Why should I Cleanse and Moisturize my dry, oily, flaky SD skin?


I came across this thread in the archives and thought it was worth highlighting it and pushing it out again.

The question asked is a good one – how can cleansing and moisturizing the dry flaky and oily SD skin be a good thing? If you have ever wondered why this is so, read on.

It was interesting to read again how for severely sensitive skin, repairing the skin barrier function is an important step.

Another related thread, also from Dr. Sy is also worth reading: Moisturizer and sensitive skin barrier

Moisturizer Oil and Seborhheic Dermatitis

From: "M. Riley" 
To: Rosacea Support
Sent: Wednesday, December 27, 2000 6:34 PM
Subject: Dr. Sy or Anyone, Pls Help: Seb Derm Questions

I recently developed these pink, dry, raised, crusty patches of skin under my eyes. By the time I was able to see the dermatologist, though, the patches cleared up.

When I described them to the dermatologist, he immediately suspected seborrheic dermatitis, as he said they typically show up around the eyes, nose and ears.

He wanted to give me cortisone for it, but having suffered from the consequences of long term cortisone use, I refuse to use the stuff. He made it seem like there was no other treatment besides cortisone.

I have read on this site that some folks here are using Nizoral or Noritate. I can’t use Noritate because it irritates my skin.

  1. As for Nizoral, can it safely be used around the eyes?
  2. Also, would antibiotics help at all? I’ve been trying to wean off doxycycline over the last month, and 3 weeks ago these dry patches appeared. Is there a correlation?
  3. I also understand using heavy moisturizer on seb derm also makes it worse, but I’ve been using Vita Oil and it seems to help. Is this okay?
  4. Would photoderm help with seb derm at all?


From: Linda Sy MD
Date: Thu, 28 Dec 2000 22:23:38

Hello M. Riley,

Of course, you realize that I can’t give you an accurate diagnosis but my guess is that the dry crusty patches under your eyes could be one of the following:

  1. Seborrheic dermatitis;
  2. Rosacea patch; or
  3. Asteatotic eczema (fancy name for severe dry winter skin).

My suggestion is for you to slow down on weaning yourself from doxycycline for now. Go back to the last dose you were on 3 weeks ago, before the appearance of the patches.

Go ahead and apply the Vita-Oil 2-3 times a day on a damp face.

One helpful way of pushing the moisture into the skin is to do this: at bedtime, apply water compress (clean soft moist towel, comfortable temp) on the areas involved; leave for 5 minutes. This softens the skin and makes it more permeable. Then apply the oil immediately.

Do this for one week and see if there is improvement. If there is, I would continue until there is clearance.

Do not add any other topical med. If no improvement, you can ask your dermatologist for a prescription of Nizoral Cream (different from shampoo) and apply at bedtime over the Vita-Oil.

Is it harmful to moisturize if this is seborrheic dermatitis?

The answer is NO.

It is true that in seborrheic dermatitis, the theory is that the sebaceous glands are hyperactive, secreting an abundance of sebum that is thicker than normal. This sebum accumulates and dries on the skin leaving dry flakes akin to dry skin but with a greasy somewhat rancid smell. The typical picture shows dry flakes predisposed in areas such as the eyebrows, T zone (mid-forehead, nose & chin) and ears.

Microorganisms, particularly yeasts such as p. ovale and some bacteria conglomerate and thrive in this milieu causing inflammation – hence erythema (redness), more flaking & even crusting. The individual thinks his/her skin is very dry and avoids washing which ironically, is a must in this early stage.

So, with inadequate washing, the condition worsens, becomes eczematous (with redness, itching, bumps, small vesicles) causing the skin to become angry-looking and sore. At this point, washing will cause burning and pain. Skin is raw, permeable and easily irritated. So, the vicious cycle continues.

When this condition approaches this late stage, there are several ways to handle this:

  1. Soften the thick greasy sebum/crusts etc. by wet compresses.
  2. Repair the epidermal barrier by lubricating it with anhydrous moisturizer that has low preservatives (like oil, vaseline and like ointments).
  3. Combat the microorganisms with antifungal creams once skin barrier is somewhat restored and can tolerate the topical med. In some cases, oral antibiotics may be needed if secondary bacteria is present.
  4. In severe cases, a short course of topical cortisone ointment to calm down the inflammation speedily. Bear in mind that this last measure should be used no more than 1 week at most.

Once skin is improved, steps 1, 2 & 3 should be maintained PLUS an adequate cleansing program instituted. All these require time for skin to heal. Unless one understands the mechanism of SD, slow progress or a little set-back with appearance of more bumps (sometimes happens) becomes discouraging and one gives up.

Will photoderm help Seborrheic dermatitis?

My suspicion is that it probably does inhibit sebum activity.

Linda Sy M.D.

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About the Author: David Pascoe started the Rosacea Support Group in October 1998. .

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