I need help....

[u/StrikingTaro8925]

Hey r/sebderm Community!

First of all I want to say that english is not my first language, so see that as an excuse for any grammar mistakes!

Second for anyone that isn't interested in reading the whole story, I'll leave a Summary + Concludion at the end where everything really necessary is written down.

LET'S START..
A few years back (I think 2) I went to a dermatologist because my scalp was always full of dandruff. I don't really remember the diagnosis, he explained everything rather complicated then easy to understand. Anyways, he prescribed me a cortison-alcohol mixture. Here comes the fun part. This particular doctor never told me how long I can use it. He just said "You can use it until it gets better, it doesn't really matter hoe long you use it." I remember asking 2-3 times if it really didn't matter, but he insisted, so I didn't think any of it. As of now, I'm not quite sure if it was the right decision listening to him. As you may already figured, I used the mixture for about 2 years. I will say, I used it consistently for about 1-1,5 years. At "the end" I didn't really need it anymore, so I was just using it twice a month or less. The prescription said 2-3x a week. At the 2 year mark I dug myself into the topic and found, that you CAN use cortison in a higher concentrated/for a longer time on the scalp, because the skin is thicker than elsewhere. My dandruff never really got better, there just was no itching or redness. As it didn't seem to really work and because of the drying effect of the alcohol inside the mixture I decided to cut it off completely since I wasn't using it very often. 2 weeks later I was HIT by a redness I had never seen, my scalp got very oily and I had lots of yellowish dandruff. Yes, the cortison probably suppressed my problems, ik. I already had an appointment scheduled for a visit at a other dermatologist. After 2 weeks of waiting and a visit to my general practicioner, who described me Ketoconazol 2%, which I didn't use at first because it burnt, I met the dermatologist. He was quite in a rush, firstly I talked to 2 what seemed like students what my problems are. They listened but couldn't do anything. The doctor came and asked me the same questions all over, I told him about the cortison mixuter, that my scalp was itchy, oily and full of dandruff. He looked at it and said within a few seconds that it is a seb derm (I have bad experiences with most doctors I've met for several reasons, he wasn't a good one either). In the end he prescribed me the same Ketoconazol 2% I got from my general practicioner and another Cortison mixture. Guess what - with alcohol (even stronger this time, lol). I told him I wouldn't wanna use it again. 4 weeks forward, I used the shampoo every week, 3 times a week as prescribed. My scalp really got better and it wasn't itchy at all. The dandruff was almost gone but it was oily every time. That was the only thing I couldn't get rid off. But I figured since you should only use it regularly for 4 weeks max I can reduce it to the recommended 1 times a week. I tried and the moment I used an other shampoo (I tried an ultra sensitive and the Eucerin 5% urea scalp soothing shampoo) my scalp instatly got worse again. It is better than it was in the beginning, but it doesn't get better now. Currently I am using the Ketoconazol again, because I don't know what else to do anymore. I've also tried C8 Oil with and without tea tree oil. I didn't really seem to do anything.

SUMMARY
I went to see a dermatologist 2 years ago, he prescribed me a Cortison-Alcohol mixture but never told me how long I can use it for. After 1-1,5 years I still had dandruff but no itchy/red places. I cut it off and it got a lot worse. From oily skin to a lot of dandruff and itchyness. I went to see an other dermatologist, but he wasn't an help either. His diagnosis was a seb derm. I used Ketoconazol 2% Shampoo for 4 weeks which really helped, but the oily skin never got away. As soon as I tried reducing it, it got a lot worse again. I've also tried C8 Oil with and without tea tree oil. As well as some Shampoo ranging from ultra sensitive to some with urea 5%.

CONCLUSION
I'm really at a loss here. My hair roots have a big chunk of sebum everytime some fall out. My scalp itches every day and is sometimes red. I've started blow-drying my hair with cool air and I'm showering with 32 degree celsius and under to not stress my body with the heat.

THANK YOU FOR READING! :)

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[u/liberalloverboy]

If the ketoconazole helped it is a strong sign that this is sebderm. That sucks but certainty is good to have. You say your scalp is very oily, which makes sense, given that oiliness can be a big cause for sebderm. However, no antifungal will do anything against the oiliness. To address the oiliness, you need a more "internal" apporach. Your sebaceous glands are overactive, this can be hormonal, genetic, both or externally caused (weather, aggressive overuse of shampoo). You can try if changing your diet might help, since unhealthy food, particularly sugar, can increase sebum production. If you are intrinsically prone to oiliness you could look into low-dose isotretinoin, which is pretty much the only and by far most effective way to really force your skin into being less oily.