How to deal with seborrheic and perioral dermatitis after moving abroad

Disclaimer 1: I am not sponsored by any of the products or individuals I mention in this article.

Disclaimer 2: I am not a doctor, so take what I say with some healthy skepticism and seek out a dermatologist if you can and do some independent research if you are dealing with any of the conditions I mention. <3

This blog post has been a long time coming. My goal through this post is two-fold: I want to finally share with my loved ones what I have been dealing with the past two and a half years in detail AND provide information which may help someone else who is dealing with seborrheic and/or perioral dermatitis. So, if you are reading this blog post and deal with either of the above conditions, this post is for YOU. I dearly hope this provides encouragement to you and helps you believe you can make it through this! Because I fully believe you will.

Justin and I moved to Ireland in July of 2019 and just one month later, I developed a small flaky patch of skin on my upper lip. I wasn’t sure what it was or how to deal with it, but I tried many different lip balms, steroids, and products which were supposed to help with eczema. By November 2019, the aggravated patch got bigger and I could no longer wear my favorite lipstick or lip gloss. I began having very small blisters develop all over my lips and it was painful. Over the next couple of months, the rash had spread to the skin surrounding my lips, and painful acne started to pop up around my chin. By April of 2020, soon after the pandemic began, the rash had spread, with red, flaky patches showing up around my eyes, cheeks and outer ears. I also had patches on my chest, near my belly button, and on my neck. I could no longer wear makeup and my skin had become very painful, with a chronic burning and itching sensation that was very difficult to manage. Not to get too graphic here, but my skin started to crack and ooze and suffice to say, I was very self-conscious about my appearance.

I sought out medical help in Ireland, but having only recently moved abroad, I had a very limited understanding of how to tackle the medical system here. I quickly learned the drawbacks of the Irish medical system – with multiple GPs trying all different types of treatments and refusing to refer me to a dermatologist. (In Ireland, it is very difficult to see a specialist without a GP’s referral.) Finally, after seeing multiple doctors, getting numerous diagnoses, and trying all of their prescribed medications from fungal creams to steroid creams to Accutane, one GP finally agreed to refer me to a dermatologist. I didn’t know it then, but I would not be contacted by said specialist for (no joke) a year and a half, because wait lists for specialists here are that long. Because of this, I was forced to take the matter into my own hands.

It was very discouraging for me to not find the help I desperately needed. At its worst, the constant pain on my face and neck kept me up at night and made me feel very low to the point that Justin and I were ready to make the decision to move home. We decided to try to hold out as long as possible since we were finishing our master’s programmes and I was hoping to continue on with my PhD. And I am glad we did.

In summer of 2020, Justin and I were able to visit home and I was able to see my dermatologist. She confirmed that I was dealing with two conditions: seborrheic dermatitis which included the red, flaky, textured patches on my face and ears, and perioral dermatitis which caused the tiny blisters on my lips and occasionally around my eyes as well. She prescribed me ketoconazole shampoo since she could also see some on my scalp and pimecrolimus cream (non steroidal) which I was to apply to my face and everywhere I had the rash.

Both helped a lot (as did being home in the sunshine and a familiar climate) but after a few months, when I was back in Ireland, two things happened. The pimecrolimus cream (Elidel) was starting to be less effective, permitting lots of little bumps on my skin, and I found out that said cream may have some dangerous health risks – a high number of individuals have developed cancer with prolonged use (which while it can’t be called a cause of cancer, it still may be correlational). It is also an immunosuppressant and overall, I just realized I didn’t want to be on that medicine long term.

So, I began scouring the web, and I found some resources that ultimately have helped me control the dermatitis and greatly improve the quality of my skin. Overall, with my meetings with doctors, and my extensive search on the web, I have found out some pretty important things about each condition, what can cause them, and how best to treat them.

Seborrheic dermatitis (seb derm) is a chronic condition where inflammation builds up on the skin as a response to stress, Malassezia yeast (a naturally occurring substance which becomes pathogenic for some individuals), and a change in climate. Unfortunately, there isn’t a lot of information on seb derm, and it is a very individual condition that presents itself as a result of individual, unique triggers.

I have found that, for me, my seb derm began because of a few different things. First is climate. I have lived in California most of my life and my body was used to the dry, warm, and sunny climate that the Bay Area provides. However, Galway is almost completely opposite that, with its cold, damp climate and very little sunshine. Additionally, Galway is a very windy place and most days there is a light to moderately strong breeze. Many days, the wind is howling and nearly topples me over with its strength. I think the cold, biting wind caused some wind burn and basically impaired my skin’s moisture barrier which caused my seb derm to worsen.

Perioral dermatitis, on the other hand, is a condition that presents itself around the mouth and also frequently occurs around the eyes (in this case it is called periorificial dermatitis). It is an itchy, burning rash that can be caused because of sensitivities to steroids or ingredients in toothpaste, face washes/creams, and basically anything you put on your skin.

For myself, I found that I had a sensitivity to SLS (sodium lauryl sulphate) in my toothpaste AND shampoo/conditioner. People are increasingly becoming sensitive to this ingredient which is present in most toothpastes, body washes, soaps, and anything that becomes foamy or cleanses.

Since triggers for both skin conditions vary from person to person, I also have spent many months trying to find more of my own personal triggers which include the following and may help give you ideas if you also suffer from these dermatitis issues:

My Triggers:

• Vaseline (aggravates perioral derm)
• Coconut oil (aggravates seb derm)
• Oils in general because malassezia fungus/yeast feeds on fatty acids which are in oils
• SLS or sodium lauryl sulfate in all products including toothpastes, shampoos, conditioners and face products
• Essential oils (a lot of “natural” oils can make seb derm worse)
• Most laundry detergents (fragrance free detergents for sensitive skin work well for me)
• Parfum/fragrance in products
• Wind/cold weather (wind burn)
• Stress
• Poor sleep
• Low sunlight levels
• Alcohol (when I am having a major flare)
• Long, hot showers
• Steroid creams prescribed for the skin
• Zinc oxide sunscreens

*all these also apply to hair products used, since anything that can touch your face/rash areas can affect it.

While I was searching for resources, I came across a couple reddit pages concerning perioral dermatitis and seb derm as well as an incredibly thorough blog about malassezia yeast – what it is, what “feeds” it, what ingredients to use and avoid in skin care products. There are two Youtubers who greatly impacted my skin care journey as well: Dr. Dray and Hyram. I’ve included links to their channels in the resources below. 

During my research, I came up with a plan of action. I wanted to help my skin’s moisture barrier heal since all the rashes led to cracked, impaired skin. I also wanted to scale back and try something called “zero therapy” which basically is a break from ALL skin care products including face washes, lotions, sunscreens, makeup etc. You are only able to wash your face with water twice daily. This would allow my skin to hopefully stabilize and heal as I searched for other products that may be more suited to my skin.

I started a skin journal for the two weeks I did zero therapy and wrote daily details concerning the whereabouts of my rashes, the pain levels, the extent of the rashes, and any triggers that may have been contributing. The zero therapy helped immensely, but I am not going to lie, my skin got worse before it got better. After about two weeks, my skin had improved about halfway and had stabilized. That is when I started to introduce skin care products one by one.

Each week I introduced a new product into my routine and if it worked, I introduced another the following week. However, if I reacted to a product, I waited an additional 1-2 weeks before starting something new to give my skin time to heal. It took a long time, but eventually, I found products that helped my moisture barrier heal and helped my seb derm and perioral dermatitis greatly improve.

My gameplan was to introduce a very short list of simple skin care products for sensitive skin and not go beyond the minimum needed to improve and maintain my skin. I reduced the number of times I washed my face and now only use soap at night before bed (and rinse my face with water in the morning). In addition to cleansing once daily, I use a very simple moisturizer twice a day as well as a serum for hyaluronic acid and a serum for niacinamide, two ingredients which help repair and maintain a healthy skin barrier and have helped me a lot. I still haven’t found a sunscreen that works for me and am discovering I may have a sensitivity to mineral sunscreens, but I am so incredibly thankful to have found the products that I currently am using.

Products that work for me include:

• Vanicream 2% Pyrithione Zinc Z-Bar (I use this to wash my face nightly M/W/F)
• Vanicream Cleansing Bar (I use this any other night that I am not using the Z-bar)
• The Inkeylist Hyaluronic Acid Serum (AM and PM after cleansing)
• The Inkeylist Niacinamide Serum (AM and PM after hyaluronic acid serum)
• Vanicream Daily Facial Moisturizer (AM and PM after serums)
• Bare Minerals mineral, powder foundation, highlighter, blush, bronzers

Also, getting good sleep and taking vitamin D3 supplements have also really helped my skin improve.

Since then, I can gratefully say that I am finally pain free and my skin has improved almost to its original state. While I understand that seb derm is a chronic condition and I will most likely have flares in the future, I know I can approach them with confidence and an assurance that I know how to deal with the flares and I will be able to manage them. This situation has greatly impacted the past two or so years of my life and it is wonderful to not have this situation weighing on my heart like it once was.

So, for anyone out there who is dealing with seb derm and or perioral dermatitis, I completely empathize with you. I feel for your pain and discomfort, and my greatest wish for you is that you can find your triggers and what products and treatments work for you so that you can be pain-free and live your life without these conditions holding you back. After spending a couple years living with dermatitis, I have come up with a list of recommendations to help anyone else who deals with seb derm or perioral dermatitis as they navigate their own skin care journey:

Recommendations:

• See a dermatologist if you are able
• Scour the internet (and my resources below) to better understand your skin conditions
• Find your triggers by eliminating certain things you think may be contributing and slowly add them back to see if they upset your skin
• Try zero therapy if you think it would work for you
• Slowly add new products to your skincare regimen, ones that will not only help with the rash, but will also heal your skin’s moisture barrier.
• When flares occur, try not to itch/scratch (trust me, I know how hard this is!) and work on managing your stress and fear with regards to the flare as best you can
• If you have received medications from your dermatologist that work for you, use them minimally to help manage bad flares, but don’t use them as a fix all
• Be patient and have compassion on yourself: I know first hand how agonizingly slow it can feel to find your triggers and products that will work. It can be a frustrating and emotional process. But try to have compassion on yourself as much as you can; you are brave to tackle these skin issues and it takes a lot of energy to not only deal with the skin conditions themselves but to also find solutions.
• Try to find one or two people you can trust with these skin conditions. Having a couple people to talk to during the bad flares can help a lot since these conditions can feel very isolating.
• Last but not least, don’t forget that you are fully capable of making it through this, because you absolutely will 🙂

Resources:

• Reddit for seborrheic dermatitis: https://www.reddit.com/r/SebDerm/
• Reddit for perioral dermatitis: https://www.reddit.com/r/perioraldermatitis/
• Malassezia yeast website (also includes an extensive list of products which are seb derm safe): https://simpleskincarescience.com/pityrosporum-folliculitis-treatment-malassezia-cure/
• Hyram’s youtube: https://www.youtube.com/c/Hyram
• Dr. Dray Seb Derm: https://www.youtube.com/watch?v=WqSc7Bpq-pU&list=PLwt4JCEyw0WUX84XDtYcIKl_9VPuV-Vqz&index=9
• Dr. Dray Perioral Derm: https://www.youtube.com/watch?v=DRhZ5xvXmFc
• Dr. Dray Moisture Barrier: https://www.youtube.com/watch?v=30yogUkbdFc&list=PLwt4JCEyw0WUX84XDtYcIKl_9VPuV-Vqz&index=12&t=50s
• Dr. Dray sensitive skin tips: https://www.youtube.com/watch?v=VjR9rJYuiFE
• Vanicream store on Amazon: https://www.amazon.com/stores/Vanicream/page/52812122-11B4-48A8-B5D7-A5DF989B0737?ref_=ast_bln
• The Inkeylist Website: https://www.theinkeylist.com/

If anyone out there would like to reach out to me to talk about skin related issues or would like to see pictures of my skin at its worst (to compare to your skin) please reach out to me. I am more than happy to chat and help in any way that I can.

For anyone who has made it to the end of this blog post, thank you for reading all the way through and for learning a little more about my life these past two and a half years.

Do you deal with seborrheic dermatitis or perioral dermatitis? Have you found what triggers you and any treatments which work best for you? I would love to hear about them. Please comment down below with any thoughts or ideas you may have!