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Suggest treatment for seborrhoeic dermatitis on forehead

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Posted on Thu, 24 Jul 2014
Question: My forehead has a rash and scabs and is starting to look worse than just standard acne. It started very small and spread. Sometimes its red and puffy with small amounts of puss and other times its dry and flaky and almost looks like a bruise. It has spread from hairline down towards my eyebrow.
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Answered by Dr. Johny Chacko (32 minutes later)
Brief Answer:
? Acne excoriee

Detailed Answer:
Hello,

Welcome to healthcare magic.

I understand room your query that you are having some lesions on your forehead.

I have seen the clinical picture attached. But it is not very clear.

With your history and available photograph, I would consider the possibilities of Acne excoriee and seborrhoeic dermatitis.

Could you give me some additional history so I can assess better?
1. Do you have the habit of scratching the lesions?

2. How do the lesions appear when they begin? Pus filled bumps or small solid bumps or blackheads?

3. Do you apply hair oil or setting gel?

4. Do you have excessive dandruff?

Please try to send a better and clear picture.

Please revert back with the above details.

Regards,
Dr. Johny Chacko
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Johny Chacko (9 minutes later)
1. yes I probably do itch them

2. most are solid bumps, on or two have had puss which i squeezed out.

3. yes I use setting gel most days, twice a day.

4. yes I do have dandruff that i control with shampoo from the chemist...quite strong with an active ingredient of tar if I remember rightly.
doctor
Answered by Dr. Johny Chacko (1 hour later)
Brief Answer:
Acne excorie

Detailed Answer:
Hello,

Greetings!

I have noted the additional history and also seen the clinical picture.

With your additional history, I would consider the possibility of " Acne Excorie".
This is basically regular acne which gets worsened because of excoriation or scratching. Itching and scratching makes them appear crusted and will also leave behind marks called as post acne pigmentation.

Another factor strongly contributing to your lesions being predominantly on the forehead is the use of hair gel twice a day. The gel could slowly seep sown ( though not visibly) and could clog the pores on the forehead leading to acne.

I would suggest to you the following -

1. You could use a gel containing 1 % Clindamycin in the morning on all the acne prone areas.

2. You could use a gel containing 2.5% Benzoyl peroxide at bedtime.

3. Use a face wash containing 2 % salicylic acid once a day.

4. Use a mild cleanser like Cetaphil cleanser during bath.

5. DO NOT SCRATCH the lesions. This is the mainstay of your treatment and hence I am writing this in capital letters. Scratching will worsen the lesions. Do not squeeze the pus out.

6. Avoid hair gels as much as possible. You could probably use it occasionally for an event or a party but do not use it everyday.

7. You could continue with the anti dandruff shampoo if it is controlling the problem well.

In some cases, the scratching habit would be due to some underlying anxiety or stress. There are patients who have been referred to counsellors to address the underlying stressors as scratching will be beyond their control. If you feel you have any underlying mental stressors, please address them as well.

Hope this helps you.

If you have any more queries, I will be glad to answer.

Take care.

Regards,
Dr. Johny Chacko
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Johny Chacko

Dermatologist

Practicing since :2005

Answered : 1916 Questions

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Suggest treatment for seborrhoeic dermatitis on forehead

Brief Answer: ? Acne excoriee Detailed Answer: Hello, Welcome to healthcare magic. I understand room your query that you are having some lesions on your forehead. I have seen the clinical picture attached. But it is not very clear. With your history and available photograph, I would consider the possibilities of Acne excoriee and seborrhoeic dermatitis. Could you give me some additional history so I can assess better? 1. Do you have the habit of scratching the lesions? 2. How do the lesions appear when they begin? Pus filled bumps or small solid bumps or blackheads? 3. Do you apply hair oil or setting gel? 4. Do you have excessive dandruff? Please try to send a better and clear picture. Please revert back with the above details. Regards, Dr. Johny Chacko