OpenHealth Q&A

Seeking Guidance After Years of Unresolved Skin Issues

I apologize if this message comes off as lengthy, but I aimed to present a comprehensive overview to solicit your insights. Although it’s not a matter of life or death, this ongoing condition has drained me. I’m willing to share photos with anyone who might offer assistance. Thank you! I’m a 26-year-old male from the United States, slim and fit. In November 2021, I experienced seborrheic dermatitis, which manifested as flaking skin on my nose. Using hydrocortisone and ketoconazole cream, the condition cleared up within a few days. However, in April 2022, a cyst appeared on my face, which was otherwise clear. After receiving a cortisone injection to eliminate the cyst, a dermatologist prescribed doxycycline for two weeks as a precaution. Several months later, in June 2022, I encountered another flare-up of seborrheic dermatitis. Once again, I applied hydrocortisone and ketoconazole, which provided slight relief. After suffering from sunburn, my skin naturally improved for a few weeks while it healed. Unfortunately, in July 2022, the condition returned aggressively and has persisted ever since. If you believe environmental factors—like my specific location in the USA—could be relevant, I can provide further information. Fast-forward to mid-2023, I noticed white sebum or suspected keratin in my beard, and regardless of the treatments, my condition remained unchanged. This situation has led to hair loss in my beard. I initially assumed it might be related to Demodex mites and subsequently treated it with 1% topical ivermectin for six months, but to no avail. I then consulted a functional medicine doctor at a university who suspected a gut issue due to my previous doxycycline use. I explored various specialists, including a rheumatologist, hepatologist, and gastroenterologist, but none provided valuable insights. Hormonal levels were tested and found to be normal. An allergist was also consulted, but there were no findings of significance. I underwent a six-month course of oral nystatin after an OATS test indicated potential Candida issues, but this treatment was ineffective. I have also tried intravenous vitamin C along with several supplements, including glutamine, S. boulardii, vitamin D, Mitocore, phosphatidylserine, and various probiotics as suggested by my functional doctor—yet none brought about improvement. Two KOH scrapes, a culture, and a biopsy of a chest area—where I sporadically experience seborrheic eruptions—were conducted (I would be glad to message you the results). Notably, a Woods lamp examination showed no concerning results. Currently, I continue to take vitamin D, while I've shifted away from other vitamins and supplements, having stopped glutamine and S. boulardii a few months ago. My skincare regimen has included akleif, Zoryve foam and cream, along with ketoconazole shampoo and cream. I experimented with various anti-fungal creams like Lotrimin, clotrimazole, and several medicated shampoos, including Head and Shoulders and prescription-strength (2%) selenium sulfide. For facial cleansing, I opted for Vanicream gentle cleanser paired with moisturizers like Cerave baby cream, Cerave in a tub, or La Roche-Posay’s water-based double repair moisturizer. I switched to these products, suspecting that Cerave might be clogging my pores, but I still experience the same adverse reactions. I have consulted a total of seven board-certified dermatologists, many of whom are highly respected, including two at a university hospital. It's been over three years of this ongoing situation. While I acknowledge that my condition may be considered mild compared to others, I am still eager for resolution. My face appears and feels unhealthy, showcasing dehydration and wrinkles in areas that were once smooth. Additionally, I’m witnessing significant beard hair thinning, accompanied by redness in sebaceous regions. In college, I had laser hair removal on the lower neck due to razor bumps; that procedure has successfully mitigated those issues. My skin tends to react sensitively. I’d appreciate any advice on next steps. Should I prioritize repairing my skin barrier? Are there any further tests I might consider pursuing through my concierge or functional medicine doctor? What other underlying conditions could potentially be contributing to my symptoms? Could this possibly stem from a food sensitivity or an issue such as MCAS, despite the absence of other typical symptoms? We are feeling quite lost, and I would be very grateful for any assistance or insights. Please feel free to reach out directly.

Answers (1)

8/8/2025, 1:50:58 AM

OpenHealth AI

Thank you for sharing your detailed journey with your skin issues. It’s clear that this ongoing condition has been a significant source of frustration for you. I want to provide you with a structured approach that focuses on your immediate needs while considering long-term skin health.

Main Points:

1. Skin Barrier Repair: Prioritize restoring your skin's barrier function.
2. Simplifying Skincare Regimen: Consider streamlining your skincare products to avoid potential irritants.
3. Investigating Underlying Factors: Explore whether underlying conditions such as food sensitivities might be involved.

Explanation:

Your history shows that you’ve dealt with various skin conditions like seborrheic dermatitis and cysts. The persistent nature of your issues, despite numerous treatments, suggests that your skin barrier may be compromised. A damaged barrier can lead to increased sensitivity, inflammation, and difficulty healing.

Given your sensitivity and the lack of response to multiple treatments, focusing on repairing your skin's barrier is essential. Complex regimens with many active ingredients can sometimes worsen sensitivity and irritate the skin.

Next Steps:

1. Simplify Your Skincare Routine:

   • Cleansing: Stick to a gentle, non-irritating cleanser like the Vanicream gentle cleanser you’ve mentioned.
   • Moisturizing: Use a simple, fragrance-free moisturizer that focuses on hydration—like Cerave's moisturizing cream, as you've used before. Avoid any products with artificial additives or irritants while you reassess your routine.

2. Barrier Repair:

   • Consider incorporating products that specifically target barrier repair, focusing on those containing ingredients like ceramides, hyaluronic acid, and niacinamide, but introduce them one at a time to monitor for reactions.
   • Avoid any harsh exfoliants and be gentle with your skin—pat dry instead of rubbing.

3. Monitor and Document:

   • Keep a detailed journal of your skincare routine and any reactions you experience with various products or environmental changes (like diet or weather). This can help identify triggers or effective products over time.

4. Explore Dietary Considerations:

   • Since there has been mention of potential gut issues, consider a brief elimination diet to see if any common allergens (like gluten, dairy, or certain additives) contribute to skin flare-ups. However, approach this cautiously and ideally under guidance.

5. Potential Consultation:

   • If the current steps do not yield improvements over the next few months, consider seeking a consultation with a dermatologist who specializes in inflammatory skin conditions, or an allergist with experience in skin-related allergies and sensitivities.

6. Support and Community:

   • Engage with support groups, either in person or online, where you can connect with others facing similar challenges. Sharing experiences and coping strategies can provide emotional support and practical advice.

Your skin concerns are valid and worthy of attention. Progress may take time, but focusing on a simple, gentle skincare routine while investigating potential underlying factors can help move you toward resolution. Feel free to reach out if you have further questions or need additional clarification on any steps.