name that rash
July 1, 2012 12:02 AM   Subscribe

Does my face rash sound like seborrheic dermatitis or atopic eczema? And, what can I do about it while I wait for a derm appointment?

Several months ago, I developed a red, flaky, dry rash on my eyelid that gradually circled both my eyes, and more recently, the sides of my nose and mouth. The rash sort of fluctuates between being really flaky then just kind of red and wrinkled.

The strange thing is, my mother developed the exact same thing a few months before I did. Her family doctor says is seborrheic dermatitis. He suggested using dandruff shampoo; she found a mild soap with zinc pyrithione and this cleared her skin up, including her eyes. She gave me some soap, but my skin is more sensitive (can definitely not use it around my eyes) so I can only use it once a day, and it doesn't seem to be clearing up like hers did.

Before the rash spread around my nose and mouth, I saw a doctor, who thought I had atopic eczema, and referred me to a dermatologist (who I see in a month). Atopic eczema and seborrheic dermatitis require different treatments, and I'm not sure what to do while I wait to see the derm! My face is full of these embarrassing red patches that make me only want to leave the house at night! (though I hear that a bit of sun could be helpful and have been trying to do that)

Hydrocortisone (0.5% is all I can get OTC in Canada) helps a bit, but I can't use that on my eyelids for long periods and it's only a stop gate measure, anyways.

So, the internet is full of advice including tea tree oil, coconut oil, ACV, and the list goes on... I'm not really up for too much experimentation on my freaked-out skin, but I thought I'd turn to the more sophisticated MeFites to ask:
-> does what I have sound more like seb dermatitis or atopic eczema?
-> what do you think I should do while I wait to the derm?

quick background - I am a 32 year old female... eat a varied diet with lots of fruits and vegetables, take omega 3 and multivitamins. Moderate exercise. I have mild hormonal acne.
posted by cejl to Health & Fitness (17 answers total) 3 users marked this as a favorite
I get both from time to time and find that the eczema will retreat a bit after I swim in a chlorinated pool (bleach baths using tiny amounts of chlorine are an accepted treatment for eczema, so that makes sense). I'd test it out by going swimming a couple of days in a row and looking for a change.
posted by batmonkey at 12:06 AM on July 1, 2012

Do you eat chocolate? candy? soda? lots of fruit ? If I have too much sugar my body reacts with eczema. I then go cold turkey and it clears up. Sugar intake may be a factor...
posted by carpediem at 12:23 AM on July 1, 2012

Have you tried frequently (at least 2x-4x/day) moisturizing with something really mild and fragrance free? It almost certainly won't make things worse while you're waiting to see the dermatologist, and I've had moderate success clearing up mild eczema and psoriasis spots that way, including a spot on my eyelid.
posted by asphericalcow at 12:29 AM on July 1, 2012

Seconding asphericalcow. I have atopic eczema and need my steroid creams to completely remove a flare up - however if I've run out of cream/forgot to take it with me on a trip, I can generally keep the rash calm by using a very mild moisturiser twice a day. I use Aveeno moisturiser, use to use QV but I personally think Aveeno is more effective. Keep in mind that everyone is different - what works for some may not work for others but if you are looking for a temporary treatment a very mild moisturiser (applied frequently) can definitely help.
posted by tegna56 at 1:22 AM on July 1, 2012

I have seborrheic dermatitis...and my dermatologist told me moisturisers will in fact make it worse. I rinse with baby soap twice a day and apply anti fungal cream if required.
posted by Admira at 2:02 AM on July 1, 2012

Could be eczema. Your description sounds similar to mine. Sometimes more rashy (sometime with bumps that weep) and sometimes more flaky and dry.

I know it sounds kind of woo, but I swear by tea tree oil. The principle is that tea tree oil (melaleuca) has anti-fungal properties. (The cause of eczema is unknown, but one of the theories is that it is a fungal infection.) I use it full strength on different parts of my body, including my face. I most often get breakouts around my mouth and chin and on my hands. If applying near your eyes, you might want to dilute in some cold cream. It sometimes has a bit of a sting, but it's certainly never made anything worse. It might be worth a try on one of your affected areas-- at worst it will have no effect, and maybe it will help. I've always had only very temporary relief from hydrocortisone and other steroid creams. If I apply tea tree oil full strength at bedtime, the area clears up in about a week. If I apply twice a day, it sometimes clears up quicker. For sure, I notice an improvement within a couple of days.
posted by amusebuche at 5:40 AM on July 1, 2012

Response by poster: Sorry, forgot to say the other things I've been using regularly:

- light, simple (no fragrance, parabens, etc) jojoba-based moisturizer (from mixed with aloe all over my face. I read that aloe has some mild anti-bac/anti-fungal properties, and it's pretty gentle, so I figure it would do no harm. It does help with itch.
- non-medicated eczema cream (from Spectro) on my eyes. It is pretty thick, but temporarily soothes the really dry, wrinkle skin around my eyes.
- anti-fungal cream (clotrimazole) on the red patches around my face, twice a day. I just started this last week, it might be helping. I do not dare to use around my eyes.
- zinc pyrithione soap (anti-fungal ingredient). I think this might help, but as I said, I cannot use it around my eyes. Also, it really dries out the corners of my mouth and makes them peel.
- also taking anti-histamines (Allegra, Benadryl)

tried tea tree oil, but it's just too harsh and irritating for my skin

I am not getting many bumps really on the rash part, like some people get with eczema. I do have oily, acne-prone skin normally, but I seem to be getting less acne. Maybe it's being replaced by this new condition? Some kind of pathogenic battle? I do have some bumps similar to acne near the rash around my mouth. Now I am wondering if all along I've had pityrosporum folliculitis and not acne, caused by the same malessezia yeast as seborrheic dermatitis...
posted by cejl at 7:11 AM on July 1, 2012

(IANAD) For anything like that, any place on the body, I first try the anti-fungal Clotrimazole 1% cream. This is sold under many brand and no-brand names for "Athlete's Foot" and "Jock Itch" and as a vaginal cream, at OTC prices from $1 to $15, and it's all the same 1% Clotrimazole. Even dollar stores have it for $1. Don't put it very near your eyes at first, only because it will sting a little there but is reasonably harmless, but if it works on your nose you could proceed carefully. This could be worth a $1.00 try - this type is sold in a small toothpaste type tube usually packaged in a box. After 2-3 days application on a test area, you'll see and feel results or not. If it works, continue for a few more days. (IANAD!!!)
posted by caclwmr4 at 8:39 AM on July 1, 2012

Response by poster: I have been using clotrimazole 1% on the patches around my nose and mouth 2 x per day but avoiding my eyes. Not sure if it is working... today it is quite red. I will keep using it, though.
posted by cejl at 9:15 AM on July 1, 2012

OP, when you tried the tea tree oil, did you dilute it with anything? I have eczema (doesn't really look like eczema to me but that's what the doc told me) and also some random dry rash that pops up in my cheek from time to time, and I have found that TTO or ACV diluted with oil, water, or cream is helpful and less irritating than full strength.
posted by sm1tten at 9:20 AM on July 1, 2012

Seeing that you're in Canada, perhaps you could try the Spectro Jel cleanser. I used to have pretty nasty eczema around one of my eyes (sort of problematic because it made me look like a domestic violence victim), and got a Spectro Jel sample from a PCP. This cleanser is very mild and brought my eczema from very itchy and flaky to just sort of red and tender. After cleaning with this one and applying some non-medicated moisturizer, things were sort of bearable (although still unaesthetic). For me, getting to this point required an oil-based (ointment) rather than water-based (cream) moisturizer.

As you're already aware, it's not exactly advisable to use corticosteroids on your eyelids. I'd personally have no qualms putting 0.5% hydrocortisone on my eyelids for a month before getting to see a dermatologist if only it had worked. In fact, I once got a 1% hydrocortisone prescription from a PCP to put around my eyes. I'd have exactly zero qualms putting it on the non-eye parts of my face (around nose, mouth, etc.)

FYI, once I got to the dermatologist, I got Elidel (pimecrolimus) for around my eyes. It's sort of scary if you read about all the side effects, but it cleared up the eczema in a couple of months (which meant I could stop using it) and I haven't really had anything that serious on my face since. According to the dermatologist I saw, most atopic eczema are sort of allergic and triggered by sensitivities to particular substances. He even offered to do the full allergy testing thing on my back, which I refused at the time (it seems to be quite a hassle: no showers for a few days, multiple office visits, etc.). By now, I think I have sort of figured out my main triggers, which are mostly mundane stuff like soaps/detergents, makeup/foundations, etc.
posted by yonglin at 10:42 AM on July 1, 2012

Honestly, this sounds like what happened to me when I developed food allergies as an adult. I tried every cream under the sun, and it worked for awhile and then stopped working. The doctors I saw at a student health service through school swore it was eczema; I have had that and knew it wasn't but could not get them to take it seriously. I suffered for longer than I should have with this before I started keeping a food diary and figured out that corn was a trigger. I would go on these 'I should eat more vegetables' kicks and start eating a cup of mixed frozen vegetables with every meal, and it would get way worse. I cut out the corn stuff and within short order, I was fine.

I would do a Google search on 'elimination diets' and go from there if I were you. A cream is treating the symptom, not the cause. And some of these creams have hard-core side effects especially in a sensitive area like the eyes. Pare your diet down to the absolute basics and then slowly start adding stuff back in to learn what your triggers are. It could be that something you are eating is triggering this.
posted by JoannaC at 12:31 PM on July 1, 2012 [1 favorite]

Response by poster: the weird thing is that my mother, who lives in a different city, developed the same thing only months before. She makes soap, so I suspected that we were both exposed to something in the soap, since she gave it to me and I used it around the time I developed the rash. But, her soap is quite mild and using it for many years. She put mint in it this time, which is new, so it's possible we reacted to it, but our reactions seem quite extreme for that...
posted by cejl at 2:47 PM on July 1, 2012

Try taking a few days off from all cleansers, moisturizers, and meds and instead washing your face with oatmeal morning and night. If your skin feels irritated, the oatmeal can be very soothing. I recently started having skin reactions (to everything, it seemed like), and washing with oatmeal brought relief in a way that nothing else has. For the red bumps and red, rough patches, California Baby brand calendula cream is surprisingly effective. It cleared up the rash in a few days and now I just dab it on anytime I see a new red bump (which is pretty much every time I use makeup and/or sunscreen on my face). I don't have an official diagnosis for my skin problems, but my nurse practitioner thinks it might be seborrheic dermatitis, rosacea, or perioral dermatitis. Whatever it is, the oatmeal treatment has been a huge relief. Good luck with all this. I definitely empathize.
posted by isogloss at 6:08 PM on July 1, 2012

I missed that you had already noted clotrimazole. Sorry. If you see no effect from it after 3 days, stop it, because it could affect or interact with anything else you try.

That mint soap is something to rule out. Suggestions: get back to basics: switch to a very plain soap like Ivory, or the oatmeal. Also, switch to a very plain shampoo, something like the most basic+cheap VO5 or Suave type without any extra flourishes. Not a "baby shampoo", which has softener agents. The back to basics diet is a similar idea and a good idea.
posted by caclwmr4 at 7:42 PM on July 1, 2012

I've had dermatitis that sounds a lot like what you're describing. Dry flaky skin around the eyes/eyebrows and down around the nose. I had a great deal of luck with antibiotics (recommended by a dermatologist) to initially get it under control, and then continuing with prescription-strength Lamisil for maintenance. You can get OTC Lamisil that'll do in a pinch, but you have to use more of it. I know it seems strange to say antibiotics would work for what's essentially a fungal infection, but amoxicillin works like magic for some reason.
posted by mullingitover at 11:02 AM on July 2, 2012

I have eczema and sounds like the same thing I have, symptom wise. In my case, even water can irritate my skin once it's broken out.

Here's what works for me, after many many years of trial and error.

If Skin is Broken Out:

- wash 3x daily (yes, really, gets any irritants off) with cetaphil unscented cream cleanser (or generic) - if you're in the shower than wash wet but you can also use this product without a lot of water - try to do so to keep your skin from getting more irritated.

- if skin is flakey, wash with washcloth or these terry cloth face mitts I get from the drug store (they exfoliate without irritating)

- once clean, rub in some special eczema moisturizer, and if my skin's very dry I will top that with some Argan oil (aka morrocan oil, you might find another kind works better ie: jojoba - whichever you pick make sure it's just oil and organic if possible).

- Do not use any further soaps (face, body, shampoo, dish, etc) for 12-24 hours and thereafter use no scented soaps period, esp in laundry or anything that will touch the skin (sheets & clothing) - this probably means no perfumes either, & potentially switch to gentle / no fragrance shampoos, body wash, etc.

- Before eating protect mouth & eye area with a barrier cream / petroleum jelly to prevent further irritation

- No makeup or products on your face period until it heals. This includes sunblock! No exceptions, explain to your bosses, lovers & friends why you look crazy and leave it at that. Stay out of the sun until your skin heals.

- take a regular allergy medicine and ensure I am away from all avoidable allergens/irritants

If Skin is Clear (using these steps it should clear in 2-6 days):

- Wash 2x daily w/ unscented sensitive skin cream cleanser like Cetaphil (or Cera Ve or whatever works for you) - moisturize

- All the same as before but you can go back to makeup as long as it's mild, organic and/or better quality, & you have a primer underneath to protect your skin and it's not old (bacteria!) or scented.

- Try to find a sunblock that works with your face skin, this will take time, I suggest asking makeup counters for samples & explain your situation

- Remove your makeup as soon as possible, which even sometimes means using non-waterproof and putting it on twice over the day, or being selective (ie: don't wear it when you can possibly avoid). When removing, use unscented sensitive baby wipes or more Cetaphil or Argan oil to remove. After washing, moisturize.
posted by SassHat at 2:23 PM on July 3, 2012 [1 favorite]

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