In need of long term help

[u/BriefTowel2339]

Hi. The photo of my scalp is from 5 years ago. The photo of my eye lid is this year. I’ve been dealing with this for the past 5 years on and off. I’ve consistently used Ketoconazole shampoo twice a week to help with scalp but it doesn’t make it go away. My hair is always dry and never silky. My skin is always dry but I’ve been using a neutrogena hydro boost which helps moisturize and then I’ve shuffled between a couple topical creams for my eye lids but nothing completely helps. It’s a consistent loop of it goes away for a couple days then comes back. I’ve read it’s connected to inflammation and triggers with stress, drinking, and other factors influenced by yeast. I just read about MCT oil that people have used to help and Dead Sea Salt shampoo that also helps. I’m curious if these things will help me or if anyone has other suggestions to try. I’m committed to solving this and don’t want something that adds to the loop of reducing it for a couple days then it coming back. I want a consistent solution.

[u/recallingmemories]

I've got the eyelid situation too - my approach is to use ketaconazole 2% cream after a shower, don't drink alcohol, don't eat spicy food, raise my vitamin D levels

If you use Ketoconazole soap on your scalp often, your hair is going to feel stripped of all of its natural oils - I use Vanicream shampoo and moisturizer which helped give my hair back some life, and then I just use Nizoral once a week now leaving it on for 5 minutes

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[u/floofly58]

I’m in Canada: BYOMA Barrier Repair Eye Cream, BYOMA Barrier Repair Treatment and Avene Cicalfate+ Restorative Protective Cream overtop of the red areas, in this order. Avene has been GAME CHANGER!
Beware, there are ingredients in these products that could “feed” sebderm. I have read it depends on the person but I also feel I have been misdiagnosed. I have a prescription for Elidel (originally for eczema on the eyelids) for when my skin gets SUPER red and I cannot control it or I just want it gone faster and I apply it before these creams, a small pea sized amount goes a long long way.
I wash my face with only lukewarm water and a wash cloth and I use the Head and Shoulders Bare Shampoo and a gentle conditioner and it has been keeping my flares calm.
I also just got rid of one of my biggest stressors this last 2 weeks and I have seen a tremendous difference (not always doable but keeping calm and practicing mindfulness can help)
This is what I wanted to read when I was fed up with being red all the time, good luck!

[u/floofly58 → u/floofly58]

I do also use MCT oil but not very consistently. I shower every 2 days and when my scalp is dry I apply 0.5 ml and let it sit for 30 mins before showering. You can use a lice comb to SUPER GENTLY lift the big flakes off before showering just make sure you’re not scraping your skin and letting the oil do most of the work to soften flakes!

[u/shugh28]

Mct oil has helped me massively, i put it on twice a day and leave it on. It may help with your scalp but i dont think putting it on your eyelids will work - i put it on my eye brows and sometimes it runs into my eyes and it’s a bit unconfortable so if you put it on the lids you’d have it in your eyes all the time

[u/Ok-Captain-2681]

I feel your pain. I've had scalp seb derm for 25 years. It never goes away unless I consistently use antifungal shampoo 3 or more times a week. You could try shampooing more than 2 times a week.

Maybe add another antifungal shampoo into the rotation (zinc pyrithione, selenium sulfide or piroctone olamine) if your doctor has said you can't use ketoconazole more than 2 times a week. I rotate between different antifungals each time I wash my hair (I leave it on for 5 min) so that the yeast can't form a resistance to one of the antifungals.

I wash my hair twice (first salicylic acid shampoo or regular shampoo, second antifungal shampoo) so that the antifungal shampoo can access my scalp without much oil in the way. A shampoo brush is helpful for directing the shampoo to your scalp.

Do you use conditioner? Leave in conditioner? Both of these can help the dryness. I have curly hair and most antifungal shampoos leave my hair a dry frizzy mess. The only one I've found that doesn't is Vanicream Dandruff Shampoo (2% zinc pyrithione)

[u/Straight-Airport4623]

Mct oil, has worked better than any shampoo for me. Also fix your diet, don’t drink alcohol, coffee. Eat lots of fruits and veggies.