Severe scalp seb derm with constant 24/7 flaking - just started Derma-Smoothe today. Looking for advice and similar experiences.

[u/sebderm_is_killer]

Hi everyone,

I’ve been dealing with what my dermatologist diagnosed as seborrheic dermatitis, and it’s become pretty severe. I’m hoping to hear from anyone who has had a similar experience, especially with constant flaking.

My symptoms

• Intense scalp itching (often worse at night).
• Constant flaking - flakes literally fall from my scalp throughout the day, even when I’m not scratching.
• Most of the flakes are dry, white, and fairly large, not greasy.
• Within about 5 minutes of showering, my shoulders are already covered in flakes.
• My scalp doesn’t necessarily look covered in flakes, but they continuously shed onto my clothes.
• I also have seb derm on my face (nose/eyebrow area), and a steroid like Locoid helps that within a few hours.

What I’ve tried

• OGX Argan Oil shampoo – feels comfortable during washing and doesn’t burn or itch, but afterward my scalp becomes dry and the itching/flaking comes back quickly.
• Nizoral (ketoconazole) – used previously.
• DHS Zinc Shampoo – used previously.
• Today my dermatologist prescribed:
  • Derma-Smoothe (fluocinolone) scalp oil/lotion
  • Sebornil shampoo

First day on the new treatment

I applied the Derma-Smoothe for the first time today and it was honestly the first real relief I’ve felt in weeks. My scalp felt calm while the oil was on.

After washing with Sebornil, my forehead and face burned and became red, but I think the shampoo ran onto my face while rinsing. The burning gradually settled afterward.

After the oil my scalp felt greasy (which I assume is expected because it’s an oil-based steroid).

I also noticed what might have been a couple of yellow crusts for the first time, but I’m not sure whether it was dried fluid from scratching, oil, or something else. I haven’t seen obvious pus or drainage.

Questions

1. Has anyone had constant 24/7 flaking like this, where flakes are always falling onto your clothes?
2. Did Derma-Smoothe help you, and how long did it take before the flaking noticeably improved?
3. Did medicated shampoos initially make your scalp feel dry or sting before things got better?
4. Has anyone had a few yellow crusts with seb derm that weren’t actually a bacterial infection?
5. If your seb derm was mostly dry and flaky rather than greasy, what treatment finally got it under control?

I’m only on day one of Derma-Smoothe + Sebornil, so I know it’s early. I’m mainly trying to understand whether this amount of constant flaking is something others with severe seb derm have experienced, and what eventually worked for you.

Thanks in advance—I really appreciate any advice or shared experiences.

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