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Derm consult request: facial seb derm

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  • Derm consult request: facial seb derm

    Employer request to shave facial hair to conserve PAPR. Beard x 15+ years. Long standing scalp seb derm (I think) that was easily managed by 2x week Nizoral A-D on scalp. Mild chin flaking that responded well to lukewarm water and intermittent good scrub in the past

    Now that the beard is gone have some pretty gnarly erythematous plaque in a chinstrap distribution. Anybody in derm with time on their hands want to throw me a bone and share a regimen? I have hydrocortisone 1%, more Nizoral, UV access... just don't want to inadvertently make it worse. Thanks for your help.

  • #2
    “Anybody in derm with time on their hands want to throw me a bone and share a regimen?”

    Couldn’t resist. Not a derm, nor a doctor, I can’t even understand WebMD. Sorry you lost your beard. Try Telemedicine!

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    • #3
      Dermpath so take that with a grain of salt.

      I'm also a bearded fellow and had this issue. In addition to Ketoconazole shampoo, I've alternated with tacrolimus and ketoconazole ointments. Anecdotally, one thing that helped me was cleaning the affected areas with alcohol wipes. That's been one of the fastest remedies for me.

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      • #4
        Every dermatologist out there is offering telemedicine services and is starved for business. I'm sure you could easily get a consultation via skype or something similar in under 24hrs. They could actually see the rash and prescribe you meds. Likely much better than you'll do on here.

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        • #5
          Well. Silver lining is that if you wear your mask all day long nobody is going to notice at work! If misery loves company, a fair number of us are also getting contact dermatitis from the N95s and some folks are getting little pressure sores as well!

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          • #6
            Originally posted by tex View Post
            Employer request to shave facial hair to conserve PAPR. Beard x 15+ years. Long standing scalp seb derm (I think) that was easily managed by 2x week Nizoral A-D on scalp. Mild chin flaking that responded well to lukewarm water and intermittent good scrub in the past

            Now that the beard is gone have some pretty gnarly erythematous plaque in a chinstrap distribution. Anybody in derm with time on their hands want to throw me a bone and share a regimen? I have hydrocortisone 1%, more Nizoral, UV access... just don't want to inadvertently make it worse. Thanks for your help.
            I'm not derm but hard to imagine hydrocortisone 1% could make it worse?

            Maybe try that BID x 1 week and then use any of the numerous telemedicine portals to find a dermatologist if it hasn't resolved?

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            • #7
              If hydrocortisone makes it worse, consider tinea incognita. Very doubtful it is this though.

              I do not recommend strong topical steroids for the face. But consider a slightly stronger topical steroid if you get mild improvement with hydrocortisone.

              Also very possible after 1-2 days of exposure the skin self resolves.
              $1 saved = >$1 earned. ✓

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              • #8
                I do not have any better advice then that already given but I will commiserate with you over the loss of the beard.

                My wife never liked my beard and is "mad" that I shaved it for Covid but not for her.

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                • #9
                  Ketoconazole 2% shampoo to both the scalp and face three times a week (use as face wash in shower). Leave on for 5 minutes before rinsing off. Treating scalp can help the face too.
                  hydrocortisone 2.5% cream 2-3x/week to affected areas on face to get under control and then back down as you get it under control

                  if still not responding to that combo, can add tacrolimus (Protopic) or pimecrolimus (elidel) or ketoconazole cream a few times a week as well.

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                  • #10
                    Same issues. I do as stated above during bad flare ups. Though rarely have flareups now since I started using tea tree oil shampoo/conditioner daily. In trying to figure out why I randomly had improvement I realized it may be tea tree oil. Tea tree oil is natural anti-fungal and my guess is it acts like using low dose ketoconazole shampoo daily. Wont be enough to treat it in flare up, but anecdotally its enough to keep flare ups away...

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                    • #11
                      Originally posted by Cubicle View Post
                      Also very possible after 1-2 days of exposure the skin self resolves.
                      this + keto to the scalp and face + some HC for the worst bits got it done. can only imagine how the cortisol running through my veins both in ICU and at home was feeding it also...

                      just replying to say thanks for the helpful comments (!e.g. "try telehealth")

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                      • #12
                        Originally posted by tex View Post

                        this + keto to the scalp and face + some HC for the worst bits got it done. can only imagine how the cortisol running through my veins both in ICU and at home was feeding it also...

                        just replying to say thanks for the helpful comments (!e.g. "try telehealth")
                        Not to sidetrack the thread, but any rad want to read some X-rays? The second set from urgent care showed some pneumonia spots on my wife’s lungs. The first one diappeared. Now back to her primary care for another Telemedicine appointment.
                        Doing our part supporting physicians that have had “electives” cut. Just tell me the drugs we need!
                        Back on topic.
                        Glad you got it fixed.

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