Possible stupid question, but...
Joined: 07 Jan 2008
| Posted: Wed Feb 13, 2008 8:09 pm Post subject: Possible stupid question, but... | |
| Are fungus and yeast different?
I've been to the derm SO many times and she has never said anything about seb derm, it's always been eczema in her opinion (or some type of atopic dermatitis) but never seb derm. I had two biopsies done a couple weeks ago. Both came back negative for fungus. Again, no mention of SD, so I figured negative fungus meant negative SD. Here is what my biopsy says: Microscopic description: Hyperkeratosis, irregular epidermal hyperplasia, spongiosis adn a perivascular inflammatory infiltrate of lymphocytes with occassional eosinophils. Diagnosis: Spongiotic Dematitis with differentials of allergic contact dermatitis, nummular dermatitis, and "id" reactions. I'm guessing if SD was a possibility it would've been listed. I still think it's related to steroid withdrawal. Any thoughts? Thanks! ~J |
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Joined: 18 Oct 2007
| Posted: Sat Feb 16, 2008 7:21 am Post subject: boo2facialredness | |
| Yeast are a type of single celled fungus. Seb derm btw is a type of non-allergic eczema, it is in fact often called Seborrehic Dermatitis Eczema.
Yeast and fungus are important in seb derm because research has shown that people diagnosed with seb derm tend to have high concentrations of a yeast on their skin called malassezia furfur (which is found in smaller concentrations on all human skin). M. furfur feeds on sebum and leaves behind dead skin. The thought is that as this yeast proliferates (one theory linking it to Rosacea is that this yeast flourishes on the warmer skin caused by Rosacea flushing) it leaves behind more dead skin causing the skin's turn over rate to become abnormal and cause the dead skin to stick to new skin cells, causing inflamed flaky skin. As everyone has m. furfur on their skin you wouldn't 'test negative' for it, but the levels of it may be of assistance in making a diagnosis (they would have to culture for it to measure the level). Question for you, do you have "dandruff" or flaky skin in your scalp. Though not impossible it is rare for seb. derm. to effect large portions of the face but not effect the scalp at all. Further seb. derm. normally (though not always) effects specific facial areas (eyebrow area, between eyes, nasal folds, cheeks and on guys the damn side burn area is a killer). As for your diagnosis, Spongiotic Dematitis simply means you have an eczema of some sort. Spongiosis simply means there is increased intercellular fluid in the epidermis causing inflammation. There are well over 30 types of eczema of which seb derm is one, so your diagnosis does not exclude seb. derm. The microscopic examination also noted some esophilic spongiosis which has a different presentation and would connote a more specific subset of dermatitis, of which atopic dermatitis is one, as would be drug reaction dermatitis. If you search for these terms you can see the full list of possibilities. In general I would say that your biopsy doesn't give a definitive answer, but I a not a dermatologist, I just play one on boards 
Clinical presentation would help rule out a number of possibilities, your derm probably did the biopsy to rule out others rather than subjecting you to treatment you might not need. I have been told by a couple derms that biopsies are not often helpful for dermatitis, generally used to rule out as much as possible rather than make one specific diagnosis. There is for instance no way of testing for Rosacea through biopsy. As for steroid rosacea, a derm would normally diagnose this based on history and presentation. My suggestion would be get the skin inflammation under control through whatever treatment works, and then find something that maintains that. If its steroid rosacea you should be on oral antibiotics, and it would clear with 8-12 weeks. If it doesn't clear you either don't have steroid rosacea or if you do there is still some other dermatitis going on (you obviously had something which caused you to use steroids in the first place). |
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Joined: 07 Jan 2008
| Posted: Sat Feb 16, 2008 3:34 pm Post subject: | |
| Thanks so much for your post, J!
I went through short period where I had an itchy scalp, but it never flaked. I thought it was somehow connected to Zyrtec, b/c it started soon after I started taking it. I stopped taking Zyrtec and pretty soon my itching stopped. I've also been using a tea tree oil shampoo, so that might be helping, but I definitely don't have dandruff. When I look at pictures, descriptions of seb derm, it doesn't really fit what I have. Two derms I've seen originally thought it was eczema, but I could never get it under control. I have eczema on my hand, which I can keep under control very easily. Not sure if the steroids aggravated my already sensitive skin and rosacea-prone skin. The weird thing is this only affects my face. Sometimes my neck and chest get a little splotchy and itchy, but it goes away. My face has not been clear in months. I'm wondering if there is any connection to any of the many antihistamines I'm taking. I take Zantac, Claritin, 1/2 a Singulair and 1/2 a Xyzal. I have a pretty bad dust mite allergy that developed over the past year, after having my second child. I had some bloodwork done last week to check for food sensitivities as well as some other tests. Don't know if that will help at all. I am going to try some Protopic on a small area and see if it helps at all. I'm also starting 100mg of doxy today. I don't have any p&p's, but the derm wants to see if it will help with the inflammation. Fingers crossed! Thanks again for your long post! ~J ETA: When the condition first started and was a small patch on my face my allergist did a skin scrape and said it tested "positive" for yeast and was therefore fungal, but then my derm said we all have yeast on our skin so of course it had yeast, and told me to stop the lotrimin treatment the allergist had recommended. Would doxy kill extra yeast/fungas as well? |
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Joined: 18 Oct 2007
| Posted: Sat Feb 16, 2008 5:25 pm Post subject: yeast/fungus and antibiotics | |
| Boo2fr,
Doxycycline is an antibiotic so it will only kill bacteria (having said that antibiotics and especially doxy have a strong anti-inflammatory effect on skin so this would presumably aid any dermatitis). Unfortunately antibiotics are shameless in their indiscriminate nature, in plain english they will take out both good bacteria (we all have it on our skin, and especially our G.I. tracts which is why antibiotics almost always cause some G.I. distress). The problem with this is that in taking out this bacteria is disrupts the natural harmony of the body. Some studies have theorized that in killing off some of the good bacteria it allows fungus/yeast in the body to flourish. This is why many women who are on frequent antibiotics get frequent yeast infections. Now 100 mg of doxy per day is a relatively small dose but a few suggestions if you are concerned that seb derm might play a role in your skin problems (note, it is unlikely at this stage that you have a single skin problem, like most of us you probably have 2-3 things going on at once, for instance I have Rosacea, Seb Derm and possibly some Allergic Eczema overlap). 1. Try taking a good probiotic while you are on antibiotics. You have to be careful here because you have allergies and "naturalpathic remedies" in my experience are fertile ground for potential allergies. Having said that I think probiotics are generally very safe and are effective in ensuring that the antibiotic does not kill off all your good G.I. bacteria. 2. Ask your doctor about a short course of itraconazole (oral). 5 days at 200 mg per day is the norm to wipe out any excess yeasts that may be playing a role. If it works you can take a maintenance dose of 200 mg per day for 2 days at the beginning of each month. 3. Doxy also comes in a low dose sustained release version made specifically for Rosacea called Oracea (check out their web site, it is made by Collagenex I believe). It is 45 mg of Oracea in a sustained release capsule. This amount has shown to be as effective as higher doses of Doxy in controlling Rosacea but it is a sub-antibiotic dose, that is it will not kill any bacteria. As you may already know, antibiotics don't work on Rosacea by killing Bacteria, it is their anti-inflammatory action that controls the disease. Oracea is only available in the U.S. though and is very expensive so if you don't have insurance...In Canada we have Periostat, which is low dose doxy that was made for gum disease (20 mg sustained release pills, taken together to equal 40 mg per day). I understand that anecdotal evidence suggests that Periostat is just as effective as Oracea and their is currently a study going on in Canada testing this. Periostat is also expensive but about 30% less than what I understand Oracea to cost. Just some final words here as I read your other post describing the steroids you were on. Who prescribed these, I am willing to bet it was a GP not a dermatologist. With the exception of desonide none of the others are appropriate treatment for the facial area. I can tell you that when I first went to a GP here he gave me dermatop (prednicarbate) which is a strong flourinated steroid for my face. I only used it a few times before I learned what is was thankfully. Trial and error later I found myself using just weak hydrocortisone lotion 1% (which is over the counter in the US, this is different from hydrocortisone butyrate which is a strong flourinated version of hydrocortisone, several notches up the topical steroid strength chart) and that is the only thing that keeps my skin calm. Before that I tried just about everything one could try. Many bad days, missing work, becoming a social hermit! I was very apprehensive about using steroids but my Derm here (who is a lifesaver) convinced me that getting my skin calm was the only way to work towards a permanent solution. My advice to you is get a good derm and listen to what they have to say and don't give up there is a solution out there. Good luck with protopic, there is a study that found it aided people with steroid induced Rosacea, clearing a number of them in as little as 2 weeks. As with any topical, be sure to taper off of it when you decide to cease using it rather than withdrawing it suddenly (if you did this with the steroids btw it is possible that you have a type of rebound dermatitis that can be quite persistent. In my readings the generally prescribed course of action would be back onto steroids, usually beginning with a stronger type and gradually tapering down to 0.05-0.1% hydrocortisone lotion and then off. Good Luck |
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Joined: 07 Jan 2008
| Posted: Sat Feb 16, 2008 6:25 pm Post subject: | |
| Unfortunately it WAS a derm who prescribed all of those topical steroids! I kept asking her if it was okay to keep using them past the 2 week point and she said yes, it was fine. She said she was frustrated b/c she couldn't get me clear or keep me clear. I think the steroids weren't helping that situation! She had me on prednisone twice. Once for one week and once for three weeks. The pred helped calm my skin, but didn't clear the redness, it got a little lighter, but never cleared. I think that was the steroid part. When I came off the three week dose of steroids I flared horribly!
I am currently taking probiotics- Natren Healthy Start system. I also have another brand that has more strains in it, but I like Natren better. I am also currently taking Candex for yeast management (just in case that is an issue). I will continue to take that while I'm on the doxy. I go back to the new derm in 2 weeks so I'll do the 100mg of doxy until then and then talk to her about other options. I did take Oracea for a few days, but was having some sort of inflammatory issue going on. I wasn't sure if it was from the Oracea or just my body responding to being off the steroids, so I stopped. I told the derm and she said if the same thing happens when I start the doxy to stop immediately. I haven't gotten the prescription filled yet. I'll most likely start it tomorrow. I feel good knowing I've been on probiotics for about a month now so hopefully that will help keep my bacteria in check a little better. I think the Candex will help, too. Thanks again for you input! ~J |
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Joined: 07 Jan 2008
| Posted: Sat Feb 16, 2008 6:30 pm Post subject: | |
| "Try taking a good probiotic while you are on antibiotics. You have to be careful here because you have allergies and "naturalpathic remedies" in my experience are fertile ground for potential allergies. "
Can you elaborate on this a little bit? I think I know what you mean, but I just was wondering what your experience has been. For me, I tried taking an Omega 3 supplement, and I think it backfired on me! My flare was happening around the time I started the supplement and I think it only added fuel to the fire. I don't think the probiotics are affecting me negatively (my allergist said she didn't know if they would help, but they "wouldn't hurt"). I think they are supposed to be good for allergies, plug the gut, improve allergies! I don't think the Candex is either, but I might stop the it once I'm done with the antibiotics. I try to stay away from most other supplements, herbal or otherwise. I think my system is too sensitive to that stuff. Thanks, ~J |
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Joined: 18 Oct 2007
| Posted: Sun Feb 17, 2008 12:09 am Post subject: allergies | |
| boo2fr,
Sure, just to expand, I had an allergic reaction to an Evening Primrose Oil supplement (hives, trouble breathing...not good). The point is just because it's "natural" doesn't mean its safe. Makes sense of course because people develop allergies to things in nature all the time (grass, flowers, pets, etc.) If you have allergies the point is you should use as little as possible to minimize your contact with things you might be allergic to. Sounds like you have been trying a lot of different things...been there, done that. You should be wary of doing too much at once because it may make it difficult to pinpoint what is causing difficulties if they indeed arise. You may bypass a good treatment option inadvertently. I know its hard when you just want your face to go back to normal. It took me 8 months to accept that better than horrible was still a good day. Now that I look "normal" more days than not, I look back at how much grief I caused myself. BTW I had a look at your pictures and something I heard recently from a derm that specializes in allergies sprung to mind. She didn't think allergies were playing a prominent role in my problems because the redness I have is very bilateral (consistent). You appear to have patches of red here and there. This according to this derm is much more consistent with an allergic contact dermatitis, tho not necessarily the case. I remember it because she was teaching an intern at the time and she told him that he would have people come in with patches here and patches there on their face that appear to have no connection to each other but in fact do. She compared it to a poison ivy rash (which is an atopic reaction), which causes patches to crop up on some people no where near the point of ivy to skin contact. As for the derm that prescribed you strong flourinated steroids for your face...well I am on my 7th derm...that kind of says it all. Just because you have a degree doesn't mean you are good at what you do (sadly). I know I am in a profession that is full of incompetents, don't see why medicine would be any different. |
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Joined: 07 Jan 2008
| Posted: Sun Feb 17, 2008 2:24 am Post subject: Re: allergies | |
| Sounds like you have been trying a lot of different things...been there, done that. You should be wary of doing too much at once because it may make it difficult to pinpoint what is causing difficulties if they indeed arise. You may bypass a good treatment option inadvertently. I know its hard when you just want your face to go back to normal. It took me 8 months to accept that better than horrible was still a good day. Now that I look "normal" more days than not, I look back at how much grief I caused myself.
Did you have steroid induced rosacea? Did you just give it time, or did you use something to help the healing process? BTW I had a look at your pictures and something I heard recently from a derm that specializes in allergies sprung to mind. She didn't think allergies were playing a prominent role in my problems because the redness I have is very bilateral (consistent). You appear to have patches of red here and there. This according to this derm is much more consistent with an allergic contact dermatitis, tho not necessarily the case. I remember it because she was teaching an intern at the time and she told him that he would have people come in with patches here and patches there on their face that appear to have no connection to each other but in fact do. She compared it to a poison ivy rash (which is an atopic reaction), which causes patches to crop up on some people no where near the point of ivy to skin contact. That is very interesting. Both my derm and my allergist thought it looked like an allergic repsonse, but to what- who knows?!? I am on several antihistamines and those aren't helping. It has actually changed a lot and I'll probably post another pic soon. It has actually spread to cover most of my forehead and my cheeks are much more symmetrical now. It looks like a butterfly rash, something consistent with a Lupus rash. I've been tested, though, and it's negative. I'm hoping the Protopic will help at least calm it until we figure out what it causing it (if we ever do). I am also going to start allergy shots soon, who knows if they will help! As for the derm that prescribed you strong flourinated steroids for your face...well I am on my 7th derm...that kind of says it all. Just because you have a degree doesn't mean you are good at what you do (sadly). YIKES!!! I'm only on my second! Hopefully she'll be better than the first. If not, I guess I'll be looking for a third. I really like my allergist, though, so I'm hoping she can help with the puzzle, too! ~J |
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Joined: 18 Oct 2007
| Posted: Sun Feb 17, 2008 8:31 am Post subject: steroid rosacea | |
| boo2fr,
I have had Rosacea for sometime but it only really gave me the flushing across the cheeks and nose with some...well warmth would be a good ay of describing the feeling. It would come and go within an hour and wasn't daily (started it my 20's). When I turned 30 it became more regular, would get diffuse redness on my forehead. At 32 I developed some slight seb derm in my scalp. Basically I ignored all of this, used no treatment and was content to live life ignoring it...but then I woke up one morning and all the skin on my face was flaking off, it wasn't red, it wasn't burning...just flaking. My previous relatively problem free skin had turned dry, rough and flaky. Then the pustules started coming, weekly then daily. Long story short I appeared to have had a bad Rosacea flare, this in turn triggered a bad seb derm flare. I was a flaky, pustuled mess. I was embarassed to go into public. After a lot of trial and error I met a derm that runs a Rosacea clinic at a good teaching hospital. With his consultation I began applying hydrocortisone lotion and a good moisturizer and my skin slowly went back to what I would consider normal. Unfortuanately despite many tries hydrocortisone lotion is the only treatment that keeps my skin from going back to the flaky pustule mess. So you see I had my skin problem before I ever applied steroids, I use the most mild steroid available and I have not had any problems. I have slowly got my life back. I have tried antiobiotics, immunomodulators, naturalpathic remedies, etc. In the end following a good derms advice was the solution. I come to these boards in my continuing journey to hopefully one day be able to discontinue putting anything on my face (I don't even like using moisturizers) and to share the knowledge I have amassed having read well over 200 articles on Rosacea, seb derm, atopic eczema and the treatments for these disorders including steroids. As for the allergic response, have you been patch tested? If not this might be a patch worth travelling. |
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