Post-military burn pit skin condition on face

May 25, 2023 1:11 PM

After getting back from Iraq and facing regular exposure to burn pits, a good friend and battle buddy continues facing long-term unresolved skin conditions on his face.

He wears a beard to hide the condition. Here is how he describes it:

Flaky itchy patches, inflammation, comes in waves (not always present), sometimes gets worse when hair starts to grow or shave, inside eyebrows, around neck, and in head hair. The only thing that seems to make it calm down a little is SELENIUM SULFIDE 1% and prescription grade cortisone steroid cream.

Anyone else have experience dealing with this? Suggestions for treatment are welcome!

One more detail, along with medication my friend has tried shea nut butter, olive oil, avocado, coconut oil, aloe vera, and plenty of others. However, if you have a special formula, please share!

posted by Mike Mongo to Health & Fitness (6 answers total)

Sounds like it could be seborrheic dermatitis. He could try washing his face with head and shoulders shampoo twice a day for a few weeks, and making sure to wash all his towels and pillows with very hot water to kill the bad flora. If it is SD, this will help. If it’s not SD, it shouldn’t do any harm.
posted by nouvelle-personne at 1:21 PM on May 25, 2023 [1 favorite]

Yes, this sounds a lot like SD, especially if the patches also seem a little greasy for no obvious reason. A dermatologist can give him a stronger corticosteroid to cope with a flare and then there are options for maintenance. Unfortunately, despite its being a common and super super super annoying condition, it is not a solved problem (you don't want to use steroids on your face long term if it's at all possible). A couple of suggestions if he doesn't want to go to the doctor just now: (a) daily application of an OTC cream containing butenafine hydrochloride (Lotrimin Ultra, not regular) and/or (b) Nizoral, ideally the 2% OTC stuff from Canada (the U.S. OTC variety is 1%), applied to the affected areas and allowed to sit for about five minutes while in the shower before wiping away (obviously, watch out not to get it in your eyes), 2-3x a week until he sees some relief, then down to 1x for maintenance. (There is a theory that most fats help feed the overgrowth of normal skin yeasts that is believed to be associated with the problem, but honestly the mechanism is not well understood and there is probably an immune component, too.)
While SD is irritating beyond belief, it does not generally lead to other, serious health conditions.
posted by praemunire at 1:30 PM on May 25, 2023 [2 favorites]

You mentioned that he's tried medication, and typically steroids are the first line, but there are also additional non-steroidal creams (they can be expensive) that might help. A family member of mine has used both tacrolimus, and when that failed, pimecrolimus, which has been super effective.
posted by chesty_a_arthur at 2:08 PM on May 25, 2023 [2 favorites]

Agree that it sounds like SD, plus a possible reaction to the cortisone cream itself, which can cause major problems with long-term use
posted by asimplemouse at 4:47 PM on May 25, 2023 [2 favorites]

for SebDerm- worth trying the trader joes tea tree tingle shampoo as a beard wash perhaps. it solved a very chronic SD problem for me. Worth perusing the sebderm subreddit too perhaps, which is where that tip came from for me.
posted by wowenthusiast at 6:31 PM on May 25, 2023 [1 favorite]

does he also have joint pain? i have psoriatic arthritis and my skin gets like that
posted by Jacqueline at 12:54 AM on May 27, 2023 [1 favorite]