Flaking skin - what is the cause?

Patient

Q: I live in san diego and wake up every morning with excessively dry peeling skin especially above my eyebrows on the sides of my nose. this does not happen when I travel to brazil and new york city. sometimes it gets so bad that I had huge red blotches on my face. I have tried hydrocortisone but it only has helped a little. what causes this and why does it only happen when I am in san diego?

Doctor

A:   You are most probably suffering from seborrheic dermatitis. This is a common skin disorder that mainly affects your scalp, causing scaly, itchy, red skin and stubborn dandruff. Seborrheic dermatitis is thought to be due to a combination of an over production of skin oil and irritation from a yeast called malessizia.
Commonly affected areas include the scalp, eyebrows, eyelids, creases of the nose, lips, behind the ears, in the outer ear, and middle of the chest. It can be uncomfortable and cause embarrassment when it develops on visible parts of your body.
There is no definitive treatment for seborrheic dermatitis. the mainstay of treatments are :
i) Anti fungal creams, lotions and shampoos like ketoconazole, ciclopirox and terbinafine.
ii) Corticosteroids : hydrocortisone 1% cream, desonide and betamethasone.
iii) Calcineurin inhibitors lower the activity of your immune system and decrease the flare up of the disease.
Seborrheic dermatitis is a chronic (life-long) condition that can be controlled with treatment. It is important that you pay attention to skin care.

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