The older I get, the more of these I end up doing. Fun times.
The reason I decided to blog about this condition is because of the general... lack of caring(?) of the dermatologists that I've seen. I made an appointment back in June or July for Cascade Eye and Skin. It had been many years since I was seen there, and I didn't remember them being so... Drive Thru Dermatology. I'm sure they see hundreds of patients a day, and I really just felt like a number, especially when I watched the doctor's nurse chilling on her phone, draped over her chair like a blanket, while the doctor explained my condition. I wasn't too upset over the care; I already pretty much knew what I had and I really just needed scripts to take care of it. They did give me Ketoconazole shampoo, Ket cream, and a watery steroid for flare ups. But she also barely looked at my skin - and maybe she didn't need to. Seborrheic dermatitis is probably one of the most common conditions that gets diagnosed. The condition is an overgrowth of a yeast called Malassezia, and it causes and itchy, flaky scalp and sometimes red rashes. Most of the rashes appeared around the edges on my hair, especially at the back of the neck and behind the ears. But, since we both basically agreed that's what I had, I figured I had it under control.
So for the first month or 2, I started changing my habits and washing my hair 3x a week instead of 2 (curly hair should have less wash time), and trying to balance using the Ket shampoo with my regular shampoo so that I wouldn't overuse the Ket. The problem with overusing Ket is that you could end up with fungicide-resistant yeast and it might stop working all together, so I was trying to find out how little I could use it in general and get away with it. But after that experiment kind of failed, I ended up washing 3x times a week with the Ket and leaving it on for 5-7 minutes while I did my other shower activities.
However, as the weeks wore on, my hair was getting worse. It would barely last a day before it would become dull, dirty, greasy and itchy/flaky. I was still getting rash flare ups sometimes on the back of my neck. So even though it cleared up behind my ears, and the shampoo worked for about a day, I began to wonder if my diagnosis was wrong. I decided to make an appointment with a different dermatologist at a different clinic to see if they had a different opinion. Of course, I wasn't having a flare up at the time, it wasn't even that itchy/flaky when I went in, so again, she barely even looked at my scalp.
I asked her if this dx was right, and if there was anything additional I could do to help with my hair. She asked me if I let my hair air dry after washing. I said yes (I squeeze dry it with a Curlsmith microfiber towel - which is really bomb btw) because my hair is curly. She said I really shouldn't, since yeast loves to grow in dark, damp, warm environments. First of all, lady.
1. You're standing within my personal space and you need to back up; it's really awkward. And
2. No. Not only would I be drying my hair for well over 30 minutes, but even when using blow dryer on low with a diffuser, my hair becomes a frizzy mess. So that's not happening.
She did not offer any other suggestions. It was a pretty well wasted appointment. She did say that I could use the steroid on my scalp where it was itchy and not just on the periphery, but the itchy spots were rarely in the same spot twice, so that wasn't very helpful either. So here I was, having to figure out things on my own. And Google (including their stupid AI bot) was the opposite of helpful. But, I had two ideas.
1. Stop wearing my silk bonnet to bed. Silk is not breathable in the slightest, so I can just imagine the dark, warm environment it's creating for my scalp each night. Plus, I only washed it once a week with my laundry, so it wasn't the cleanest thing either. I've gotten really used to having my hair out of my way while I sleep though, so I found these mesh sleep bonnets from Amazon. The holes are small enough for my hair to stay inside, but still breathable. They work great.
2. Double wash. Nobody that I've found online advises this. But I had a theory. See, Ketoconazole shampoo is, by definition, a shampoo, but first and foremost a fungicide. I decided that it wasn't a very good shampoo, so I washed my hair with a small amount of my regular shampoo first, and then washed again with the Ket. Because most of the grime was washed away with the first cleanse, the Ket foamed up really nicely, and I thought well, this also probably helps with distributing the fungicide all over my scalp as well. After doing this, my hair lasted MUCH longer after one wash. It no longer gets nasty after just one day, and the flakes have pretty much disappeared. It still gets a tad itchy, but at least it's not all greasy and gross.
I just find it really annoying that I had to figure this out on my own instead of getting advice from a medically trained provider. If you're also suffering from this condition, I would also advise you watch this video about a new Pantene product that I will consider buying after my other shampoo is gone to see if it also helps. It talks about oxidative stress and an unhealthy scalp that might be the reason the yeast overgrowth happens in the first place. It's always better to treat the issue and not just the symptoms, you know?
Hopefully this helps someone!
