Seborrheic Dermatitis: Mustache, Beard, and Scalp

SEBORRHEIC DERMATITIS: MUSTACHE, BEARD, AND SCALP AREA. As a General Practice Physician, who has suffered with this same condition discussed in this forum for over 20 years, I have decided to respond with a long post. I shall attempt to tell you more than you care to know about this nagging condition, in hopes that you may find peace and solice from this troubling, tormenting, time-consuming, financially-draining, and self-defeating disease. If I help one person to take control of this condition, it was worth my time. The vast majority of the posts I have read, seem to suffer from CLASSIC: Seborrheic Dermatitis (As I have for years). And, some of you may have a mild component of "Rosacea" (a redness disorder, extreme sensitivity to any facial product, sunlight, and possibly foods), or "Psoriasis" (a cell-turnover disorder or "skin shedding disorder") mixed-in with your "Seb Derm". In this post, I will attempt to tell you: 1) the basic CLASSIC MEDICAL APPROACH to treatment of this Seb Derm; and 2) methods that may not be completely conventional, but are based on MEDICAL SCIENCE and have been shown to work in many cases. IT IS IMPORTANT TO KEEP IN MIND, THAT THE SKIN IS A UNIQUE ENTITY. NO TWO SKIN CONDITIONS ARE THE SAME. This is largely because of genetic factors, skin type, ethnicity, climate, and even your state of "hydration" can affect your skin. SO, WHAT WORKS FOR ONE PERSON, MAY NOT WORK FOR YOU. TREATING SKIN CONDITIONS IS LARGELY TRIAL AND ERROR. With Seborrheic Dermatitis, A.K.A. "Seborrhea", A.K.A. "Dandruff" in common terms (A.K.A. "Cradle Cap" in Babies) one will have: 1) crusting/flaking in any of these areas: mustache, beard, or scalp. 2) itching; 3) redness. There may also occasionally be a "greasy" clearish-yellow, oily "ooze" from these areas, during a severe flare-up (this is "sebum", flowing from the inflamed sebum glands). As a physician, I can tell you that [medical school teaches] that this is caused by a yeast called Malassezia furfur, formerly known as Pityrosporum ovale, on the skin surface, which over a period of days overgrows leading to an ARMY of yeast on the skin surface. These yeast release mycolic acids on the skin, which are very irritating to it. This also alters skin pH. You then..... S C R A T C H like a mangy dog! You rub BACTERIA + YEAST into your broken skin, further irritating it. It does not appreciate this! It gets MAD! The fact that you just mowed the lawn, and sweat like a water buffalo also helps the yeast to grow, as they love the warm humid environment. Now. Something that med school DID NOT and still to my knowledge DOES NOT [YET] teach, but [MOST] Dermatologists, and other Physicians accept as another important contributing factor to "Seb Derm" can be [get ready, I hope you are sitting down], face mites. Now, these are primarily associated with Rosacea, not seb derm. However, there is becoming more evidence to show that there is more overlap between these two diseases. These "FACE MITES" are actual little bugs, also known as "eyelash mites", that live down in the base of the hair follice, inside the Sebum gland. The more scientific name of this mite is called Demodex folliculorum. In dogs, a variant similar to this is what causes "Red Mange". If you would like to see a picture of these mites just google them. Now that I have you totally scared to death: Realize this- EVERYONE has these mites normally- to some degree. These live on everyone. However, those with Rosacea, and [probably] seb derm as well, have MASSIVE AMOUNTS of these mites on their faces and skin surface. These mites, both male and female, only come out at night, while you are sleeping, they breed, and then crawl back into their hole, which is: the Sebum Gland. All these mites living in your sebum gland help keep it inflamed and irritated, and encourage it to pour out sebum. (theoretically). This thick oily sebum, is then "Thanksgiving Dinner" for the YEAST! So, the COMBINATION: 1) YEAST; + 2) FACE MITES; and 3) NORMAL FACE BACTERIA; (particularly Staph), tends to keep your face in a Royal Mess! It is speculated that the reason one person gets seb derm, but another person does NOT get seb derm, is because of TWO FACTORS: 1) GENETICS- Seb Derm itself, is not inherited; however, the tendency to GET Seb derm IS inherited. What one actually inherits, is an INABILITY of the immune system to [for some reason] fight off either the fungus, or the face mites, or both ==> ultimately allowing fungal overgrowth and redness and itching. 2) IMMUNE SYSTEM VULNERABILITES- If you have had Seb Derm since, let's say, High School, you most likely have the genetic type. If however, you are well into adulthood, and suddenly develop Seb Derm for the first time ever, and have never had any "dandruff" type problems before- you should probably ask your doctor to do some blood work to check your immune system- as SEB DERM can be the FIRST SIGN of other more serious IMMUNE DISORDERS. (Don't panic here folks, just ask them and get it checked) (all of the ones I am talking about are very treatable). GENERAL TIPS: 1. Realize that this disease requires DAILY DISCIPLINE/MAINTENANCE/PAMPERING OF YOUR SKIN, or it will get worse. 2. Depression and Anxiety will worsen this disorder. (they cause an elevation of cortisol, which the yeast thrive on!). So get any emotional problems treated by a professional, if you are depressed or anxious- this should help your skin! 3. You must have meticulous hygiene, and you can no longer be "the lazy cave man, who says "oh I'll shave tomorrow....next week". 4. Take charge, and this thing cannot control your life. 5. Read everything you can get your hands on, and educate yourselves about the 3 conditions I have discussed, from CREDIBLE sources. BE SURE they are CREDIBLE sources folks. Some might be, ***edited by moderator*** web addresses not allowed, etc. Go to your local library if necessary. Print up articles. File them. Become your own expert. 6. Go to a Good Dermatologist who will spend time with you, or even a family doctor if they are willing to work with you and spend time with you and listen to you. A good doctor is not always the one with the most qualifications, but the one with the investigative wit, tenacity, and interest in your case. If you are not happy- MOVE ON TO ANOTHER DOCTOR. 7. You may want to bring articles of interest (i.e., pictures of the face mites) to your doctor for discussion for emphasis. (these mites are actually NEW in medicine, and many doctors are unaware of them). 8. Don't be afraid of making your doctor mad, or of getting another doctor, if he is not willing to hear what you have to say and try to seek out the best treatment. THIS IS NOT A POPULARITY CONTEST. YOUR HEALTH COMES FIRST. 9. Consider asking your doc to test you for: 1) immune deficiencies, and 2) Auto-immune disorders (i.e., Lupus, etc.) 10. INSIST on a "Demodex Scraping" if you are at a dermatologist who is familiar with them, and/or does them. (they will look at a scraping under the microscope for the face mites). (you can just ask the derm's nurse if they ever do demodex scrapings, she'll know) 11. INSIST on a SCRAPING of the RASH for YEAST CULTURES, BACTERIAL CULTURES, and HISTOLOGY. Tell them you want to know a "Laboratory Confirmed Diagnosis", not just a "Clinical Diagnosis". (the fungal cultures will take weeks to get back, but it's worth it- mark your calendar, and CALL THEM to follow up, don't expect them to call you, nowadays, medical mishaps happen way too often). 12. Once 9, 10, 11, is done- a more concrete diagnosis can be reached, things can be excluded, and treatment can be guided to your specific situation. 13. Steroid Creams will usually get your condition under control fast. The tradeoff: they will cause THINNING of the skin over time and can cause "red blood vessels" to become visible on your face. (this is part of Rosacea, called telengectasias). Steroids can also cause "rebound" or withdrawal flareups. Do do I use steroid cream? Yes. There is a place for them in my opinion. But they should be used sparingly. I use a weak steroid ointment- for mild flares, or 1% hydrocortisone for more troublesome flares. However, if one maintains GOOD HYGIENE, and GOOD SKIN CARE, you will find it is very rare that he requires topical steroids. Even then, I would probably only use it when I needed a quick fix (i.e., such as social event coming up). Also, be very careful of the STRENGTH of steroid cream you put on your face- make sure it is one for the face. Using too potent a cream can thin the skin. I intended to go more into the specific medications, but it is late at night, and I'm tired, so I will just tell JUST A FEW of my favorite meds (and some OTHER TIPS) and you can ask your docs about them. Here goes: PRESCRIPTION ONLY: Nizoral Cream (Ketoconazole Cream 2%) - Still one of the best Antifungal Creams- works great to kill the specific yeast we discussed. Nizoral Shampoo (Ketoconazole Shampoo 2%) Permethrin Cream - great to kill the demodex face mites. (also kills scabies, lice, etc); good for those with pustules/acne; Metrogel- an antifungal and antibiotic; reduces the demodex mite population on the skin. Triamcinolone Ointment 0.1% - is a very weak steroid for the face; yet is very moisturizing; can be put on at night. Hydrocortisone Cream 1% - or other steroid creams (there are many) for flairs. RECOMMENDED OVER-THE-COUNTER FACIAL PRODUCTS: Aveeno Positively Radiant Cleanser (or Pads)- The best, non-irritating facial cleanser- with nutrients, I have found; Buy at Walmart. Shaving Cream: Nivea For Men, Sensitive Shaving Gel, Alcohol-Free (white/blue can) ; Wal-Mart Nivea For Men, Sensitive Lotion; (apply within 2 minutes of shaving) (always keep face clean and moisturized) ("baby your skin") BEST RAZOR: Panasonic ES-LA93-K Vortex Men's Shaver- $192.26 at Amazon; I recommend switching to a VERY GOOD electric razor. This one is expensive, but worth it. It is also excellent for scalp shaving. FOR SHAVING ON THE GO: Braun M90 Mobile Shaver, $19.62 at Amazon, Great way to shave on the go, if you are a busy person. (Note: I would recommend waiting until your face is doing well to switch razors, as to not further irritate it) GENERAL TIPS: Maintaining good hydration and fluid balance (i.e., drinking water) is important for skin health. Maintain Good Nutrition, generally, I recommend a multi-vitamin, b-complex, and fish oil. (that's about it) (don't over do it on the supplements) (there are tons of claims out there, and I have yet to find any that work). 15-20 min. SUNLIGHT: HELPFUL for Seb Derm, but usually aggravates rosacea. You may have to experiment and see what works for you. HOT WATER: DEFINITELY aggravates Rosacea; and to a lesser degree, Seb Derm. (best to use cool or tap water on face) FOODS: Rosacea- often worsened by hot food, hot tea/coffee/beverages; Liquor; spicey foods such as jalapeno peppers, etc.; experiment! NOTE: No Rubbing alcohol on face. Ever. This is known to provoke Rosacea. VERY IMPORTANT: RULE OF THUMB IN REGARDS TO FACE PRODUCTS: IF IT BURNS WHEN YOU PUT IT ON YOUR FACE, DO NOT USE THE PRODUCT. DO NOT USE SOAP ON THE FACE, ETC. - BABY YOUR FACE. USE THE CORRECT REGIMEN, ALL THE TIME, EVERYTIME. GOOD LUCK GUYS, Stewie, M.D.