Do you know if the ‘dry skin’ in the middle of your face is really just dry skin?  Has your scalp started to itch a little too? If so, you may have seborrheic dermatitis. 

In my dermatology practice I see a lot of patients whose seborrheic dermatitis really acts up as the weather turns cold. The good news is that with some over the counter products, you can control your seborrhea and keep your skin and scalp healthy and attractive instead of red and scaly.

Seborrheic dermatitis is a frustrating, confusing and at times embarrassing rash that’s really common.  Most people don’t know they have it until they see a doctor.  Patients commonly misinterpreted the redness and scale of seborrhea as dry skin. They layer on the moisturizers, which of course don’t fix the problem because seborrhea is a rash, not dry skin.

Seborrheic dermatitis is so common that almost everyone will have it at some point in their life. You’ve undoubtedly seen it on yourself or someone you know, it’s:

•    Cradle cap in babies
•    Red, greasy, scaly skin in the nose cease or between the eyebrows in teens
•    ‘Dry’ and itchy scalp starting in the teen years  and going on throughout life
•    ‘Dry’, red, scaly skin in the T-zone of the face at any time in life
•    Red, crusty skin on and behind the ears
•    Flaking of the eyebrows
•    Crusty scale and itching of the eyelashes (blepharitis), especially in the morning when you wake from sleep
•    Greasy, red scaly skin on the chest and upper back

Seborrheic dermatitis may or may not be accompanied by tender, itchy pimples on the scalp, around the hair line and on the neck, chest and upper back.

If you are prone to seborrheic dermatitis then you’ll always have a tendency for this annoying rash.  We don’t know what causes seborrheic dermatitis and we don’t know how to cure it. Treatment is aimed at controlling the problem, and extending the time between flair ups.  The good news is that with medicated products, and good skin and scalp care, you can have clear, healthy skin by controlling your seborrhea.

Seborrheic dermatitis is one of the most common skin problems I find during a skin exam.  I’ve found  many great treatments for seborrheic dermatitis using over the counter products. In my next series of blog posts, I’m going to outline my favorite remedies for seborrheic dermatitis and recommend products.  This is the information I give my patients in the office.

My Seborrheic Dermatitis Series:

Remedies for the Dry Itchy Scalp of Seborrheic Dermatitis

Remedies for the Dry Itchy Scalp of Seborrheic Dermatitis-Part 2

Remedies for Really Stubborn Scalp Seborrheic Dermatitis

Itchy Crusty Scaly Ears; More on Seborrheic Dermatitis

Dermatologist’s Tips for Treating Facial Seborrheic Dermatitis: It Looks Like Dry Skin, But It’s a Rash!

Dr. Cynthia Bailey’s Tips for Facial Seborrheic Dermatitis Control

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Chapped Lips: The Remedy Depends on the Cause

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Dermatologist’s Simple Tips for Athlete’s Foot Fungus Treatment

Brilliant Skin Care For The New Decade

Essential Winter Skin Care; 2 simple tricks to healthy winter skin

Making Sense Of The Vitamin D Dilemma And Sun Exposure

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Dermatologist Dr. Cynthia Bailey’s Recommendations for Brewing Kefir:

Home brewed kefir milk is a probiotic powerhouse and my first choice for probiotic therapy. Kefir contains a broader range of beneficial probiotic organisms than other cultured foods or probiotic capsules. The probiotics in home brewed kefir are alive and ready to immediately get to work improving your health and thus the vitality of your body and skin. Everyone benefits from probiotics, but especially people who have had antibiotics in the past. (If you are immunosuppressed or have intestinal disease, please consult with your physician to supervise your probiotic therapy.

Kefir brewing is easy and inexpensive. It’s been done for thousands of years in kitchens all over the world. Below is my method for brewing kefir milk in my kitchen. You can find additional instructions from the the web sites I reference at the end of this post.

Materials that I use to brew kefir:

All of your kefir brewing materials need to be glass, ceramic, plastic or silicone. Kefir grains (colonies) don’t do well if they come into contact with metal. Materials needed include:
* A bottle with loose fitting lid for storing the culture between brewing (like a pint sized, hinged canning jar with the rubber seal removed)
* A bottle and lid to store your brewed kefir milk (like a quart wide mouth canning jar and a fitted plastic lid)
* A brewing container like a 4 cup Pyrex measuring cup
* Funnel, strainer, spoon (all non-metal)

My Kefir Brewing Materials

I use the plastic canning jar lids, not the metal lids with the screw-top rings.

Brewing your First Kifir Milk: Activating Your Kefir Grains for the First Time:

Most people receive their kefir grains from one of the sources on Kefir.org noted below. The grains are typically sent in the mail and you need to reinvigorate them after their trip. You may not need to do this if you were lucky enough to find someone locally who shared their grains directly from their supply. In this case, you can skip this initial brewing/activation step.

When you receive your live kefir grains, inspect them. They should be lumpy creamy yellow and moist. Bring them to room temperature for several hours and then you are ready for your first brewing to awaken your culture (for more detailed instructions see my step by step instructions below for brewing kefir to drink):

* Place your newly arrived grains in about 1 cup of room temperature milk (not cold) into a non-metal container like the Pyrex measuring cup. (You can use goat, cow or sheep milk, or soy milk or coconut. Whole fat milk is best. It can be pasteurized or raw.)

* Add a small pinch of sugar to invigorate the little culture grains after their journey.

* Place the Pyrex cup with the milk and culture in a dimly lit location (not direct sun, but not necessarily dark either). They like your company so put them somewhere in your kitchen where you will pass by them for a little stir every now and then. Cover the Pyrex cup with a clean kitchen towel while the kefir grains are working.

* Allow the culture to sit for about 36 hours. Swish it or stir it with a plastic or wooden spoon often, and talk sweetly to it.

* The kefir is ready when it has lumps all the way to the bottom of the container, and is slightly thick like a milk shake.

* To strain your first brew, use a NONMETAL strainer (like plastic or silicone) or a slotted plastic spoon with very small holes to strain the milk from the grains. Place the strainer on the funnel over your storage bottle. Pour the brew from the Pyrex into the strainer. Gently shake the strainer to separate the kefir grains from the curds of the milk.

* Place the grains in a clean Pyrex cup with about half of the kefired milk from this first brew batch (throw the rest of this first batch of milk away, don’t drink it). THIS IS YOUR LITTLE WORKING KEFIR CULTURE; YOU ARE NOW READY TO BREW KEFIR TO DRINK

Brewing Kefir to drink:

Kefir is an ancient food and has been brewed in many varied conditions, in many countries and climates. Information about brewing is also varied, though there are some important points for kefir brewing that everyone seems to agree on. They include:

1. Never expose your grains to metal,

2. Don’t squish your grains,

3. Don’t expose your grains to chemicals including detergents,

4. Don’t place your grains in direct sunlight,

5. Feed your grains mammal’s milk every now and then or they will get weak (this is only important for people fermenting soy milk or other non mammal milks).

I am not as fastidious about providing the temperature conditions for my kefir brewing that others recommend and my kefir quality seems to be consistent with what others describe. At the end of my instruction I list other authors so that you can compare instructions.

This is how I brew my kefir (and it seems to work fine for me):

* Place about 1¼ cup room temperature milk (I actually use cool milk from the fridge and haven’t noticed any problems) into your Pyrex measuring cup (or ceramic jar or bowl). The amount of milk you add may depend on the volume of your grains. Some sources recommend a ration of about 1:10, meaning if your grains are 1oz. you add about 9 oz of milk. I don’t actually worry about ratios and it has worked fine for me every time. Eventually, as your culture grows you will be able to brew a full 4 cups in your Pyrex.

* Cover the container with a clean kitchen towel and place in a dimly lit location in your kitchen. Kefir colonies should not be placed in direct sunlight.

Kefir fermenting goat milk in a dimly lit corner of my kitchen

* The ideal temperature for brewing kefir is between 72 to 86 degrees F. Kefir brewing heating pads are available if your kitchen is cooler than 72 degrees. My kitchen is probably about 65 degrees and my kefir seems rich and fine, so again, I’m not sure how much the temperature affects brewing and kefir quality.

* Gently shake or stir your brew with nonmetal utensil as often as possible. Honestly, I can only do this about 2 times in a 24 hour period.

* Your kefir will be ready in about 24 hours; it will be thicker than milk and slightly lumpy all the way through the container. If you have chosen to use lower fat milk, your brew will have a layer of watery separation. If you have warm conditions and a lower volume of milk to grains, your kefir may be very thick like a mousse.

* Strain the milk from the grains by placing the plastic funnel on the wide mouth quart canning jar. The strainer goes on top of the funnel. Pour your brew into the funnel. The milk falls into the canning jar and the grains collect in the funnel.

Note the lumpy grains in the strainer and the liquid milk below in the jar

Kefir grains strained from the brewing milk

Note the thick slightly ’slimy’ milk that clings close to the grains

Leave some of the ’slimy’ liquid with the grains. Place the grains into their resting refrigerator jar with a loose fitting lid. I use the hinged pint canning jar.

* To store your grains in their resting jar, add about 1 cup of new milk to the jar containing your grains and put them in the fridge.

Kefir grains in the hinged canning jar with fresh milk, ready to rest in the fridge

You can store this little colony in the fridge without changing the milk for up to a week (maybe even 2 weeks) until you are ready to make a new batch of kefir. If you are going to be gone, have someone change the milk every week by repeating the straining step just described. (see storage info below)

* Your kefired milk is ready to drink. Store it in the fridge.

Kefired milk ready to store in the fridge

General Kefir Brewing Points that I’ve Learned .

* Your kefir culture will improve its ability to ferment milk over time. After about 5 brewing cycles, your little colony will be able to ferment a larger volume of milk (perhaps 60 times its own volume) in 24 hours. Initially, ask your new culture to only ferment about 1 ½ cups at a time. I brew 4 cups in 24 hours at room temperature which for me is between 65 and 70 degrees.

* Play with the fermentation time to find the taste and consistency you like. Longer brew times and smaller milk volumes will make a thick kefir with a carbonated taste.

* Kefir storage: Store your brewed milk in the refrigerator and drink a at least a glass every evening.

An evening glass of kefir; the ultimate probiotic ‘night cap’

Store your culture in about 1 cup of milk in the refrigerator. Change the milk every week, two at the most. The little guys need food, they are alive!

* As your colony grows, give some away. Teach others how to brew kefir and send your little guys off to a new home for others to enjoy and benefit from.

Kefir grains going off to a new local home

Kefir grains in their transport container with a little fresh milk for the journey

For more information on kefir you can reference the following web sites:

http://en.wikipedia.org/wiki/Kefir

http://users.chariot.net.au/~dna/kefirpage.html

http://www.kefir.org/

If you found this post helpful, you may like to read these other posts:

Dermatologist’s Recommendations for Natural Skin Health; Kefir, the best probiotic for healthy skin

Natural Skin Health; Dermatologist’s Diet Recommendations for Healthy Skin

The Alkaline Mediterranean Diet; A Magic Wand for Overall Health and Beauty

Making Sense of the Vitamin D Dilemma and Sun Exposure

Surprisingly, you need  beneficial probiotic bacteria and yeast  to have healthy,naturally beautiful skin!

Your skin is the biggest organ in your body, but the surface area of your intestines would cover a tennis court if it was stretched out flat.  Every bit of your intestinal surface is covered in important probiotic bacteria and yeast that keep you healthy.

Your body depends on its huge intestinal surface to get good things in (like nutrients) while keeping bad things out (like mercury). The beneficial germs that live in your gut play a key role here and that’s why probiotics are essential for the health and beauty of your skin.

As unsavory as it is to think about beneficial germs living in your intestines, the little guys are a really big deal.  You have about 5 pounds of intestinal microorganisms in your gut and you really want them to be the good guys not the bad guys.  They do critical work for you: they make important vitamins (B vitamins, biotin, vitamin K to name a few), they produce germ killing substances that keep you from getting infections, and they’re your ‘hazmat’ team removing food born toxins like mercury.

Modern life has rocked our little intestinal microbes like never before. We start acquiring our microbe population immediately after birth from the things we eat and drink.  Up until modern times a lot of these probiotic microbes came from the bacteria and yeast cultures used to preserve food by a process called fermentation. With the advent of modern food science we now rely on preservatives, refrigeration, pasteurizing, and canning (sterilizing food with high heat).   Our diet no longer contains a constant supply of beneficial probiotics. Add to that the use of lifesaving antibiotics, which wipe out what probiotic population we do have, and you can see that for our intestines, it’s a brave new world.

That’s why I recommend foods with probiotics, especially after antibiotics, but frankly we all need them.  I think that our deficient intestinal microbial environment may play a role in many health conditions, including skin diseases like psoriasis, rosacea, eczema and acne.  In my opinion, the best probiotic to replace our lost intestinal microbes is home brewed kefir made from live kefir grains (kefir grains is the name for kefir colonies).  These are the same microbes that our ancestors used to ferment their food.  Human bodies live symbiotically with these microbes, meaning that both we and the germs benefit from the arrangement.

Brewed kefir from kefir grains contain more of the beneficial microbes than other probiotic sources like yogurt and probiotic capsuels. When home brewed  as I describe in my next post, the organisms are alive and ready to repopulate your intestines immediately.  Kefir brewing is easy and inexpensive. Kefir milk tastes like buttermilk and if you don’t like the flavor, you can add fruit or honey and make a smoothie.  It’s best drunk at night before bed.  Ideally, this should become a ritual that you continue throughout your lifetime.

An evening glass of kefir

Commercially prepared kefir products available in the supermarkets lack the full benefits of home brewed kefir.  I’d rather you use them than no kefir at all, but they’re typically made from commercially prepared starter powder, not the kefir grains (cultures) and so they don’t contain the full range of organisms and health benefits of brewed kefir.  Some commercial producers may use live, perpetuated kefir grain cultures to make their kefir, but without calling the company and asking, you just don’t know.

There are other probiotic containing cultured foods that are also worth eating from time to time, but none are as easy as kefir.  These include barrel fermented sauerkraut and pickles (not canned/sterilized), miso soup, kombucha, and cultured cheeses.  As with all live probiotic foods, you have to remember not to cook them because high heat kills the beneficial organisms making them useless for repopulating your intestinal microbe population.

In my next post, I’ll outline how to start brewing your own kefir.  You’ll have all the information you need to start reaping the health benefits of this probiotic powerhouse food.

For more information on kefir you can reference the following web sites:
http://en.wikipedia.org/wiki/Kefir
http://users.chariot.net.au/~dna/kefirpage.html
http://www.kefir.org/

If you found this post helpful, you may like to read these other posts:

Dermatologist’s Recommendations for a Probiotic Powerhouse; Home Brewed Kefir

Natural Skin Health; Dermatologist’s Diet Recommendations for Healthy Skin

The Alkaline Mediterranean Diet; A Magic Wand for Overall Health and Beauty

Making Sense of the Vitamin D Dilemma and Sun Exposure

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The foods you eat should be packed with vitamins and minerals. When most of the foods you eat are nutritionally rich foods, your skin will be its healthiest and most beautiful! This is far from the magic bullet we all want in our fast paced lives; healthy eating requires real commitment.

What are nutritionally rich foods? Every time we buy manufactured food there’s nutritional information on the labels. In fact, we’re bombarded with nutritional information. Even junk foods list vitamin content. It’s confusing and so I use my common sense to figure out what foods are packed with vitamins and minerals. I recommend that the majority of what you eat be high nutrition foods including:

1.Naturally or organically farmed foods. This means foods grow from soil that’s packed with nutrients. I’m a vegetable gardener, and I know that I can force plants with nitrogen and chemical fertilizers but their flavors are blander and the plants are more susceptible to garden bugs and diseases requiring me to use chemicals to protect them. I think strong, tasty produce has more vitamins and minerals.

My first recommendation for naturally healthy skin is that 90% of the food you eat should be naturally farmed. Organic products would fit these criteria, but you can also find local small farmers in your area that farm naturally without organic certification. All you need is a few sources, like at farmers markets, restaurants that buy organic or naturally farmed produce, or the organic section of your grocery store. It also means meat, eggs and dairy from animals raised on a natural diet and without antibiotics or hormones. Yes, these foods are more expensive, and so the trick is not to over buy; waste is expensive.

2. Freshly prepared foods that haven’t been processed or preserved. Foods lose vitamins and minerals as they’re processed and stored. Fresh foods have the most vitamins and minerals and are a powerhouse of vitality for your skin. Processing food depletes vitamins. Think about white flour, so processed that manufacturers add back (enrich it with) processed vitamins. They put the enriched vitamin content on the label and you think you’re getting all the nutrition you need! Well, adding back vitamins isn’t the same as leaving the real ones there in the first place. Less processing means more vitamins and more vitality for your skin cells.

To be certain that most of your food is fresh, minimally processed and teaming with vitality, I recommend that 60% of the foods you eat should be freshly prepared by you or someone you know and trust. That someone may be your local natural food grocer or a restaurant, but I don’t trust big corporate food producers. It’s hard to make money using expensive fresh ingredients and making foods with short shelf life. I think there’s too great a temptation to cut corners, and your nutrition.

It’d be great if we could freshly prepared 100% of our food, but that’s not realistic so I recommend aiming for 60%. Life is busy and we’re not going to bake all our own bread, make our own crackers, pasta etc. We can cook our own dinners, make our own lunches or buy from a restaurant or grocer that freshly prepares food from nutritionally rich ingredients.

In addition to a diet packed with freshly prepared, nutritionally rich foods, I recommend you aim for a low fat and low protein diet to keep your skin healthy and attractive.

3. A low-fat diet may lower your skin cancer risk. Eating a lot of dietary fats appears to increase a person’s risk of developing a type of skin cancer called squamous cell carcinoma. I’ve recommended a low fat diet to my cancer patients for years. This month another scientific study was just reported from Australia showing that people with a history of squamous cell carcinoma are more likely to develop additional cancers if they eat a high fat diet. (International Journal of Cancer October 2009 Ibiebele TI et al.) I see a lot of patients with the common precancerous lesions called actinic keratosis and I recommend they eat a low fat diet too because actinic keratosis are pre squamous cell carcinomas. You need some oil in your diet for healthy skin, but it needs to be a ‘good’ oil. I recommend virgin olive oil as particularly beneficial due to its antioxidant power and balanced fatty acid composition. (Clin Dermatol. 2009 Mar-Apr)

4. A low protein and low calorie diet may keep your skin cells younger longer. Limiting our protein and calories seem to slow the aging of our cells. This probably applies to our skin cells along with all our other cells so I recommend limiting calories and protein in your diet to keep your skin healthy and young looking. High calorie and high protein diets seem to be stressful for cells. The latest evidence came from scientists at the Buck Institute for Age Research who just reported that a low-protein diet increased the life span of fruit flies by boosting the function of an important cell structure called the mitochondria.

So-

The Dermatologist’s Diet for Natural Skin Health

* Eat mostly vegetables, fruits and grains- organic or naturally farmed.
* Limit meats, fish, dairy and eggs-use them as an embellishment to your meal, not the main portion of what you eat-and be sure they’re from naturally farmed animals
* Use virgin olive oil
* Consider processed foods as a treat, not your main source of calories and nutrition

If you found this post helpful, you may like to read these other posts:

Dermatologist’s Recommendations for Natural Skin Health; Kefir, the best probiotic for healthy skin

The Alkaline Mediterranean Diet; A Magic Wand for Overall Health and Beauty

Making Sense of the Vitamin D Dilemma and Sun Exposure

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http://www.flickr.com/photos/galant/3833161207/

Patients often ask me for a vitamin that will give them healthy skin, strong nails and thick hair. We’d all like a magic bullet for not having the perfect diet. I’ve kept my eyes peeled for this magic bullet and learned a lot along the way.

Sometimes a scientific study or product claim comes up that holds promise; CoQ10, alpha-lipoic acid, biotin, selenium, , beta carotene, vitamin E or some combination of B vitamins curing wrinkles or dry skin, growing hair, strengthening nails etc. With some rare exceptions however, these magic bullets don’t deliver results when my patients try them. Combine that with the fact that I don’t entirely trust vitamin supplements. I remember all too well seeing patients in the 1980s with eosinophilia myalgia syndrome, the deadly and debilitating disease from the popular L tryptophan supplements used as a natural sleep remedy (http://en.wikipedia.org/wiki/Eosinophilia-myalgia_syndrome).

Nutritional supplements are what I consider ‘processed food’. Each processing step potentially alters nutritional content. My conclusion -there’s no substitute for eating real foods; foods farmed to maximize nutrition- rich in vitamins, essential fatty acids, protein and micronutrients (some that our scientists may not even know about yet). I think our bodies evolved over thousands of generations to get all our nutritional needs from real food and there’s no short cutting it.

I’ve been a ‘health nut’ since I was 15 and so I’ve looked for natural health remedies all through medical school and my medical practice. I’ve tried many of the modern natural health kicks myself, and collected more interesting experiences from my patients. My intent is to share my observations and recommendations over the course of my blog posts on natural skin health.

The first, most important lesson I’ve learned is that there’s no substitute for a healthy diet of real foods. But:

• What are real foods?
• How do we conveniently work them into our real life, our real daily schedule?
• Organic and ‘natural’ foods are often expensive, how can we afford them on a budget?
• Can they satisfy your need for a quick snack, comfort food, a craving?

I say YES to all of the above-most of the time!

Next post I’ll define what I mean by ‘real foods’ for natural skin health.

If you liked this blog post, you may also want to read:

Cynthia Bailey MD’s Recommendations for The Alkaline Mediterranean Diet

The Alkaline Mediterranean Diet-A Dietary Magic Wand for Overall Health and Beauty

Natural Skin Health: Dermatologist’s Diet Recommendations for Healthy Skin

Dermatologist’s Recommendations for Natural Skin Health: Kefir the best probiotic for healthy skin