Jan 11, 2009

Last dermatitis stopped!

[REMINDER TO FIRST-TIME VISITORS: Be sure to read the oldest posts first. They describe the "-itis" problems I have faced and the main solution. The later posts, including this one, deal with details.]

As I explained in my oldest post, a series of "itis" (inflammation) problems have appeared during the last 47 years of my life. Four were skin problems (eczema, rosacea, scleroderma, and seborrheic dermatitis). My "anti-itis diet" (which I now humorously call the "prelithic diet") has stopped the arthritis, bursitis, tendonitis, iritis, colitis, and three of the four dermatitis problems.

I discovered recently in talking to my dermatologist that the cause of my fourth skin problem, seborrheic dermatitis, is unknown. (Stress, which is notoriously difficult to measure and track, is one suspect, either in the emotional form or the immune-system form.) Not surprisingly, there is no cure for it.

Apparently the sebaceous glands produce too much oil. The extra oil makes the skin scale--making the skin look chalky and dry. Itching accompanies the scaling, and the skin is very vulnerable to abrasion (which causes redness, swelling, itching, and peeling). Rubbing from an electric razor, a hat brim, or a large, stiff collar are examples of abrasion. I have not been able to shave with an electric razor for many years. (I have been using a hair trimmer set at the lowest setting, on my face and scalp.)

Last week, my dermatologist suggested a treatment program that has eliminated the symptoms. Following is the program, but be sure to consult your own physician. Your situation may be different. I am naming the particular brands I use, but there might be others equally effective.

FACE: Daily, apply a small amount (perhaps one-third teaspoon) of Hydrocortisone Lotion, USP 2.5%, Qualitest, available by prescription. Use it like a moisturizer. A little goes a long way, covering all of my face and front upper neck, that is, all the areas that had rough patches from scaling skin. I apply it about 15 minutes after taking a shower in the morning, when my skin is clean and dry. (I have not used plain soap on my face for fifteen years, but it was very irritating to my skin problems.) The prescription suggests applying it twice daily for the first week and then once daily after that. How long will I need to use it? Perhaps forever, if the purpose is only to suppress symptoms. I may experiment with cutting back the frequency, after a few weeks.

SCALP 1: Every night before bed, apply--throughout the scalp but especially in scaly areas--a small amount (perhaps 1 teaspoon total) of Fluocinonide Topical Solution, USP, 0.05%, 60 ml, TEVA Pharmaceuticals. This application is easy for me because my hair is extremely short. The nurse who told me how to use it has long hair; She said she soon learned to use the squeeze bottle to apply it efficiently and then use her fingers to spread it around the scalp.

SCALP 2: With a medicated shampoo, wash scalp (not the face) every morning. (Be sure to leave it on for a few minutes before washing it off.) Rotate the daily shampoo among the following five medicinal shampoos. I assigned each to a day of the week, for simplicity's sake (and I wrote the day on the bottle with a bold felt pen).
- 1. Monday: Prescription Ketoconazole shampoo, 2%; Perrigo.
- 2. Tuesday: Over The Counter (OTC), RiteAid "Dandruff Classic Clean" shampoo, containing pyrithione zinc 1%.
- 3. Wednesday: OTC, RiteAid "Therapeutic Shampoo," containing coal tar, 2.5%.
- 4. Thursday: OTC, RiteAid "Dandruff Shampoo," containing selenium sulfide, 1%.
- 5. Friday: OTC, Neutrogena T/Sal Therapeutic Shampoo, containing salycylic acid, 3.0%.
- Saturday: repeat shampoo from Wednesday.
- Sunday: repeat shampoo from Thursday.

With this approach, the scalp condition is medicated by a series of active ingredients in the hope that at least one of them will reduce the symptoms. Perhaps the various shampoos work individually to reduce different aspects of the symptoms. I do not know.

What I do know is that the treatment program outlined above works for me, and after only about five days of application. (My doctor cautioned me to continue even if the symptoms disappeared.) For the first time in 47 years, I am symptom-free!

This is not a cure, but it is a way, if applied regularly, to eliminate the symptoms.

I am very glad I live in a country that still has a little freedom of choice for doctors and patients.

Burgess Laughlin
Author of The Power and the Glory: The Key Ideas and Crusading Lives of Eight Debaters of Reason vs. Faith, www.reasonversusmysticism.com/


Burgess Laughlin said...

After only nine days of following the program I outlined in the main post, my symptoms are completely gone.

I have decided to begin experimenting with cutting back on the frequency. E.g. I will try using the hydrocortisone lotion only on Tuesday, Thursday, and Saturday, and only once on each of those days, in the morning.

My reason is that I do not want to use any medication--even supposedly mild ones that are over-the-counter--unless I must.

MariusA said...

I have the same problem: seborrheic dermatitis. Same eating pattern, only that I eat seeds(only flax seeds actually). I reduced a lot the effects on my face, but on my scalp not so much. I mean I still have those white pieces of skin that fall off, but reduced in numbers. My only problem is the itching, on my scalp, no itching on my face now, if I don't scratch no problem only a mild itch. If I'm stupid enough to scratch just a bit and don't control myself I have serious problems: redness, sore spots and more scales that fall.

Do you know or has the doctor told you that hydrocortisone containing products have adverse effects used over more than 2-3 weeks? I used them as my doctor told me and did nothing than agravate my problems, a lot. I gave up on them.

As shampoos only one with selenium sulfide from Vichy worked for me, it cured completely my scalp. The other you mentioned didn't work. Only temporarily the one with pyrithione zinc, but just for 2 weeks.

But I want to address the problem and not the effects. I'll just keep eating this way and wait. Need to take some Yoga or relaxation exercices to heal my body, I think.

Any suggestions?

Burgess Laughlin said...

Based only on my own experience (and remembering that I am a layman), I would suggest the following.

1. If I were on the same diet (absolutely no animal products and no plant foods made from seeds [legumes, grains, nuts],* then for consistency, I would not eat flax seeds--at least as an experiment for a couple of months. If flax seeds are absolutely necessary, which I doubt, I would look for a non-seed substitute.

2. I would keep in mind that my own experience is that SD was the only inflammation problem I had (among many) that did not fully respond to diet change. I still had it, even on the strictest non-acid-producing diet. That tells me that possibly there is another cause. My doctor and various sources I checked online said the cause is unknown (which is why treating it is so difficult).

3. Since I was using a variety of pharmaceuticals (some daily and some in rotation), I don't know which caused the SD to disappear. I am continuing to use the lotion on my face (but only 2x weekly now) because it is the only one prescribed for my face. The many other drugs were for my scalp. I am continuing to rotate them (but used only 2x weekly now) since I don't know which one was effective--or if all of them are necessary in succession. Each medication may treat a different aspect of SD, or perhaps the doctor prescribed them all because some work for some SD patients but not for others.

4. I too would like to address the SD problem and not just the effects (symptoms). The difficulty is that the problem's cause is unknown, so one is left dealing with symptoms. However, I wonder if, for me, the situation is analogous to an enduring fever: it goes on and on, but if I take even just one or two aspirin, that knocks the fever out and the fever doesn't return, even if I stop taking the aspirin.

The point is that I wonder if SD, like some other inflammation problems, is feeding on itself: Some sort of stress causes SD, SD causes stress, and that stress refuels the SD so that the SD goes on and on. Is that the case? I don't know, but it fits what has happened to me: SD for decades, a week of pharmaceuticals, and the problem is gone. Will it return as I continue to cut down the medication week by week? I don't know. I will see.

5. I trim my hair very short, weekly. I use hair trimmers, set on the lowest setting, not a shaver, which is more time-consuming to use but it is an option. Having very short hair seems to reduce problems (the hair itself may be irritating the scalp) and it makes applying shampoo and the coal tar much easier. I won't win any beauty contests, but I feel much better. If I let my hair grow out, even for a couple of weeks and with the medication, a tiny bit of scaling starts to come back. Ergo, buzzing off my hair.

If anything I've said isn't clear, please ask.

* With the exceptions noted in my weblog--e.g., hazelnuts and possibly green beans because they are not acid-producing according to the PRAL listing and my own food experiments.

MariusA said...

I will try to talk about what you said.

1. I only use flax seeds when I don't eat salads with green leaf vegetables. I am a layman like you, but read a lot, and omega 3 EFA is anti-inflammatory and I try to take a greater dose over a couple of months to see the effects. Natural sources of course.

2. Same here, a lot of doctors, a lot of reading, unknown causes. But what I found out is that SD is caused by faulty sebacee glands. They just don't secrete enough fat or was it the other way around? So this is what I hope that I(you) must address. But how to regulate those glands? Many(doctors) say they are related to stress. But stress is such a vague term and you just need it to be able to live and function properly. So I think that long lasting bad eating habits are the source of a deficiency and this is what we should find(guess).

3. Again, have two or three products(same as the ones you use, I mean same active ingredient) which if I use I get rid of SD. But, as I told you before, I want to address the cause and not the effects.

4. As I read, all inflammatory diseases feed themselves, cancer being the worst. Read a book on cancer by Servan Schreiber "Anticancer", lots of anti-inflammatory guides there, but not all good. So you need to stop all inflammatory causes and active all anti-inflammatory ones. And yes stress is one of it as I read in that book, but again, stress seen as loneliness, lack of support, real heavy working hours with a lot of deadlines, all of them at once actually. The author went even forward and with some cited studies, compared the inflammtory effects of strees to food, physical exercise, carcinogenic substances etc.

5. I too keep it rather short, because I don't like big hair and my SD doesn't get any worse if I have long hair, not by much actually.

So next on the list for me is to keep my strict MCDougall diet(same name on his forum MariusA), physical exercices and wait. Another idea is to find out what regulates the activity of sebacee glands and what can be done. Need more reading.

Thank you for your thoughts.

Burgess Laughlin said...

About point 2: My understanding (which comes from what my doctor told me, confirmed by at least one written source) is that the sebaceous glands, in seborrheic dermatitis, produce too much oil. The excess oil then causes (in some way not clear to me) the skin to separate and scale. Ironically, excessively oily skin looks dry, but that is because (I suppose) the scales dry out as they separate from the skin.

Each of us may be different. I would not eat seeds of any kind (because so many of them, for me, were triggers to skin problems) in order to get an ingredient that can be gained elsewhere without acid-production (which is a problem for me).

Each to his own experiment!

Burgess Laughlin said...

Here is a comment from someone who did not follow the rules of etiquette. (I accept no anonymous or pseudonymous comments; see "Comment Etiquette.")

I've developed eczema & seborrheic dermatitis after rapid weight loss. I went on all the slandered shampoos and prescriptions, none really helped. I did a little research and found out that it could be related to a zinc deficiency. I did a blood test, and sure enough I was deficient in zinc. I now take zinc picolinate daily supplement and my dermatitis and eczema is gone.

There are several puzzles here:

1. Why did he lose weight rapidly? What diet was he following when he lost weight?

2. What is a "slandered" shampoo? Did the writer mean "standard"?

3. My understanding is that eczema might be a consequence of any one of many causes. Is zinc deficiency one cause? I don't know.

4. Why was the writer's diet deficient in zinc? What might the writer have done to increase the amount of zinc in his diet -- naturally, eating whole foods, rather than resorting to possibly dangerous supplements?

My layman's suggestion: As always, if you can't find a whole-foods source, and if you choose to take supplements, be sure to find the safest, most effective way to supplement.

The writer's suggestion to get a blood test for zinc or other substances may be the best step to take if you suspect deficiency. Find out if there really is one before supplementing.

Best wishes!