I'm 59, and have had red skin sores since I was 5. The following write up is based on a lot of research and experience, and I want to share it with you. I'm not selling anything. Since I'm finally getting better, my blood pressure has dropped 10 points and my skin is so much better. Yes, it's a long post but the skin condition is complicated.
Fungal Skin Problems that Appear Crusty, Red and Circular
If you have circular red crusty sores and never ending hive like itching, and other areas on your body where the skin is thick or hard, wet your entire body and wash with an over the counter (OTC) antifungal shampoo, leaving it on for 3 to 5 minutes in the shower before rinsing off. Use a soft bath brush to scrub your soapy skin while the shower is turned off during this 3 to 5 minute period of time. Use a heater to warm your bathroom to 80 degrees so you can tolerate standing around wet for 5 minutes. After rinsing off, air dry your body with a hair dryer, as using a towel will tend to wipe off the medicine remaining from the shampoo. Afterwards, do not apply any oil based lotions -- the fungus causing the circular sores is malessezia, which is lipophilic, which means it metabolizes fats and oils. A non-comedogenic lotion, like Cetaphil, is a non-oily lotion. You may have been diagnosed as having seborrheic dermatitis, atopic dermatitis, tinea versicolor, eczema, or oily dandruff. If you instead have psoriasis, which produces white irregular scaly patches (instead of red circular patches caused by fungus) an antifungal treatment will not be effective.
Three Effective Over the Counter Anti-Fungal Shampoo Treatments for Malassezia
The most effective OTC shampoo is Hegor 150 (Climbazole 1.5%). Hegor 150 is made in France and is available in the US only on EBay and it will be shipped from Europe.
While you are waiting three weeks for your shipment of Hegor 150, you can mail order OTC Nizoral (Ketoconazole 1.0%) shampoo, which is available only online in the US -- after 2011 it has not been sold in brick and mortar drug stores. Nizoral is effective on malassezia, but less so than the Hegor shampoo. Both Climbazole and Ketoconazole work by slowly dissolving fungal cell walls.
Also consider applying Hibiclens (Chlorhexidine Gluconate 4%) just before you apply the antifungal shampoo, as fungi are capable of working with other microbes to create symbiotic biofilms, but be careful to keep the Hibiclens away from your nostrils, eyes, and ears. This is an off label use of Hibiclens.
The third alternative shampoo is Selsun Blue (Selenium Sulphide 1.0%), which is sold by all drug stores. Selsun Blue is a 1970’s compounding of selenium disulfide that activates the body’s natural defenses against Malassezia but does not dissolve the fungal cell walls, which is why Nizoral and Hegor shampoos are recommended. However, the most useful aspect of Selsun Blue is that it is effective only against Malassezia and can thereby provide a quick, easy to purchase diagnosis. Use it for 3 or 4 days, stand in bright sunlight and scratch your scalp. If you see far more white flakes than you ever saw before, you have an abundance of malassezia. Alternatively, after using any of these shampoos daily for 3 to 4 days, if your skin turns red in blotches, you have an accurate diagnosis that malassezia has colonized your skin.
Nevertheless, if your doctor actually took a skin scraping with a razor blade and looked at it under a microscope to accurately diagnose malassezia, as most veterinarians would do, and then prescribed 2.5% selenium sulphide, you might consider other alternatives. Two years ago doctors were not very well informed about malassezia because the fungi were difficult for researchers to categorize and study, and the human body has an abundance of numerous microbiota. Now, with DNA genome sequencing, much medical research has been published and new perspectives on malassezia have become widely distributed. Nizoral 2.0% prescription shampoo would be an acceptable prescription choice for a doctor, but in any event, Hegor’s Climbazole 1.5% costs only $16 for a 150 ml bottle, is OTC and is more effective.
The use and importing of Climbazole shampoo is legal because the FDA and the EU in 2011 licensed up to 2.0% Climbazole in OTC shampoos. However, as of 2012, only Hegor of France manufactures a shampoo with Climbazole. In addition, Climbazole is soluble in isopropanol whereas Ketoconazole is soluble in ethanol, so Hegor’s Climbazole shampoo does not have the slight smell like Nizoral shampoo. A 150 ml bottle of Hegor 150 lasts about 3 weeks in daily use, so order three bottles at a time because of the 3-week shipping delay.
Head and Shoulders and many other OTC antidandruff shampoos contain zinc pyrithione, 1% or 2%, and are effective only on dry dandruff, in other words, where the dandruff is a non-inflammatory condition of the scalp. Zinc pyrithione is thought to improve the bonding and elasticity of the skin, and as a consequence will not treat any part of the red crusty circular inflammation caused by malassezia. Likewise, none of the other antifungals designed to treat jock itch, foot fungus, or toenail fungus will have any effect on malassezia. Corticosteroid lotions in theory will reduce itching, but because they always contain oils, the lotion will feed the malassezia and make the problem worse.
Alternatives Taken Internally
Ketoconazole 200mg tablets are considered effective against malessezia and are available by prescription for internal use, but impairment of liver function is a known risk. In addition, you will probably be advised to ingest 400mg of Ketoconazole along with Coca Cola, and then exercise and sweat for an hour, and afterwards to not shower for 3 hours, so that the Ketoconazole can be delivered to your skin, which is not practical for a chronic, recurring immunodeficiency condition. There is no cure, only treatment. However, if you are already immune compromised then of course you should follow your physician’s advice. Fluconazole is less harmful antifungal than Ketoconazole, but it is completely ineffective against malassezia and should never be prescribed for it. Climbazole should never be taken internally, although it is safe for topical use.
All the treatments described here are also useful for dry dandruff, but dry dandruff is merely an annoyance. The same fungus that causes dry dandruff also causes the irritating dermatitis that is seen as itchy red crusted patches all over one’s body, but the inflammation must be treated, because the inflammatory skin reaction also causes a histamine response that is harmful to healthy functioning of the adrenal glands if left untreated over the course of a lifetime.
At first, some parts of your skin may appear to turn a red, purple or magenta, which results from your body recognizing that there are fungal foreigners, to which the body’s first healing reaction will be inflammation, which is normal.
During the course of this treatment your skin will begin to flake off in small white flakes. You may ultimately flake off a large portion of the superficial outer layer of your skin, because the fungal plaque or biofilm is composed mostly of your own skin. Some of the circular sores may boil up again and slightly bleed out as your body reacts to the fungus. The skin that rubs off may be white or surprisingly brown, dark grey or even black, apparently from years of environmental dust being incorporated into a biofilm on the skin.
If you have a fever for no apparent reason, it may be a Herxheimer Reaction to the byproducts of the fungus dying off in large numbers. Do not scratch the sores – gently rub off the dead skin. All of the foregoing however should occur with progressively less itchiness. The daily treatment may take weeks or months depending on the level of involvement between the fungus and your skin, which varies from person to person. When your skin has softened and the flaking stops, you can change over to once a week shampoo treatments.
An Effective Antifungal Lotion can be Purchased
It is legal to buy and import Nizoral (Ketoconazole 2%) cream from India without a prescription, for your own use only, at a price of $14 for a 20ml tube, when purchasing six tubes at a time, for a total cost of $84 for 120 ml of cream. Based on the price for a tiny tube this is not a viable treatment, because the tubes are tiny, and no one has a small inflammatory response to malassezia – it’s either a large problem or practically nothing. If your doctor prescribes Nizoral 2% cream, consider buying Taro 2%, a cheaper generic alternative available with a prescription from most US online pharmacies.
An OTC veterinary Climbazole based shampoo was available in 2011, but it appears the manufacturer, Duoxo, recently changed the formulation in the US and deleted the Climbazole component. As a result there aren’t any Climbazole based shampoos currently sold in the US. Climbazole based lotions are not sold anywhere in the world, although in 2011 the FDA and the EU authorized up to 1% in OTC lotions.
Compounding an Antifungal Lotion
You cannot legally buy Climbazole powder without a HazMat Certificate. However you can legally buy and import Ketoconazole powder, only for your personal use, and compound a lotion similar to Nizoral 2% or Taro 2% cream, using a 98% Ketoconazole powder (cosmetic grade) purchased from China at a price of $120.00 for 25 grams.
Home compounding of a final product of 7 ounces of Ketoconazole 2% lotion requires a digital scale accurate to at least 1/10th of a gram, and 1 ounce of 200 proof ethanol (100% wood alcohol) purchased from a chemical supply store, mixed with a 3.6 grams of Ketoconazole powder and warmed slightly in a water bath to about 10 degrees below its boiling point of 173 degrees Fahrenheit, in a sealed jar for one to two hours to dissolve the powder, and then mix the dissolved Ketoconazole into 182 grams of Cetaphil lotion in the original lotion container.
In this example, purchase an 8 ounce bottle of Cetaphil, pour off 44 grams of the lotion to make space, to use 182 grams of pure Cetaphil lotion. The “sealed jar,” used in dissolving the Ketoconazole powder in ethanol, is clear glass, has a plastic stopper with a red rubber seal, and uses a bail type wire closing system, which can be purchased in an upscale food store that sells luxury pancake syrups. A meat thermometer, to check the temperature of the water bath, can be purchased at any grocery store.
Using the Compounded Lotion
Shake the compounded lotion well each time before using, as separates slightly. Do not use the compounded lotion on your lips as severe chapping will result from the ethanol used to dissolve the Ketoconazole. The commercially available Nizoral 2% lotion can be used on your lips and apparently uses food grade ethyl glycol or a distillation process to make a less volatile form of the lotion than is possible at home. When the skin on your lips is pealing off, use the commercial Nizoral lotion on your lips and drink through a straw. The compounded lotion has a slight ethanol smell not present in the commercial preparations. As you can’t determine exactly where the fungus previously created a plaque or biofilm until it boils up again, this lotion is applied over the entire body and 7 ounces lasts only two weeks in regular use, so begin treatment with the Hegor shampoo, and proceed to use the compounded lotion only if you are still experiencing red circular skin crusts after two months of using the recommended shampoo.
It is legal to buy thirty 200 milligram Ketoconazole Nizoral tablets from India for $65, again, for personal use only. Thirty of these pills yield 5.0 grams of pharmaceutical grade Ketoconazole. However the tablets are rock hard and it takes an hour to pulverize 18 of these tablets into 3.6 grams of Ketoconazole powder, and the tablets include an additional 40% binder by weight that does not dissolve in ethanol. Based on the price and the problem with the binder, pharmaceutical tablets are not recommended for compounding a lotion. As discussed above, Ketoconazole has liver toxicity when taken internally and is not recommended for a chronic topical infection of the skin.
Homeopathic and any natural treatments that include any kind of oil will feed the malassezia because this fungus metabolizes fats or oils. Physicians in China have not been able to find any means of treatment under Traditional Chinese Medicine even though Chinese researchers have tried to find such a cure, as TCM is respected by many physicians and researchers educated in China. Acupuncture focusing on the kidneys, which include the adrenal glands, may be effective in reducing the itchiness.
Also consider that shaving gels contain oils and lanolin, which is like throwing gasoline on a fire if you are already suffering from malassezia skin reactions. Malassezia is an unusual fungus, in that is lipophilic, which should be kept in mind when evaluating any treatment program. For example, shave before you shower. Likewise, all soaps and body washes contain oils so showering should include Hibiclens, which reduces the biofilm substrate in which the malasezzia thrive.
Malassezia in Nature
Malassezia is the only member of the Mycota kingdom that is able to metabolize oils. All malassezia that colonize people are also lipid dependent, and as such, it will not grow in culture media unless oil is added. Malassezia’s dimorphic nature, existing as both yeast cells (budding cells) and a larger hyphae form, can be seen by putting a skin scraping on a properly stained slide under a microscope at 100x as “spaghetti and meatballs.” Malssezia is also photo sensitive. Tinea versicolor is an example of the hyphae phase protecting itself from sun damage, and so called “reverse freckles” are examples of the yeast phase protecting itself from sun damage.
Malassezia prefer parts of the skin that are rich in secreted oils, such as the scalp, chest, and back. Malassezia is normally present on everyone’s skin. The reaction that some people have to malassezia is not completely understood by medical science, but it is thought to be an immunodeficiency as the fungus co-opts some of the host’s immune reactions so that the host’s skin does not recognize the fungus as an invader until the fungus has created a plaque or a biofilm, in which the fungus grows with less threat of being detected by the body. Malassezia is thought to interfere with the body’s immune system by modifying IL-6 and IL-8, in order to trick the body from recognizing the fungus as a foreign object, an aspect of medical research that holds promise for the future.
All mammals – dogs, cats, rhinoceroses, and even sea lions to name a few of the documented cases over the last hundred years -- can potentially suffer from an inflammatory skin reaction to malassezia. However, just like people, most of the individual members of any particular mammal species do not suffer an inflammatory skin reaction to malassezia, so the problem of skin flare ups continues to puzzle researchers. That other mammals likewise react to malassezia tends to refute beliefs that modern environmental toxins are at fault for the inflammatory reaction that some humans experience. The condition is probably genetic. My father and grandfather had the same skin problems as I do, but my siblings do not. If you are reading this and are related to me, please tell me more about yourself. My great great grandfather with the same name as me, Tom Busby, emigrated to the US from Stowe Longa in what was known as Huntingdonshire in 1855 with his wife, neé Mary Knight. Finally, the condition is infectious to the host but not contagious to other humans or mammals, except for premature babies, and persons with HIV/AIDS, using catheters, on dialysis, or with suppressed immune systems.