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Is it normal to have redness on face post treatment for seborrheic dermatitis?

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Dr. VINAY KUMAR

Dermatologist

Practicing since :1980

Answered : 480 Questions

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Posted on Wed, 21 Oct 2015 in Skin Hair and Nails
Question: Hi,

I had my first bout of Seborrheic Dermatitis a few weeks ago and after going to 2 Dermatologists the second one gave me a steroid cream Desonide and an antifungal Econazole Nitrate to use on my face for 2 weeks. After two weeks I went back and she said that the worst was gone and to stop using them (though I can use the antifungal occasionally). However, I still have some (much fainter) redness on my face (nose and spreading out to the cheeks as well as some in the forehead and chin but very faint) and upper chest that appears to stick around. I'm not sure if this is from the dermatitis as it is in the same place but is this a permanent effect of it? It hasn't gone away and I've been using moisturizers as my dermatologist told me to do. is this something that is normal (I notice that some other people have redness in those areas)? Also, after I shower my face, forehead, chest and back are much more red which subsides after some time. Cleansers, moisturizers and the antifungal cream also cause temporary increased redness in those areas - is this due to irritation or is it normal? I've tried the products my derm recommended (Cerave moisturizer and cleanser) as well as some others (Cetaphil, Aveeno) but they all do this. I've attached pictures that show what I'm talking about. The redness isn't that bad usually (but noticeable - it looks like a weak sunburn when I look in the mirror) but gets much worse when I shower or use creams.

I also have some bad acne on my back and I've been using 10% Benzyl Peroxide wash for the past few weeks again on my derm's recommendation but there doesn't seem to be much difference and it seems to make my skin even redder, probably due to irritation? My skin used to be fine until I got my first seb derm flare and now it seems to have some issues with redness and sensitivity.

Thank you for any help.
doctor
Answered by Dr. VINAY KUMAR 1 hour later
Brief Answer:
Please use modified treatment for lasting relief

Detailed Answer:
Hi Dear

Welcome to this site!

I am Dr V XXXXXXX a Sr Consultant dermatologist.

I understand your concerns fully as I have examined your attachements and gone through your case notes.

The redness on the face and chest is a part of Seborrhic Dermatitis.This change is not permanent but tends to recur in several patients on the same regions.

Benzoyl Peroxide is a skin preparation that leads to removal of skin layers and thus causes some redness and irritation. Most of my patients having Acne on the back respond better to the use of Clindamycin preparatyions than Benzoyl Peroxide.

Since the skin in certain regions tends to get inflamed, therefore, application of any skin preparation (especially if it is rubbed into the area) is likely to cause more redness which tends to lessen with the passage of time. Additional help comes if you sponge the area frequently.

In a situation like yours, I would recommend the following to my patients:

1To use anti allergics medication for control of itching

2 Antifungals by mouth if the problem is too bothersome and recurrent

3 Steroids for local use are best avoided but in some cases, may have to be given for short period

4 Tacrolimus 0.03% has been of great adavantage in good number of patients and is one of the better alternatives to steroid use.

5 One must also attempt to define triggers for flare ups and avoid them.

Please be assured that the problem runs a longish but mild course and some adjustments in daily skin care routine are usually sufficient to cope with the problem.

I am hopful that you will bebefit from this information and have a good and healthy skin.

Our best wishes, always!
Above answer was peer-reviewed by : Dr. Sonia Raina
doctor
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Follow up: Dr. VINAY KUMAR 19 hours later
Okay, thank you. Should I see an allergist to see if I'm allergic to something that is causing the flare ups? One of my derms gave me a oral antifungal actually (itraconazole) twice a day for a week but it didn't seem to do much - the only thing that seemed to help was the topical steroid and antifungal.

Also, I also think I have it on my penis as well - I've uploaded more photos. It's a little redder than normal but after I masturbate it causes some red patches on the glans and foreskin. My penis also seems more sensitive and gets sore easily, as well as some minor pain during urination (I'm going to see a doc tomorrow to see if it is an UTI or something). It started at around the same time as the rest of my seb derm and seems to have similar symptoms, I also showed another dermatologist on this site the pictures and he confirmed that it is seb derm (it's hard to show a doctor in person because the issue only arises after sexual activity and my penis looks relatively normal otherwise, though more blotchy than before). When I went to see her about a month ago for my seb derm my dermatologist said I could use the steroid and antifungal cream on my penis for one week and I think it helped but obviously it is still an issue.

How should I treat this? I read online that some people had results from using moisturizers and antifungal creams but the symptoms would come back if they stopped the antifungals. Are antifungals safe to use daily? The steroid helped and I finished my one week use of it about a month ago, how long should I wait between uses (I know that the penile skin is thinner and more absorbent so it is more prone to steroidal damage so I am wary of using it). It looks very unsightly and is causing a lot of discomfort.

Thank you for any help.
doctor
Answered by Dr. VINAY KUMAR 47 minutes later
Brief Answer:
Here are your queries answered

Detailed Answer:
Hello Dear

Welcome back.
You have very genuine concerns and I will help sort them out.

1 There is merit in going for an allergy test if the doctor thinks it will help.The examining doctor gets to know more about your problems as he has physical access to give you a focused opinion

2 The steroids by virtue of being anti inflammatory definitely give rapid relief that is difficult to match. Prolonged use can be risky though.

3 I have seen the fresh pictures uploaded by you and I am sure that most likely the redness is temporary and unrelated to any dermatological issue. This kind of redness would be expected in a normal person especially after sexual activity. It is likely to vanish even without applications of medication but can recur due to handling of the skin or friction.

4 I appreciate that you have proactive approach. I fully agree with you that steroids better avoided in such cases. My advice to my patients is always to wash the area at the time of bathing by pulling the foreskin back as a routine and not to apply any medication unless so directed by the physician. It works every time.


Normally, one should stay healthy without treatment courses whether spaced at short or long intervals. The more the steroid used, the thinner the skin gets and leads to redness even after a gentle touch. So one needs to avoid unnecessary use and adopt simple hygienic habits to stay well. I believe you too can get well with these simple but effective tips.

Have a great time and relax, my Dear!

Our best wishes.

Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. VINAY KUMAR 1 hour later
3 I have seen the fresh pictures uploaded by you and I am sure that most likely the redness is temporary and unrelated to any dermatological issue. This kind of redness would be expected in a normal person especially after sexual activity. It is likely to vanish even without applications of medication but can recur due to handling of the skin or friction.

Hm, okay. The thing is that it seems to happen after every time I masturbate and I don't recall it happening before until a few months ago (though I may just not have noticed). Is their any way to prevent it from happening (apart from washing)?
doctor
Answered by Dr. VINAY KUMAR 21 minutes later
Brief Answer:
In due course, the problem is likely to improve

Detailed Answer:
Hi Dear

Welcome back.
To me, it seems that the steroids that you have used in the past have caused the skin to get thinner and this might be contributing to the redness. Ina young person, this should recover to a great extent and might eventually disappear.

For best outcome, you are advised to refrain from using anything except the measures that have been outlined. In my experience, these measures have worked every single time and I think you please allow natural recovery to take place as that would be everlasting.

Hope this helps in clarifying the query.

Best wishes, always!
Above answer was peer-reviewed by : Dr. Sonia Raina
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