Suggest Treatment For Seborrheic Eczema

Posted on Tue, 15 Jul 2014

Question: Hi,
I have asked about a skin condition on this website before and given the photos online, it was said to look like seborrheic eczema and this was almost one year ago. The condition hasn't completely gone away. I have recently tried a few applications of fungicort and while the condition seemed to improve, the skin has now become quite obviously red after about 4 applications but it only became red a few days after stopping application. Should I stop applying fungicort and try another steroid such as advantan? If I don't apply the steroids anymore, will the skin return back to normal at all? I note that the instructions for fungicort suggest that it should not be applied too often on the face. How many times could it applied to the face without consequences?

Thanks.

Answered by Dr. Bharatesh Devendra Basti (3 hours later)

Brief Answer:
Details required

Detailed Answer:
Hi
Thank you for query. I am Dr Bharatesh D Basti answering your query.
Your past history and photos is not available.It will be good if you can forward all the details like rashes, complaints, current sites of invovement, treatment taken other diseases diagnosed ,any immunosuppresives being taken, current photos.

If you are taking fungicort for diagnosed seborheic dermatitis, it is a combination of miconazole and steroid hydrocortisone.Advantan is steroid cream only.
Usage application on face should also be minimal depends on severity usually not more than twice per day.
Tapering steroids slowly will be important. Antifungal shampoo and creams are more beneficial on long run.
The disease runs chronic course like hypertension etc.Climatic conditions secondary infections alter the course of these.
I will try to help you with details provided.
Thank you
Dr Bharatesh D Basti

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Bharatesh Devendra Basti (6 hours later)

Dear Dr. Basti,

Thanks for the reply. The full history begins in May 2013 with an infection on the side of the face, cause unknown. I then took almost 4 courses of antibiotics as well as using bactroban ointment. The antibiotics were e-mycin, keflex and then when the infection still didn't fully resolve, I took bactrim in combination with ciprofloxacin. I have the photo of the infection after the first couse of e-mycin and keflex.

The bubbling and yeast-like appearance appeared soon after the scab fell off. After the face becomes wet, the bubbling was more obvious and the yeast like material could easily be wiped off. It could also be scraped off when dry. That is how the condition has persisted for about a year. There is no real itchiness but I note that the parts of the face where the yeast like material touch or come into contact can become red. Advantan helped but only for a while, as did fungicort but now the skin appears red a few days after stopping the ointment. These ointments were started only recently.

Thanks.

Answered by Dr. Bharatesh Devendra Basti (1 hour later)

Brief Answer:
Some more remedies for seborheic dermatitis.

Detailed Answer:
Hi
Thank you for follow up query.
It is likely to be due to seborheic dermatitis.
Please look for dandruff ,if present use anti dandruff shampoos with ketoconazole .If severe dandruff combination with salicylic acid may be better.
Clean your face with cleanser or mild soaps atleast 3- 4 times per day to keep area dry.
Use antifungal creams like ketoconazole or terbinafine gradually tapering the fungicort cream instead of going to advantan cream.
Can use antifungal dusting powders to keep area dry.
These are chronic conditions you need to have patience and perseverance for them to act.
You can get back if any clarification required else please close the discussion.
Thank you
Dr Bharatesh

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Bharatesh Devendra Basti (46 minutes later)

Thanks Dr. Basti,

I have just uploaded the most recent photo and this was after application of advantan so the redness is much less than it was just 12 hours ago. The area of redness is about 2cm by 2cm.
My concern is that the redness only really appeared after application of fungicort (about 4 applications) and I just wonder whether continued use will lead to a serious issue because usually if medicines have side effects, they are to be discontinued.
Is there any past evidence to suggest that the redness is to be expected after application of creams like fungicort and continued treatment will eventually handle the problem?
Also, do the ointments you have mentioned normally require prescription?

Thanks.
Regards.

Answered by Dr. Bharatesh Devendra Basti (2 hours later)

Brief Answer:
Steroid variation cause effects.Use it sparingly.

Detailed Answer:
Hi XXXXXXX
Thank you for follow up query.
The latest photos have mild redness and almost no lesion.
Steroids can be used when the lesions are exacerbated or severe.Once controlled better to taper it down.
The antifungals may act as a substitute to steroid and have less side effects than steroids.If no response or exacerbates you moderate with steroid cream as suggested.
Alternatively you can use mild salicylic acid topical creams to reduce usage of steroids.
Redness may be due to steroid variation also.
Some of these may be available without prescription. It varies with countries.
You can get back if still clarifications is needed else please close the discussion.
Thank you
Dr Bharatesh

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar