u/Then-Spare-8729

Hi Everyone,
I developed FA after a course of antibiotics and steroids following surgery in December. It started on my chest then I got it on my forehead, hairline, scalp, and chin. It’s been a brutal journey of itchiness. I tried all the things(all the azoles (Nizoral, cloitrimazole 1% & 2%, 2 rounds of oral fluconazole), ACV, selsun blue, benzoyl peroxide, de la Cruz sulfur mask, urea moisturizer, MCT C8 oil, washing my pillow cases, washing my hair more frequently, etc). I’d get a little improvement, but it would keep coming. My skin barrier also started to struggle a little so I pulled it all back and began the experiment of what FA safe products work for me. I tried going no-actives for a couple weeks but the itching became intolerable and the bumps were still coming. I read SSS posts, so many posts on this subreddit, listened to podcasts, etc. I am on herbs from herbalist as well to help with my immune system response to the malassezia.

I ended up chatting with ChatGPT about a pattern I noticed: improvement for 5 days or so then relapse, repeat, even though there was no product-related difference. Chat helped me deduce that while I was clearing surface yeast, my routine wasn’t attacking the deeper biofilm that was protecting the yeast deeper in the follicle. Malassezia can exist in biofilm-like communities. What that means:
treatment penetrates → symptoms improve
deeper layers survive → repopulate
symptoms return days later 👉 This often creates a **repeat flare every 5–**10 days in some people. What is need to actively disrupt the biofilm are 1.) Keratolytics (Salicylic acid (BHA), which penetrates follicles & dissolves oil, Sulfur an antifungal & keratolytic, & Urea (10–20%) which softens keratin plugs), 2.) Biofilm disruptors that create a mildly acidic pH (Azelaic acid or Mandelic acid); these don’t “kill biofilm” directly—they destabilize it, and 3.) Immediate anti-fungal follow-up like Ketoconazole (2%), Ciclopirox (possibly better for biofilm-associated cases), or Zinc pyrithione. Turns out the** **timing matters: apply antifungal right after disruption phase.

ChatGPT helped me come up with a new routine. I’ve been on it for 2 weeks and it’s working, I haven’t had a relapse yet. It’s early, but I wanted to share it b/c I know how desperate this condition can be -

Mornings:
1.) Happy Cappy Medicated Shampoo (zinc) as my face wash. Leave on for 3 minutes!
2.) Naturium’s Azeliac Topical Acid 10%
3.) Purito Oat Gel Moisturizer mixed with The Ordinary Squalane Oil

3 Different Night Routines that are meant to sequentially address the problem of not getting deep enough on active antifungal, but also not irritate the skin. Rotate thru these: A, B, C, then repeat.
Night A: BHA Penetration Night
This night is about opening clogged follicles and attacking the biofilm.
1.) Happy Cappy as a wash face. Leave on for 3 minutes.
2.) Naturium’s salicylic acid 2% (leave-on)
3.) Purito Oat Gel Moisturizer with The Ordinary Squalane Oil

Night B: Active Kill
This night is about actively killing the yeast.
1.) Happy Cappy as a wash face. Leave on for 3 minutes.
2.) De La Cruz sulfur mask for 10 minutes
3.) Purito Oat Gel Moisturizer with The Ordinary Squalane Oil
*once your skin is tolerant, you can reverse the order of the sulfur and zinc wash

Night C: Restore & Repair
1.) Vanicream Gentle cleanser
2.) Skynbio Urea Moisiturizer with another moisturizer (Purito, Squalane, etc).
*Once a week, I do a manuka honey mask on this night before moisturizer to deepen the repair.

Shower:
Vanicream shampoo & conditioner
Vanicream body wash
Non-FA safe conditioner on just the lower 1/3 of my hair (I have ethnic, thick wavy hair that just can’t survive without at least some extra moisture)
MCT C8 oil as a hair oil after shower
*My scalp is still itchy and I’m still tinkering with what works.

My dermatologist confirmed FA but she’s been otherwise useless. I do have an appt with a functional medicine doctor next week that I’m hoping will take this progress to a curative level. I have always had SIBO so I’m wondering if perhaps that made me more vulnerable. I’ve taken antibiotics before without issue, but the surgery I had was a big one and so was the course of antibiotics. I also have never take antibiotics & steroids at the same time before. With SIBO, you can’t just Willy Nilly add probiotics in as most will worsen the condition thus my going to a FND.

I truly hope this helps somebody. I am happy to answer any questions.
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My skin type: Normal, but since FA, my forehead has been oily & tight for the past 5 months. The rest of my skin remains normal.

Climate: dry, cold, high altitude

My diet: I eat only whole foods. I don’t eat gluten or soy. I eat grass fed yogurt a few times a month & otherwise no dairy. Typical day of eating looks like:
Breakfast: 2 pasture raised eggs, 1 banana, 1/4c organic old fashioned oats, side of arugula.
Lunch: Big green smoothie (zucchini, celery, cucumber, 1/2 avocado, kale, spinach, strawberries, cinnamon, coconut water) & 4oz of lean protein
Dinner: 4-6oz protein, 1/2c of complex carbs (brown rice, quinoa, Japanese sweet potato), 2-3 servings of veggies
Dessert: 1 date or fresh fruit or 1-2 squares of chocolate (never processed sugar). Usually 2x/mo I’ll have grassfed yogurt.
I only cook with avocado oil and olive oil. I have 1 cup of decaf coffee everyday. I drink herbal tea that I make myself everyday (usually nettle, calendula, red raspberry leaf, oat tops). I do drink about 1/3-1/2 bottle of kombucha everyday b/c it’s the only way I can get down my herbal tincture from my herbalist (anybody who knows how TCM herbs taste like, it’s like that but worse lol!).

Supplements: Vitamin K, Grassfed Beef Liver (I have low ferritin), liposomal glutathione, zinc, creatine, collagen, mushroom powder, & magnesium glyncinate.

I’ve been trying to find the urea percentage for Skynbio’s Hydrashield moisturizer and I can’t find it anywhere. I’ve tried posting on FB & asking too, but no response from owner. Anybody know?