Hello M. Riley,
Of course, you realize that I can't give you an accurate diagnosis but my
guess is that the dry crusty patches under your eyes could be one of the ff:
1. Seb dermatitis; 2. Rosacea patch; or 3. Asteatotic eczema (fancy name for
severe dry winter skin). My suggestion is for you to slow down on weaning
yourself from doxycycline for now. Go back to the last dose you were on 3
weeks ago, before the appearance of the patches. Go ahead and apply the
Vita-Oil 2-3 times a day on a damp face. One helpful way of pushing the
moisture into the skin is to do this: at bedtime, apply water compress
(clean soft moist towel, comfortable temp) on the areas involved; leave for
5 minutes. This softens the skin and makes it more permeable. Then apply the
oil immediately. Do this for one week and see if there is improvement. If
there is, I would continue until there is clearance. Do not add any other
topical med. If no improvement, you can ask your derm for a prescription of
Nizoral Cream (different from shampoo) and apply at bedtime over the
Vita-Oil.
Is it harmful to moisturize if this is seborrheic dermatitis?
The answer is NO. It is true that in seborrheic dermatitis, the theory is
that the sebaceous glands are hyperactive, secreting an abundance of sebum
that is thicker than normal. This sebum accumulates and dries on the skin
leaving dry flakes akin to dry skin but with a greasy somewhat rancid smell.
The typical picture shows dry flakes predisposed in areas such as the
eyebrows, T zone (mid-forehead, nose & chin) and ears. Microorganisms,
particularly yeasts such as p. ovale and some bacteria conglomerate and
thrive in this milieu causing inflammation - hence erythema (redness), more
flaking & even crusting. The individual thinks his/her skin is very dry and
avoids washing which ironically, is a must in this early stage. So, with
inadequate washing, the condition worsens, becomes eczematous (with redness,
itching, bumps, small vesicles) causing the skin to become angry-looking and
sore. At this point, washing will cause burning and pain. Skin is raw,
permeable and easily irritated. So, the vicious cycle continues. When this
condition approaches this late stage, there are several ways to handle this:
1. soften the thick greasy sebum/crusts etc. by wet compresses. 2. repair
the epidermal barrier by lubricating it with anhydrous moisturizer that has
low preservatives (like oil, vaseline and like ointments). 3. combat the
microorganisms with antifungal creams once skin barrier is somewhat restored
and can tolerate the topical med. In some cases, oral antibiotics may be
needed if secondary bacteria is present. 4. In severe cases, a short course
of topical cortisone ointment to calm down the inflammation speedily. Bear
in mind that this last measure should be used no more than 1 week at most.
Once skin is improved, steps 1, 2 & 3 should be maintained PLUS an adequate
cleansing program instituted. All these require time for skin to heal.
Unless one understands the mechanism of SD, slow progress or a little
set-back with appearance of more bumps (sometimes happens) becomes
discouraging and one gives up.
Will photoderm help Seborrheic dermatitis? My suspicion is that it probably
does inhibit sebum activity.
Linda Sy M.D.
Linda Sy Skin Care
http://www.lindasy.com
Voice:Toll-free 877-Lindasy (546-3279)
Outside US: 925-256-0178
FAX: 925-939-5207
----- Original Message -----
From: "M. Riley" <adanac@earthlink.net>
To: <rosacea-support@egroups.com>
Sent: Wednesday, December 27, 2000 6:34 PM
Subject: [rosacea] Dr. Sy or Anyone, Pls Help: Seb Derm Questions
> I recently developed these pink, dry, raised, crusty patches of skin
> under my eyes. By the time I was able to see the dermatologist,
> though, the patches cleared up. When I described them to the derm,
> he immediately suspected seb derm, as he said they typically show up
> around the eyes, nose and ears. He wanted to give me cortisone for
> it, but having suffered from the consequences of longterm cortisone
> use, I refuse to use the stuff. He made it seem like there was no
> other treatment besides cortisone. I have read on this site that
> some folks here are using Nizoral or Noritate. I can't use Noritate
> becasue it irritates my skin.
>
> 1. As for Nizoral, can it safely be used around the eyes?
> > 2. Also, would antibiotics help at all? I've been trying to wean off
> doxycycline over the last month, and 3 wks ago these dry patches
> appeared. Is there a correlation?
> > 3. I also understand using heavy moisturizer on seb derm also makes > it
worse, but I've been using Vita Oil and it seems to help. Is this
> okay?
> > 4. Would photoderm help with seb derm at all?
>
> Thanks.