POZ Community Forums
Meds, Mind, Body & Benefits => Questions About Treatment & Side Effects => Topic started by: CaveyUK on April 01, 2016, 10:59:49 am
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Ok so for a few years (assume it ties in with my HIV but may have started beforehand) I have had a bit of seb derm and a fair bit of dandruff, on and off.
I've always treated my hair/scalp with Nizoral shampoo (Ketoconazole), and my face with standard OTC atheletes foot cream (clotrimazole or ketoconazole) with a couple of days when anything gets red or tender with some OTC hydrocortisone.
Last year, pre-diagnosis, it was getting quite bad with stubborn flaky bits between eyebrows and down the side of nose, and sometimes under my beard area.
Since diagnosis, when starting meds and also when having various antibiotic courses for other STI's, it seemed to clear up and become super-manageable, ie. when it showed up a bit of cream seemed to calm it down.
My problem is in the last few weeks, it has come back quite aggressively. I seem to have perpetual rough, red skin between my eyebrows - often flaking, same down sides of nose and I trimmed my beard to see a ton of redness and flakes there. In addition, I've had phenomenally itchy scalp which - as I am fairly bald on top (and seems to have become thinner up there since diagnosis), I can now see flakes visually. To cap it all off, I have a small lymph node swell up painfuly behind my ear, which from past experience can sometimes co-incide with an outbreak.
The creams sort-of work (my doc gave me a combined steroid/fungal cream a month ago, but it's pretty much the same as I applied separately anyway)
Would the worsening of this condition indicate any worsening of my CD4s? (I'm going for my 3 month bloods in a few days)
The only things I can think that have changed in recent weeks are :
- I have not been having strong antibiotic treatment (other than daily septrin)
- I have been eating an unusually large amount of sugary foods (easter and all that)
- Lots of people I know are sick with colds/flu apart from me
Basically, is this something I should worry about unduly? I was rather hoping the HIV meds had made this easier to handle, but that seems to have stopped...
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Hello caveyuk,
I am also on Bactrim (Septrin) and although I do not have exactly the skin issues you describe, i do get itchy from time to time on my scalp, forearms, ears, legs....no rash or redness, just itches a bit and goes away. My doc says it could be the antibiotics namely the Bactrim but in the absence of a rash or visible skin changes, I don't worry too much about it but it can be annoying. Let me know what your doc says because I am really curious about Bactrim/Septrin and if that is the culprit.
I hope you skin issues resolve as I am dealing with HPV warts right now.....not fun.
John
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That sounds a little like Psoriasis ?
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That sounds a little like Psoriasis ?
Hi Wade. I'm pretty sure it is Seb Derm not Psoriasis. It affects principally the T-zone on the face, and scalp and manifests as red pimply rash, with white/yellow flaking. At my last clinic visit, my doc commented that I have some 'seb derm' on my face and gave me some cream. Oddly, I didn't think I had any visible at the time, but since then it has gone a bit crazy
Let me know what your doc says because I am really curious about Bactrim/Septrin and if that is the culprit.
I hope you skin issues resolve as I am dealing with HPV warts right now.....not fun.
Hi Jon - I don't *think* septrin is causing the seb derm (as I've had it on and off for years) but I do wonder about the itching. One thing that always made my skin MUCH better is sunlight. I don't tan and tend to burn, but exposing my face to the sun when on holiday or in the summer usually results in it being completely clear for some time. I really hope I can get off the septrin before the summer, for that reason as I have read that the antibiotic can make you super UV sensitive and burn easily which wouldn't be good!
As for warts.... I have had some annoying warts on my face for about a year (2 or 3). Thankfully under my beard so not that visible. All started with one, which I didn't think was a wart so picked it and it bled, spreading elsewhere of course! It's another thing that I hope goes away in time with meds, but in the meantime I have to trim my beard short and periodically treat them with an acid treatment. I know everyone says not to use it on the face, but it does get rid of them - at least for a couple of months. The advantage the facial warts seem to have is they are fragile. One application is often enough for them to drop off the next day, perhaps two.
To be honest, if the warts would eventually go for good, I'd be happy enough to clean-shave, which would render the seb derm problem in that area null and void. But of course, shaving the area is likely to spread them further :(
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caveyuk,
I am with you on the skin issues! Glad to know I am not the only one dealing with "warts" on the face. Mine are at the corners of my mouth that started when I had oral thrush last summer (one of the first signs that something was seriously wrong besides my weight loss). The thrush disappeared quickly after I took Difulcan and has not returned but the corners of my mouth were cracked and then two pimple like things developed there. Dermatologists shaved them off and biopsied them which revealed it was viral warts (HPV). Since the shave biopsy, they have come back but not as large and barely visible to the naked eye but they are there. I go every 3 weeks for "freezing" with liquid nitrogen....the warts dry up and fall off but come back....very small and hardly noticeable but I just want them gone. No way of knowing when that will happen as my dermatologist explained that HIV neg get warts too and they can be difficult to clear....not what I wanted to hear. So back to her office in a few weeks for another liquid nitrogen application.
As for shaving, I too wonder about that because I have one pimple like thing on my left lower cheek that my dermatologist says is molluscum contagium. My HIV doc looked at it too and didn't think it was because it is only one and he said usually it is in clusters. Again this pimple like thing is not very noticeable because it is flesh-colored and barely raised but I notice it! So, I was advised to not shave or be very careful of shaving around it.
I hope the both of us that our skin issues be resolved quickly. I never had these things before and can only assume it is HIV related. I thought maybe it was IRIS but my HIV doc said no probably not since my CD4 count are creeping up very slowly and usually IRIS happens when there is a dramatic and quick uprise in CD4....has your doc every said anything about IRIS to you? Just wondering.
As for Bactrim/Spetrin, I asked when I can stop taking it and was told not until my CD4 was stable at 200 for about six months......so looks like I could be on this antibiotic a long time.
Hang in there!
John
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I think even in HIV- individuals, warts (which are common) can take over a year for the immune system to fully resolve on its own, so I wouldn't expect any quick turnaround for us, I'm afraid.
Interesting about the molluscum. I have one or two individual dome-shaped pimple type things on my face, which are not hugely noticable but seem to have sprung up in the last year. They don't itch or hurt in any way and are on my cheek mainly. As they are not in a 'shave zone' they don't get sliced, but I never dreamt they could be molluscum. Perhaps they are.
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Yes, that is exactly what is on my lower left cheek......a dome shaped pimple like thing that does not itch or hurt.....Dermatologist said it was mollusucm but it is that one and it has not gone away. I haven't tried any treatment yet on it but we will discuss at my next derma appt. I just hope it doesn't spread elsewhere on my face. They are not really noticeable from a certain angle because of the flesh color but it just bugs me to have it there. I guess like evertyhing else with HIV I need to be patient.
John
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If you are anything like me, you are choosy about what mirrors you look in when certain lighting is in use. Some mirrors seem to exaggerate things like that :)
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HA HA HA yes, I am constantly looking in the mirror to see these tiny mouth warts and molluscum....most people tell me they don't see what Iam taking about but if you look carefully you can see them. I guess to us they are magnified 1000x.
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I have seb. dermatitis as well. Mostly in the eyebrow area, but also on the sides of the nose and behind the ears when it's worse.
No doubt when your CD4's are tanked it can get much worse with skin flaking off your entire face, but there is no reason to assume a CD4 drop just due to a flare up.
I use Rx Desonide Cream 0.05% a couple of times a day and it clears it right up without the side effects you're seeing from putting that other stuff on your face.
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I have seb. dermatitis as well. Mostly in the eyebrow area, but also on the sides of the nose and behind the ears when it's worse.
No doubt when your CD4's are tanked it can get much worse with skin flaking off your entire face, but there is no reason to assume a CD4 drop just due to a flare up.
I use Rx Desonide Cream 0.05% a couple of times a day and it clears it right up without the side effects you're seeing from putting that other stuff on your face.
Just looked that up, and it's a corticosteroid cream, like the one I'm using.
The only other thing I'm putting on my face is an anti-fungal, which I don't think has any obvious side-effects (it's one of the 'azole' antifungals, which are also used in the medicated shampoo), unless the side effects are making it worse - which I don't *think* is happening :)
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Oh, just remembered something else that happened just before my spate of recent flare-ups... I had the first jab (of 3) of the Hep B Vaccine.....
Am sure that wouldn't interact with topical steroids/fungal medication, as the Doc gave me those on the same day I had the jab...but just throwing that out there...
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You may also try neutrogena t/gel extra strength, it has different active ingredients for seb derm. (http://www.neutrogena.com/category/hair/t-gel-.do). I've used that before when things were bad, seemed to work pretty well.
Otherwise, I guess it's luck of draw on the side effects. No idea if an oral anti fungal would help if it's the fungal cream causing the issues.
I've seen no reasoning behind when mine will flare up, my numbers have been stable for years.
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Went to the clinic for standard CD4/VL bloods to be drawn, as well as my second Hep-B vaccine shot.
Brought up my skin issues, including the seb derm, a couple of red 'bumps' that appeared the other night at the side of my forehead, and some bumps under my hair which I had scratched and infected (causing a lymph node behind my ear to swell). The nurse specialist didn't feel they were anything to worry about but did say there is a possibility of mild IRIS being behind them as my immune system recovers.
Did ask her about the spot on my cheek. She said it wasn't molluscum but was a 'regular fluid filled spot'.
All she said was to monitor and if it got significantly worse to not hesitate to call them and they will sort me out with a doc's appointment.
Just hope all the above doesn't mean my CD4 is nosediving or anything. Will find out next week...
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Hey cave yuk,
Glad you are getting some possible answers for the skin issues. I wondered too if you had some IRIS going on. I asked my HIV Doc the same thing last month and he didn't seem to think I had IRIS as my CD4 wasn't rising that fast but is always a possibility like a mild case your nurse had mentioned.
Glad to hear you do not have molluscum. I decided to try a different dermatologist for my possible mollusucm spot. I am hoping it is just a fluid filled sac too. My HIV doc didn't want to say my original dermatologist was wrong, but he seemed not convinced I had molluscum contagium as it is only one spot.....but he is not a dermatologist so I will go with another dermatologist and take care of it either way.
Thanks for updating.....some comfort in knowing others experience skin issues with HIV. I've never had these skin problems before so I can only assume it is from HIV.
John
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Well my nurse isn't a dermatologist either, but I figure being an HIV specialist she will have seen enough molluscum to have a good idea ;)
To be honest, I'm more worried about a couple of bumps that have appeared at the side of my forehead. They are a bit red (prob inflammation only), don't hurt or itch and sprung up within a couple of hours of using a new shampoo the other evening. The nurse said they look more like insect bites, but they don't have a 'head' (that I can see). I was rather hoping they would have disappeared by now but they are still there.
The money is still on the shampoo I guess, but I'd still rather they disappear as they are cosmetically concerning.
All I want to have is a day now where I'm not itching like mad or worrying about some stupid facial skin complaints!
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Eeek...took a photo of the lumps and I think I can see a head/puncture there...
Not trying to diagnose across the internet, and if it still looks like this I will call the doctor tomorrow, but does this look like a bite? Or is there something else that could manifest in this way (quickly arrived, feels hard and like a lump, no itching or pain)
(http://i63.tinypic.com/apgsnl.jpg)
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If you ask me, go see the GP already, I hate to tell you this but it looks sore whatever it is.
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If you ask me, go see the GP already, I hate to tell you this but it looks sore whatever it is.
Thats the weird thing. It isn't sore, or itchy.
And I will try and call the clinic in the morning if it's not better. GP is a last resort as I haven't disclosed to them yet (and don't want to at the moment)
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What do you mean by "I haven't disclosed to them yet"....do you mean you have not told your GP that you are HIV+?
I think it would be wise to tell all your health providers. My GP definitely knows as she works with my HIV doc, but I also told my dentist, dermatologist, opthamologsit, and other health care provider I may come in contact with in the future. I just think it makes sense to let them all know about your status as it could have an impact on how they treat you and medications they may prescribe.
Let us know what the GP says about the skin.
Hang in there,
John
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What do you mean by "I haven't disclosed to them yet"....do you mean you have not told your GP that you are HIV+?
I think it would be wise to tell all your health providers. My GP definitely knows as she works with my HIV doc, but I also told my dentist, dermatologist, opthamologsit, and other health care provider I may come in contact with in the future. I just think it makes sense to let them all know about your status as it could have an impact on how they treat you and medications they may prescribe.
Let us know what the GP says about the skin.
Hang in there,
John
It may make sense, but I have reasons for not disclosing, which may change over time.
Long story short, I live in a small town where I don't fully trust their discretion. I have a pool of GP's I get to see (rather than a specific one) so I have no relationship built up with anyone there. It's the admin staff I don't trust rather than the doctors.
In the short term I can check contraindications for prescriptions by using the same website they use to check.
Same with the dentist.
I may change that stance but for now I'd rather keep it that way. The HIV clinic records are not directly linked into the NHS records, and for now I would prefer to keep my status off my main medical record, if I can help it!
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I don't want to be alarmist it's just better safe than sorry. I mean whatever it is, if it gets infected it could cause a world of problems, than again it might be nothing at all.
Jim
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I don't want to be alarmist it's just better safe than sorry. I mean whatever it is, if it gets infected it could cause a world of problems, than again it might be nothing at all.
Jim
I'm in total agreement Jim. As well as being cosmetically horrible, I don't need any crazy complications.
Discussed it with my gf who was on the sofa with me Sunday afternoon. I was moaning about seb derm so she was looking specifically at my face, and she confirms that at that time there was nothing there at all. So it has come 'up' rather quickly.
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just in case anyone is on tenterhooks waiting for an update....
I lathered antihistamine and steroid cream on them last night, and this morning they were still there, but a little smaller and less red. Will just keep an eye on them now in case they flare up again but hopefully they are on their way out.
What un-nerves me more is what the hell bit me, in a cold UK April....
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Hi Cavey,i understand this is an old thread but it perfectly mirrors what i`m experiencing now and so would love to know what your results were at this time ?
I have that flaky skin T`d across my brows and down my nose..also my ear lobes and cheeks..and a kinda lesion like thing on my neck just down from my jaw.Of course my fear is that resistance has occurred and my cd4`s are plummeting.I feel well other than my face feeling a little hot and am just using an after shave balm to cool things down and smooth over the embarrassing flakes.
Many thanks,P.
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Hi Cavey,i understand this is an old thread but it perfectly mirrors what i`m experiencing now and so would love to know what your results were at this time ?
I have that flaky skin T`d across my brows and down my nose..also my ear lobes and cheeks..and a kinda lesion like thing on my neck just down from my jaw.Of course my fear is that resistance has occurred and my cd4`s are plummeting.I feel well other than my face feeling a little hot and am just using an after shave balm to cool things down and smooth over the embarrassing flakes.
Many thanks,P.
All I can say is that when I had the flare up mentioned in this thread, there didn't seem to be any resistance or CD4 nosedive. Everything seemed fine in that regard, so probably just one of those things that can be worse at times than others. Especially during months of cold weather.
I would recommend not putting loads of balm's and stuff on your face. In my experience it tends to make things worse as your skin when experiencing a flare is super sensitive. I've found that Clotimazole, which you can find in athletes foot ointment in the supermarket works well to quell a lot of the problem, and some occasional use of 1% hydrocortisone can calm down the redness quickly (although sometimes takes a day to do so, and can be a bit redder whilst it's happening). Other than that, just occasional water rinses are fine.
By way of an update from my perspective... In October, all my facial warts which were under my beard area disappeared literally overnight. It's like a switch went and they spontaneously resolved. I can only put that down to my climbing CD4. I *still* have the seb derm problem though, but now the warts have disappeared I have shaved my beard off (when it wasn't flaring of course!) and hopefully that will restrict the problem to my scalp, between eyebrows and side of nose. I can manage the scalp through frequent medicated shampoo'ing, whilst my eyebrows/nose can use the cream I mentioned quite easily to keep on top of things, so touch wood - I will have fewer issues going forward.
Looking forward to the summer where I can try and get some sun on my face which always makes things better too.
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Cavey that is just your horns growing out.
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Cavey that is just your horns growing out.
It is the tail growing that I'm more concerned with ;)
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Try a three headed penis..growing out your forehead. :o
Thanks for your reply as always Cavey.Things improving here although lesion like thing on my neck still there.I have an appointment on feb 1st for another round of bloods so will know more then.
Yes some sunshine on our little Hiv faces would be good for all.Wishing you peaches and cream skin for the spring :)