Q. I have acne and seborrheic dermatitis on the face and steroid cream did not help. Why?

Answered by
Dr. Dhepe Snehal Laul
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Sep 17, 2020 and last reviewed on: May 06, 2022

Hello doctor,

I have acne and seborrheic dermatitis on the face. Proactiv 3 step system has been used for a very long time which controls the acne. However, about 18 months ago, I started getting a red bumpy rash around the areas next to my nose and under my eyes. I then went to a dermatologist. He said I had seborrheic dermatitis and gave me a steroid cream. This cream did not help and instead blocked my pores and brought back acne. It is extremely frustrating trying to deal with both. Currently, I am using Proactiv and trying to avoid the areas that develop a rash, and the only thing I have had success with controlling the rash is zinc oxide, but I would rather find a system I can just put on my whole face as it is exhausting doing it the way I am doing it and I feel this system is not sustainable.



Welcome to

Do you have severe dandruff or seborrheic dermatitis, intense itching? Any history of photodermatitis? Prolong sun exposure, heat rash, etc.? Acne Rosacea? Aggravation factor for the same? Do you have dry, flaky facial skin or extremely dry skin? Do you have greasy scales on an erythematous base? Any allergic reaction to cosmetic products? History of atopy or allergies? Dandruff issue in the scalp?

Answer these questions for the confirmation of diagnosis.

Thank you doctor,

No dandruff and no itching. No history of photodermatitis. It is not a heat rash as it began and continued in the cooler months. I have had lots of sun exposure as I am a surfer but I do not believe this is relevant to the issue. The dermatologist I seen ruled out acne rosacea. When the rash began first it was very greasy and flaky at times then became very red and bumpy. No dandruff issues on scalp.

I do not generally have any allergies. As mentioned, I have used Proactiv my whole life without any issues other than a bit of dryness. One day this rash just popped up and got worse and worse. I attributed it to the Proactiv and stopped putting it in the area. However, this did not really fix it because as soon as I do not put zinc oxide on it the rash returns.



Welcome back to

Mild steroid cream would be useful. You can apply 0.5 percent or 1 percent Hydrocortisone cream in a very small quantity mixed with Ketoconazole cream (KZ cream) for 10 days and then switch to plain Ketoconazole cream for the next 10 days (at daytime). Apply Pacroma 1 percent ointment in the night over affected area for 10 days.

Sunscreen is very important to decrease redness. Use photostable sunscreen on the whole face (at 8 AM, 12 PM, and 3 PM) daily for 20 days.

For dry skin, Cetaphil moisturizer can be used two to three times a day. Use mild soap like Dove or Cetaphil and Ketoscalp shampoo twice weekly for four weeks (to prevent flare).

Take tablet Loratidine 10 mg twice daily for seven days (for allergic rash due to cosmetic product). Use Cetaphil cleanser to wash your face twice daily for 15 days (when dry skin use Cetaphil cleanser to wash face) or Ahaglow face wash (if oily acne-prone skin).

Avoid sun exposure, harsh soaps, and perfumes. Other differential is photodermatitis (as a history of prolonged sun exposure). Avoid hot water shower and rubbing of skin.

Use Zinc tablet once daily for one month. Eat diet rich in antioxidants.

Previous treatment details? Which steroid cream was used which cause aggravation?

Next differential can be rosacea. Any burning sensation when exposed to sunlight? Do you consume spicy food, alcohol, coffee, hot beverages, etc.?

In seborrheic dermatitis, there are greasy scales on erythematous base and associated with dandruff issues mostly. So it is necessary to rule out the causes.

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