YNMDerm, but need help!

September 7, 2017 6:42 AM

YNMD: For the past year or so I've had a recurring dryness/flakiness on my eyelid and around my eyes and a little on my nose (see pic). I've seen two different dermatologists who've diagnosed this as dermatitis Does anyone have any OTC/remedies that have helped here? Or think of a combo optha/dermatologist they might recommend in NYC?

Moisturizing creams don't seem to work-- only really hydrocortosone does. I'd rather not use that around my eyes indefinitely as it can thin the skin.

posted by sandmanwv to Health & Fitness (12 answers total)

I recommend asking your dermatologist for a patch test so you can figure what you're allergic to and avoid it. I had the same symptoms and it turned out to be from cocamidopropyl bentaine (a super common ingredient in soaps and shampoos). Changing my face wash and soap brand was enough to stop it from coming back once I used steroid cream to get rid of it.
posted by halfsquaretriangle at 7:16 AM on September 7, 2017 [2 favorites]

I had something exactly like this for most of the winter. Hydrocortisone is usually my go-to for face rash stuff, especially since I am prone to eczema. However, it just wasn't going away and after doing a lot of reading and not getting a lot of help from the Dr I talked to someone who mentioned that cortisones and steroids can actually cause this. I had also been taking a steroid allergy spray daily. I stopped the hydrocortisone and the spray and got rid of any products that were irritating. I also found sun seemed to help but it may have been coincidence. As well I tried to eat well since I get a lot of skin issues when I'm not healthy in general. It has cleared completely.
posted by photoexplorer at 7:44 AM on September 7, 2017

Detmatitis is really just medicalese for "dry, itchy skin." It's just a group of symptoms that could have any number of underlying causes—it could be fungal, bacterial, chemical-induced, autoimmune, allergy-related, idiosyncratic, basically anything. Without knowing the cause it's hard to know how to cure it. Steroids (like cortizone) will certainly calm down the symptoms, but they won't treat the cause and you don't want to use cortizone on your eyelids long-term because it can eventually lead to skin atrophy and places like eyelids where the skin is already quite thin are particularly succeptible to that. (Occasional short-term use is perfectly fine.)

I'd go back to the dermatologist and press for at least an educated guess as to what the cause is, and for a treatment plan based on that. It can sometimes be really hard to pin down what the cause of dermatitis is so you may have to go through a few different courses of treatment before you find something that works. For instance, perhaps your doc will think it's most likely fungal (no idea, just a random example) and will prescribe an antifungal cream. When that doesn't work maybe they'll say "Well, then the next-most-likely thing is that it's an allergic reaction," and they'll prescribe a round of allergy testing and maybe an antihistamine or something. You see where I'm going with this.

Anyway, "dermatitis" doesn't tell you anything you didn't already know. Talk to your doctor about figuring out what the root cause is and then treating that.
posted by Anticipation Of A New Lover's Arrival, The at 7:53 AM on September 7, 2017

I have something similar (although never diagnosed by a doctor) and the only thing that's helped is daily washing in the shower, (with a washcloth to gently exfoliate the flaky skin, no soap or other products) followed by E45 cream (has to be the "cream" in the tub specifically, the "moisturising lotion" doesn't work the same for me). I need much more of the E45 in the winter/when the air is dry compared to the summer.
posted by EndsOfInvention at 8:34 AM on September 7, 2017

Spitballing here, as I am not a dermatologist (I am, however, someone who has had various chronic problems with her facial skin). I get this sort of thing, especially in winter, and I think it's fungal/yeast/rosacea-related (similar to dandruff). If you want an easy and non-dangerous way to test whether yours is similar, you could buy some Nizoral shampoo (the 2% is prescription, the 1% is OTC). Use it as face wash for a few weeks, leaving it on your face for a few minutes (don't wash off immediately, as it needs time to work). I'd also recommend going back to your dermatologist to get more specific recommendations. I wouldn't use hydrocortisone on a long-term basis, personally.
posted by ClaireBear at 8:36 AM on September 7, 2017 [1 favorite]

This is one of those very common problems that bizarrely have not yet been fully solved by modern science.

Nonprescription medicines to try: Nizoral (1%, or get someone to smuggle you in the 2% from Canada, where it's OTC), Lotrimin Ultra (needs to be the Ultra, which is a different antifungal than most on the market)

Prescription meds: Elidel (your carrier may balk at covering it as a first-line treatment, though)

Long-term use of hydrocortisone on facial skin is not recommended.
posted by praemunire at 10:02 AM on September 7, 2017

I had my weird face rash biopsied and it turns out to be rosacea, it just doesn't really look like it. So, you could get a pin biopsy and see what it is.

For me, I've swapped to CeraVe face products and they've helped immensely - the only thing that helps in conjunction with the gel stuff the doctor told me to put on it.
posted by Medieval Maven at 10:35 AM on September 7, 2017

Moisturizing creams don't help the flaky and dry skin around my eyes, and I won't put hydrocortosone anywhere near them. What does seem to work is coating all around my eyes with Vaseline every night. Even when I'm not having any flare-ups of dry skin. It's annoying, but does help.
posted by still_wears_a_hat at 4:44 PM on September 7, 2017

just as a test, try not using hand sanitizer or those wipes at the grocery store for the cart. this is what caused that for me and my sister. also found out that eyelids are one of the first places to show that you touched something with your hands that you shouldn't, that you are sensitive to.
posted by cda at 6:01 PM on September 7, 2017

My skin was a little like that under one eyebrow and coconut oil fixed it.
posted by pinochiette at 6:29 PM on September 7, 2017

Seconding asking about testing for sensitivities. I also had recurring itchy flaky skin around my eyes, and patch testing turned up allergy to methylchoroisothiazolinone, a preservative that's in a lot of liquid soaps. But once I replaced my shampoo, conditioner, body wash, face wash, hand soap, and dish soap, it went away.
posted by Princess Leopoldine Grassalkovich nee Esterhazy at 7:36 PM on September 7, 2017

Can I ask if you've had your eyebrows threaded? And if so, did the practitioner use the older method where they put the thread in their mouth?

If any of this is possible treat this as a fungal infection, a few days of lamazil will show if this is a form of Dobhi's itch, if not than the remedies above.


Another Mefite put me on to snail muscin which has improved the flakiness more than anything else I've tried except hydrocortizonem I am SOOO grateful.
posted by Wilder at 4:50 AM on September 9, 2017