Skin republic

Dear Dr. Jen,

I've had dandruff on my scalp for a couple of years. But lately, I noticed that the scales have spread to my ears and even on my eyebrows. It seems oily and dry at the same time. No matter how much I scrub and exfoliate it, it just keeps coming back. The toner doesn't alleviate the oiliness either. Please help me.

Tom

Dear Tom,

There's a condition called "seborrheic dermatitis". This usually starts out as scales on the scalp and can even affect sebum-rich areas (oily areas) such as the face (eyebrows, around the nose, upper lip), ears, and trunk. It is often misdiagnosed as eczema or psoriasis. It can be itchy and can become very red when irritated.

While the exact cause is not yet fully defined, it is believed to be multifactorial. Genetics and a certain yeast (called Pityrosporum) play a major part. Stress, dry climate, and poor general health are often seen in people who are flaring.

The most common treatment would be to apply some topical corticosteroids (such as desonide or hydrocortisone) on the area. It must be noted that antifungals should be partnered with this regimen. Antifungals are essential to eliminate the Pityrosporum that thrives in seborrheic-rich areas.

Likewise, hair products that contains antifungals like ketoconazole and ciclopiroxolamine are reliable anti-dandruff shampoos. This must be left on the scalp for a couple of minutes before rinsing off.

Seborrheic dermatitis is a chronic condition. It comes and goes. What is important is to be ready to treat it once it flares up so it can be suppressed immediately. Scrubbing and exfoliating will not treat it at all and may just irritate your already inflamed skin. Hope this helps your seborrheic dermatitis.

Dear Dr Jen,

I had my ears pierced two years ago. I noticed that my ears get itchy and get a rash on my ear lobe every time I wear fancy earrings. I get a similar rash around my fingers when I wear fake rings. I decided to wear real gold earrings but they still seem to be itchy. I love using accessories but now I don't know what I can and cannot wear anymore. I would appreciate any advice you can give me.

Chloe

Dear Chloe,

For a person who loves to wear accessories, how unfortunate that you might have nickel-contact dermatitis! Contact dermatitis to nickel is not just limited to jewelry. Belt buckles, keys and coins in pocket, watch straps and mobile phone cases can even be a source of nickel. It is best diagnosed by doing a patch test.

In most gold products, nickel is used to harden the metal. There is usually some amount of nickel mixed to most gold products. If you think about it, a very soft 24k gold earring will not retain its shape unless a hardener such as nickel is added to it. It was previously thought that all gold with 18k and above were devoid of nickel. Recent studies have proven this wrong.

Coping with nickel allergy involves several strategies. The first is to apply some anti-inflammatory cream to the rash area. Second is to make sure all your jewelry are nickel-free. If you cannot be certain of this, there is a nickel guard you can apply a coat of on your jewelry to prevent your skin from touching the nickel. A poor man's alternative will be to coat the jewelry with clear nail polish. There are also plastic backs that you can secure on your earrings instead of the gold ones. Using stainless steel and natural titanium is also a good alternative to gold.

Good luck in dealing with your nickel-contact dermatitis!

If you have any questions or concerns please text 0922 845 5556 or email [email protected].

Dr Tan is a diplomate of Philippine Dermatological Society (PDS). She is affiliated with Perpetual Succour Hospital. For other information on PDS, check http://www.pds.org.ph/.