19 September 2017Last updated

Features | People

Ask the expert: I’m suffering from severe eczema

The description of your complaint fits the diagnosis of seborrheic dermatitis or eczema

Dr Ikramullah Al Nasir
2 May 2016 | 01:10 pm

I’m a 30-year-old man suffering from severe redness and scaling of facial skin for the past six years. It is most severe around my nose and cheeks and my scalp, eyebrows and ears are also affected. Topical steroidal applications have not helped.

The description of your complaint fits the diagnosis of seborrheic dermatitis or eczema. Factors like genetic predisposition, personality type, climate, transitory immunity suppression by an acute systemic disease and severe stress are said to contribute to the condition. The active presence of malassezia furfur fungi on the affected areas of the skin is also believed to aggravate it.

This list of causes indicates that a total cure or prolonged remission are difficult to achieve. Together with the medical treatment, lifestyle changes and personality as well as behavioural modifications are also equally important in order to treat all cases of seborrheic dermatitis.

Topical steroidal remedies remain the mainstay of prescriptions. However, their prolonged use can lead to potential side effects, including thinning of the skin with visible blood capillaries. A persistent redness of the face is also sometimes associated with acne-like pustular lesions, a condition called steroid-induced rosacea. The condition can also become refractory 
or non-responsive to continued treatment. Therefore, I avoid prescribing continuous use of topical steroids to treat seborrheic dermatitis.

Effective alternative treatment options include topical anti-fungals. In severe cases, a short course of oral anti-fungals usually prove to be of great help, but again, they cannot be recommended for long use. Shampoos containing tar, selenium sulfide or ketoconazole can also be used as supportive treatment. Frequent application of any suitable moisturiser can provide significant relief too.

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Dr Ikramullah Al Nasir

Dr Ikramullah Al Nasir

is a specialist dermatologist and founder and president of Dermacare Skin Health Services.