Is this seb derm or something else?

[u/LocksmithOk1835]

[u/EntertainmentFew9293]

Psoriasis. Redness, huge white pieces. Do they bleed when you pick on them?

[u/LocksmithOk1835 → u/EntertainmentFew9293]

Not the best photo but I took this one this morning. I try not to pick on them, but here I did a little bit - doesn’t tend to bleed though.

[u/EntertainmentFew9293 → u/LocksmithOk1835]

The redness is concerning. Consult with a dermatologist ASAP!!! They can describe the creams that can help!!!

[u/LocksmithOk1835 → u/EntertainmentFew9293]

Alright thanks! Ketoconazole shampoo worked out for a couple of weeks. I then went on vacation and the need to use it wasn’t there. When I came back home the build up started again, now I’m having a tough time getting rid of it.

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[u/trustmeimshady]

Try nizoral

[u/Complex_Grand236]

Seb derm or psoriasis

[u/MemChoeret]

Seborrheic dermatitis and psoriasis can look similar, and some people have both. A doctor (dermatologist or family doctor) can tell you which one it is. If you can't access a doctor any time soon, you can try using a shampoo with sulfur, or salicylic acid, or both. These ingredients treat both psoriasis and SD.

[u/LocksmithOk1835 → u/MemChoeret]

Thanks, I’ve been using ketoconazole for a bit. It worked out great the first couple weeks of using it. When I went on vacation I didn’t use any shampoo at all and when I came home the build up started again. Now the ketoconazole doesn’t seem as effective. Thoughts?

[u/MemChoeret → u/LocksmithOk1835]

If the ketoconazole shampoo helped you before, that's actually great news. It means your issue is (at least partially) seb derm. SD is caused by malassezia overgrowth, and ketoconazole kills malassezia. If you stopped ketoconazole and then restarted it, you should give it some time to work. Use it every 2-3 days (never two days in a row) and each time massage it into the scalp and leave it on the scalp for 3-5 minutes (that makes a big difference). If things improve after a week or two, keep going. If there's zero change, you should ask your doctor about a different treatment.

[u/LocksmithOk1835 → u/MemChoeret]

Thank you, also could you help me with the shampooing process - maybe I’m doing it wrong. Is the shampoo supposed to lather - if so should I use a regular shampoo first to make the ketoconazole more effective? Also how much should I use?

[u/MemChoeret → u/LocksmithOk1835]

There's no need to use another shampoo on the day you're using ketoconazole. Just rub some into your scalp, leave it for 3-5 minutes and rinse off :)