hope you can bring your seb derm under control very soon.

  7. Very informative,I find rosacea flares in spring /summer something to do with hayfever histamine release,whereas seb kicks in with windy wet days,cold months,my scalp is getting red and raised at the moment ,just in time for chrimbo,had to crop down to the scalp to treat with daktacort and dermol etc...brilliant blog.

  8. Thanks anonymous. Yes I have the same thing; in spring my normal walks outside cause hayfever related flushing and in late fall and winter, the cold brings out the seb derm, and that brings out extra flushing and rosacea redness and burning. Best time of year is late summer and fall. Crimbo (love that word) is a nightmare usually; too warm indoors, too cold outside, allergic to xmas trees, issues with the open fires and bad foods i cant avoid. Good luck this month for you too :)

  9. Hi Scarlet

    My condition is just like yours but all over my face and scalp, and I have Rosacea and am very allergic to any contact. I am 47, am a red head, and have had this condition for 30 some years. I threw in the towel about 3 months ago and have done nothing to my skin ever since. I am trying to allow my skin protective mantle to get stronger. My skin right now is much better. I still get major dead skin build up, but it is slowing since I stopped all cleansing (no rubbing of any kind). I only now rinse with Spring Water. I tried distilled water up until about a week ago, but even that is too acidic for my poor thin skin. Since I switched to spring only, my skin is better able to hold moisture, much less flaking, less red, softer etc.. If at all possible, I recommend no product of any kind contact your skin, not even shower water. I only sponge bath now using spring water. Avoiding the chlorine and other irritants from hard water has been the single biggest benefit to my improvement. Also allowing my skin mantle to repair itself has cut down on acne probably 90%. Email me anytime if you have any questions. You are young enough to save your skin. I wish I knew now back then.

    Take care

  10. Thank you Paul for your comment and tips. I agree! I actually haven't been sing anything on my skin for the past 8 years. I also only clean my face with organic cotton pads and bottled (very low chloride) water and like you, I noticed that skipping some days is actually making me less red. So I make it clean like this every 3rd day now. I also get the dead skin build up and wonder why with ' normal people' this falls off by itself, the dead skin cells that is, and not with me. But perhaps that is because I never have my face under the shower (aim water at neck and below) and also enver rub my face clean with a towel (brrr the thought). So that way dead skin cells just stick and stay? I use jojoba oil, mixed with some bottled water, on the area around my eyes and mouth only, to avoid getting premature wrinkles and that's it. This winter I have had very little seb derm actually. Nothing like what I had the years before, which I pictured here in this thread. At the first signs I used my pharmacy home-made ketoconazole cream without preservatives on it (only the forehead area) and its still clear at this moment, despite it being really cold here.
    May I ask, how do you get rid of the eventual skin cell build up? I feel I need to give my face a proper rub every 4 to 6 weeks, to make it more smooth again and get rid of this build up. How do you do that when you don't cleanse it like you did before? And is there anything else you do to limit your facial redness?

    Thank you :)

  11. Hi Scarlet

    I'm only in my 3rd month of nothing touches my face except spring water. My dead skin build up appears thinner and lighter now compared to when I was using distilled water just last week. I would prefer to just leave that thin layer on without taking it off to allow my skin to continue to heal or get stronger (hopefully). However, if I feel I need to help it along a bit, I will just lightly rub with my finger or towel if it's loose and ready to come off. If not, I'll not force it. This usually occurs after splashing the spring water on, and towel patting dry, when the dead skin is somewhat damp. Also if I really feel the need and the dead skin is not cooperating, some jojoba oil on those patches of excess might loosen enough.

    Regarding redness, my skin is permanently messed up, thin and acid mantle not good, so it will always be a bit red or at best pink because of being so thin. Aside from avoid hard water at all costs, keeping it hydrated by drinking lots of spring water (or distilled with celtic sea salt added for minerals) helps, also taking in lots of fatty acid oils (omega 3s and 6s) in the form of something like algae and hemp oils or similar. Exercise each day, get a good sweat, stay away from acidic and caffeine drinks (coffee, alcohol) helps as well :-). Glad you are doing much better!

  12. Thank you, that is excellent advice. I think my skin works a bit similar as yours. I also notice that when I leave my skin alone, and leave the dead skin build up to some degree, I get this more normal colored ' film' ove my face, which masks some of the bad redness. When flushed, it still shines through but it looks less stripped and red at least. I think that my skin is very thin and abnormal too, maybe because of the constant inflamation of the blood vessels, but it's normal protective layer seems gone. When I do rub the excess skin off, I am left with baby thin skin that is red and a bit shiny (despite being super dry) and it feels like I had a very aggressive skin peel or acid peel and my top layer of skin is gone. Very weird. I will be more careful to leave attached dead skin alone and only remove very gently with bottled water and cotton pads when the excess skin loosens by itself. Class advice, thanks for sharing. I also agree with trying to build up a sweat as a natural way to decrease skin dryness and idem for the omega 3's (be careful with omega 6 by the way, they can actually increase inflamation from what I read). Flax seed oil and algae oil is what I use, as fish oil contains so much histamine that it makes me beet red...
    Im doing better seb derm wise, not rosacea wise unfortunately.
    Take care

  13. I just started using an anti fungal cream and I hope it keeps working. My doc only prescribed a steroid cream which I've only use sparingly because it thins the skin. I'm also trying to drink less pop (less sugar). Thing is, since the condition gets worse in the winter, and better in the sun, I've started taking vitamin D liquid drops. They say most of the population is deficient in vit D, and it even helps protect against cancer. The old recommendations were 400 units per day, but if you google new vitamin D recommendations now, up to 3,000 units is recommended. So my theory is that if our condition improves in the summer due to the vit D we get from the sun, it should follow that taking vit d liquid (which is absorbed faster than tablets) should help us greatly. And, if protects against cancer, MS etc, then its good for us anyways!

  14. Thanks for your comment hollysharon. Yep, I see that pattern too, seb derm in winter, no seb derm in summer. I'm very deficient in vitamin D as well and try to sunbathe an hour at noon when there is sun in the sunny months. It might be that vitamin D levels in the body correlate with worse and less seb derm. I also suspect, personally for me, that the cold air of winter makes my seb derm worse. I also use a fan often for my rosacea, so that makes the air feel even colder. And perhaps the dry air in winter also is at play? Oh well, and sugar and yeast for sure. For sure, I read a lot of articles and studies on the benefits of vitamin D, and even sun exposure, and how the frenzy against sun exposure, to avoid skin cancer, is good, but has a lot of negatives attached. Like you wrote, having sufficient vitamin D levels has proven to have protective actions against a lot of auto immune diseases, inflammatory diseases and several types of cancer... - nope, not skin cancer. As I don't burn but bronze naturally, I don't use sunscreen lotion and sunbathe my body (never face - because of the rosacea) for an hour a day around noon.

    I hope you are seeing progress now that you have added the antifungal cream, I find ketoconazole very effective personally.
    Best wishes

  15. I received a question from someone who described the following symptoms and asked for advice if it could be the effects of demodex mites perhaps, and my view on it.

    "What a wonderful blog you have. I've read it several times before. Thank you for sharing, you are a inspiration. What is your opinion on Demodex Mites relationship with acne rosacea.?" The writer recounts having used a self test with mineral oil test and a microscope and how he detected at least 6 to 15 Demodex mites. Suspects now to suffer from Demodicosis. He adds his symptoms:
    -Constant T zone facial redness
    -Enlarged pores around cheeks, nose & forehead
    -Extremely oily skin
    -Alternating dry skin
    -Extreme itchiness & crawling feeling on face, eyes, eyebrows, eyelashes, scalp and body
    -Eye brow hair loss. I've lost half my eye brows in 6 months
    He expresss his surprise that no derm has offered him much, nor demodex tests and that he was diagnosed with seb derm but that his dermatologist assured him that the condition does not cause hair loss. "I've lost half my eye brows already but I don't have flakes or scaling. I just have itchiness & crawling. Could Demodex mites be causing my hair loss? Any advice will be greatly appreciated."

  16. Here is part of my reply:
    "thank you for your message and thank you for complimenting the blog. It comes mostly from frustration about lack of consistant information out there and wanting to do something meaningful with my at times isolated life.
    Demodex mites, I am actually working on a blog post about it.. I have understood from my dermatologists that they believe it is usually not a factor in vascular rosacea, with only flushing and (on and off) redness. So not with the vascular subtype, but more so with the papular subtype. That makes more sense to me as well, as the paps and pimples can be a result from the mite inflammation. They don't just disappear in an hour and seem to need some form of treatment. Whereas I can wake up red and be pale in an hour (with help of fan and sitting up). So I didn't understood how that could be linked with demodex mites, something you expect to cause some more resilient symptoms. But, the verdict seems stil out there and for all we know, mites can also cause the underlying blood vessels to be permanently dilated, as some allergy reaction.
    All I know about demodex treatment is what is out there online. And I am not through that info yet to be honest. I understood that some have effect using tee tree oil on their faces, or apple cider vinegar or other substances that should control it. Others mention systematic drugs like anti parasite meds, also rifaximin, but then the infection can come back once you stop the medication.

    It makes sense to me to keep your skin very clean yet moisturized when suffering from this
    The T-zone redness can also be seb drm. I have it too in winter and it cases skin scaling, redness, even pimples. I showed some pictures of the seb derm rashes and redness I can get in this blog post: http://scarletnat.blogspot.nl/2013/05/seborrhoeic-dermatitis-seb-derm-in.html
    Seb derm also typically causes the greasy flakes, YET dry seeming skin, so that would be another clue in that direction for me personally, looking at what you describe. But the crawling less so. Also, seb derm tends to appear in the T zone only, not in thre middle of your cheeks usually. Well, some do actually, but it's not often. And from what I read, demodex is appearing in the warm skin zones, so yes the faults of your mouth/nose etc but also the cheeks itself. Then, the eye brow hair loss is quite typical for seb derm again as well, see the blog, I added pics. I lost 2/3 of my usually full eye brows because of it. So I would say, treat it as seb derm first, and get some ketoconazole cream. I have mine made by the pharamcy, with no preservatives, but you can try normal ketoconazole cream first (on prescription here in Europe), or Lamisil (otc). Once you see some clearance of the symptoms, you are most likely on the right track. Seb derm can make your skin feel itchy yes. Try to cut back on your sugar and yeast intake too by the way, they worsen the sen derm once you are in a flare. (continuing)

  17. YES seb derm DOES cause hair loss. Again, I gathered patient testimonials of that in the blog post, you and I are not the only ones with deb derm and lost eye lashes and eye brows. Not all derms are up to date on this or are focused enough on finding out more, apart from what's in the text book. Unfortunately. Oh and from what I read, people with normal skin also have some demodex on their face, as they are part of normal skin flora and balance. So 6-15 of them sounds like in the normal range to me but I might be wrong, I remember some articles mentioning that around 8 found ones in a culture was not an abnormality. Maybe it is also our immune system that reacts badly to these normaly present mites. And on top, tose with rosacea tend to have warmer skin temperature, where mites in theory thrive.. Demodex tests are constroversial still amongst dermatologists I think, nobody was willing to give me one at least over time. But I alse feel people should be careful not to self medicate this out of desperation, because the creams and oitnments used to 'eradicate' the mites (they will come back, as they are part of normal skin balance), may worsen your rosacea and aggrevate your delicate skin. So caution is warranted.

    Best wishes, Scarlet :)

  18. Keep it up! You are very pretty:)

  19. Thanks Will, that's lovely of you to say

  20. I feel sorry for you. I used to lose my eyebrow hairs due to atopic dermatitis, because i rubbed and scratched my face a lot, Cortisone cream helped me and nowadays i eat healthy; veggies, fruits, oils and stuff to keep up the good condition.... I still sometimes lose eyebrow hairs, i notice them in the morning all over my face, i don't know if it's due to scratching, because my brows are not itchy anymore, but i see some white stuff under my eyebrows, is that sebum or what????

  21. Bloggabja95- You are eating fruits and veggies pretty much only now and still having issues? I have been thinking about trying just fruits and veggies to see if it helps my scalp seb derm. Scarlet- Try the raw or Manuka honey. It has helped so many! You are so intelligent and beautiful. Glad I found this blog!

  22. Thanks for your comment Bloggabja95. I eat the following foods mostly; breakfast; some type of fruits; pears, melon or mango usually. Lunch; I make often pancakes from whole grain rice flour, organic egg, almond or rice milk and have some fruit jam on it. Dinner is often a stir fry of fennel, broccoli, courgette, sweet potato, carrot, olives and something sweet like dried plumbs or some dates or figs. Most days I eat meat with it too; organic beef, lamb or chicken. Or tuna fish once a week or salmon, but it is pretty high in histamines and I can't handle it too often. For me the seb derm is not as much related to diet, as long as I stay away from sugar overload and yeast overload (breads mainly). Mine is always back once the weather gets cold thoug; red rashy areas along the T zone of the face and forehead. There is always some seb derm in my eyebrows unfortunately. I feel in my case winter is the worst trigger. Thank you for the manuka honey tip, I tried it once and found it a bit messy but that was many years ago so I might want to try it another time soon. I hope you are well and found ways to control your seb derm.

    best wishes Scarlet

  23. Hello scarlett,

    When you have a seb derm flare do you notice your rosacea goes a bit haywire too? I'm having a hard time telling the 2 apart. I am getting the seb derm flare under control but notice my cheeks are really red.

  24. I just wanted to say thank you for the time you spend writing your blog. It is comforting to know there are others out there like me who also understand what it is like to manage this frustrating condition. I wish you all the best and hope that you are able to find relief. I am an aspiring medical student who aims to expand on the research being done on this condition in hopes that a long-term treatment or cure can be found.

    I've found pyrithione zinc to be one of the most effective treatments for me after experimenting with a wide variety of treatments. I typically apply some standard shampoo (Head and Shoulders) containing this ingredient to the area and leave it for 5 minutes before washing it off. I then use a moist washcloth to carefully remove any build up of scales and then apply a light moisturizer or a very small amount of coconut oil.

    You are beautiful by the way. Take care.

  25. Thank you Eric, very lovely to read your message. And exciting that you might be on the front line as a doctor to find better treatment options and understanding of these skin conditions, seb derm, rosacea even perhaps! Sorry you have seb derm problems too, I will post some winter pictures over the years tomorrow if I can finish it by then, showing the seb derm and redness winter has brought me each year so far. I find the ketoconazole effective but will look into pyrithione zinc as well, another friend (also a medical student, aiming to become a dermatologist actually) uses it too for her seb derm and also finds it effective. Thanks for sharing that :) take care and best wishes

  26. Hi anonymous,

    yesss, very much so. I find the seb derm makes the rosacea flare and also, seb derm in winter gives me red rashes around my mouth and inner cheesk, along the T line. I will try to add some more pictures of that tomorrow. The redness and flaking really resembles rosacea with me, but I find seb derm to be more flaky yet fatty (shedding extra skin cells), and also that seb derm is really located and restricted to the (broader) T-zone area, so not so much on the apples of the cheeks for instance, where my rosacea is worst. Also, it responds to ketoconazole cream, whereas rosacea doesn't or gets worse from it when I put it on my cheeks. It helps me to keep indoor temperatures not too cold, the cold really worsens my seb derm. I also try to keep indoor air a bit on the humid side, not too dry (which is normal in winter here). Also trying to eat healthy, low sugar and carb. Not much else I have found to beat it, every summer I think; wow my skin is so calm, I will avoid seb derm this winter! But I never manage to, and besides, will power is not enough for that haha.

    take care and best wishes

  27. This comment has been removed by a blog administrator.

  28. Let me first say what a superb blog you have put together on this frustrating problem. I suffer from mild web deem out breaks that happen 2 or 3 times a year. I believe the seb derm is caused by hormonal changes throughout life. I had outbreaks early on in life (teenage years) and now from the age of 35 - 39. The cold brings it out (makes it look worse) as the skin is exceptionally dry. A humidifier is on my wish list. Stress is a major factor and can make hormone levels go through the roof. I keep an eye on diet but have found little or no consistency (my experience). I have not got round to reading all the blog yet but would be interested in hearing if anyone has IBS and or acid reflux. Thank you for your great blog.

  29. Hi Nick, thanks for your kind words and sorry you suffer from seb derm too. I agree, my seb derm just started again last month, now that temperatures are low. I do use a cool mist humidifier in the house when the air humidity is below 40% or so, depends also how tight my skin feels an dhow dry it looks as I can't moisturize it topically as my skin is too sensitive. The ketoconazole cream I get made is partly effective at pushing the seb derm rashes back but I haven't stayed seb derm free any winter yet the past decade. I made a blog post about underlying digestive issues and IBS with rosacea, but it could also apply for seb derm sufferers I think. Maybe it has something of interest in it for you. http://scarletnat.blogspot.fr/2013/12/rosacea-and-bowel-or-digestive.html

    Thanks for reading my blog and commenting, best wishes Nat

  30. Oh and food isn't always a trigger for everybody... From what I know seb derm has mostly to do with a yeast overload and cell division and an autoimmune response, but for some eating less sugar and yeast containing food products helps, as the malassezia yeast feeds on it. But they also feast on dead skin cells, so the food relation is more empirical perhaps, and possibly different for each patient.

  31. I also have this problem over 10 years
    thanks for the information
    keep going!
    and you are really really beautiful

    ps. sorry for my english , my english is not good

  32. This is a fantastic and really helpful site. I started suffering with seb derm last year and still have 'flare ups' usually triggered by food. My doctor suggested steroids but I was reluctant to take them so I started to research natural remedies.
    I went to a Chinese herbalist and take herbs for the condition which has helped a great deal. From a Chinese diagnosis it is caused by heat - usually internal heat not necessarily heat related to your temperature. Heat accumulates with certain foods and emotions. Heat causing foods are red meat, any alcohol, spices- chilli, for me raw garlic, wasabi, sometimes eggs, always MSG, chocolate and dates. I find the more natural the food the better.
    Women often have more flare ups around the time of their period as some experience night sweats and I am more prone to a flare up at this time if I eat any of the food I am not supposed to have. The internal heat is much stronger for a few days before. My seb derm is on my face and head only and if you think about heat, it rises so it makes sense for my diagnosis that it is on my face.
    I also have acupuncture to help 'clear the heat' and this works really well. I am flare free at the moment and really found an easy natural way through with this 'heat' theory. My skin is nearly better than before the seb derm ( no alcohol!) .
    I also found this natural cream that helped me with no parabens or parafin. It is called Argentum Plus Seb Derm Lotion you can buy it on line and I swear by it.
    Good luck in your self experimenting.

    1. Thank you for your post! I am also known with the Chinese medicine approach to inflammatory skin diseases. I wrote about the suggestions I received in the Food thread on this blog, but it echoes what you mentioned; indeed red meat, spices, garlic, unions, alcohol, diary and my Chinese doc also mentioned predatory fish. Non predatory fish are fine. I think many of the foods she listed as heat inducing inside the body are the type of foods we rosaceans see a skin reaction from already; either because they are high in histamine, or blood vessel dilating by itself (spices, alcohol, caffeine). But there were also some surprising foods, I think mango was also on the black list and strawberries. Again though; both are high in histamine, which is a blood vessel dilator.

      I find sugar and wheat my worst triggers personally for my seb derm. And the cold of winter. Im seb derm free now as it is getting close to summer but in the winter my ketconazole cream helps me a lot and just eating health; lots of vegetables, organic poultry, some white fish, whole grain rice flour, apples and pears mainly.

      I'm sorry you also suffer from seb derm and somehow am glad you stayed away from steroids, as they can potentially leave you with flushing as a problem on top, which is even harder to tackle often than seb derm.

      Thank you for all your suggestions and I hope your progress will last and continue :)

      best wishes

  33. Seborrheic Keratosis is a medical condition of skin which appears as wart-like bumps all over the skin. Apparently it is noncancerous but still it is commonly known to be causing cancerous growths in adults.

  34. Hi, Sorry haven't read the whole blog to know if you have come to this conclusion but you definitely have ulerythema ophryogenes on your eyebrows and therefore I do wonder if you have kpaf/kprf on your cheeks. Sounds like you have been down this route however as someone with these conditions who was incorrectly misdiagnosed with roscacea I know what it is like trying to get a correct diagnosis for 'redness' on the face.

    1. Thanks so much Unknown, I have never received the diagnosis ulerythema ophryogenes unfortunately, every doctor shrugs the eyebrow redness and brow loss off. I always assumed it was seb derm in my case (as I do get seb derm around my mouth and nose some times). But you are right I think, it looks exactly the same. It is crazy but despite seeing so many dermatologists over the past 20 years or so, I never discussed the possibility of my face redness and flushing being Keratosis Pilaris Atrophicans Faciei... But your comment makes me think it could be a factor at least. I have responded badly to IPL and laser, I don't get pimples or typical rosacea inflammation. I am going to read up more about kpaf/kprf (I defo don't get the red KP rashes on my arms though). Thanks so much for your comment!


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