How To Reduce Oily Skin Reddit
J Clin Aesthet Dermatol. 2017 Aug; 10(8): 49–55.
Published online 2017 Aug 1.
Oily Peel: A review of Treatment Options
Abstract
One of the almost common dermatologic concerns is oily skin, and the demand for effective treatment options is ever apparent. This review article addresses numerous topical treatment options such as retinoids, olumacostat glasaretil, and various cosmeceutical agents. several systemic and procedural techniques that incorporate isotretinoin, spironolactone, oral contraceptives, botulinum toxin, photodynamic therapy, and lasers are reviewed besides. Each treatment pick is analyzed in terms of the proposed machinery of activity, efficacy reported in the literature, and potential adverse effects.
Keywords: Oily skin, seborrhea, sebum product, topical retinoids, olumacostat glasaretil, niacinamide, green tea, 50-carnitine, isotretinoin, spironolactone, oral contraceptives, botulinum toxin, photodynamic therapy, diode laser
OILY SKIN IS A Mutual DERMATOLOGIC concern reported past all types of patients, including those without acne, given its association with larger facial pores and an "unclean" or "greasy" appearance (Figure 1). Even a quick search on Amazon.com for "oily skin treatment" reveals ix,907 products geared toward treating this very issue. Price ranges for these products vary from just a few dollars to nearly $i,000 each. One product on the high terminate of the cost spectrum claims to be an "anti-aging fluid that combines modern technology with traditional knowledge of healing ingredients for oily or acne-decumbent skin." Regardless of whether consumers believe these statements, this scenario sheds light on the demand for an effective treatment for oily skin.
Acne and larger pores are often attributed to oily peel. Prototype used with permission from VisualDx.
Unfortunately, why some people endure from excessive sebum production while others suffer dry out skin remains difficult to explain. Numerous factors have been proposed to play a role in the pathogenesis of oily skin. Thus, pinpointing one successful treatment is challenging. Here, nosotros review the physiology of sebaceous glands equally well as current and up-and-coming treatment options that can exist offered to patients concerned most oily skin. Of note, specific over-the-counter products are non reviewed individually due to lack of objective information. Rather, private active ingredients are impartially discussed.
SEBACEOUS GLAND ANATOMY AND PHYSIOLOGY
Bated from the free sebaceous glands on the vermilion lips (Fordyce granules), eyelids (meibomian glands), areolae (Montgomery tubercles), and labia minora and prepuce (Tyson glands), the duct of the sebaceous gland connects to the infundibulum of a pilus follicle.1 These glands are highly full-bodied behind the ear and on the face up, upper breast, and back, which happens to be the same distribution as acne vulgaris.2 The major cells comprising sebaceous glands are sebocytes, and these cells atomize and release sebum via holocrine secretion. sebum is a viscous fluid composed of squalene, wax esters, triglycerides, costless fatty acids, cholesterol esters, and gratuitous sterols.three , 4
The amount of sebum a person produces varies throughout the class of his or her life. sebaceous glands are present at birth and display relatively loftier product of sebum at this time. presently after birth, sebum production decreases until puberty, at which time it dramatically increases. sebum production does not turn down once more until after menopause for women and around the sixth to seventh decade for men.one Androgens, peculiarly 5α-dihydrotestosterone (DHT), play a major role in the differentiation and proliferation of sebaceous glands as well as sebum production.5 , half dozenThe average rate of sebum product in adults is 1mg/10cm2 every three hours.7 When rates are less than 0.5mg/10cmii every iii hours, patients can suffer from xerosis or dry skin. Conversely, when sebum production exceeds ane.5mg/10cmii every three hours, it is considered excessive and results in seborrhea or oily skin.1 , seven
The rate of sebum product amid different individuals is highly variable, and the explanation as to why this is remains to exist fully elucidated. several factors have been described and can be used to help explain to some patients why their skin might be more than oily than others (Table 1). Men in general take higher sebum output attributed to higher testosterone levels, although sebum product does increment during ovulation in women, likely secondary to increased progesterone.8 sebum also varies according to i's environs and the time of year. several studies have described an increase in sebum production during the spring and summertime and in more than humid climates.9 , 10 In general, in terms of race, Chinese women brandish notably smaller pore size and lower density while Black individuals take enlarged pore size that can exist attributed to higher rates of sebum output.11 , 12
Tabular array 1.
Risk factors for oily skin
| Male sex activity |
| Premenopausal women during ovulation |
| Spring or summer seasons |
| Humid climate |
| African American |
| Conditions with elevated androgens (i.e., built adrenal hyperplasia, androgen secreting tumors of the ovaries or adrenal glands) |
Despite the pessimistic view of sebaceous glands equally a result of their role in oily skin, they practice play a vital function in the peel'due south well being. sebaceous glands display endocrine function (particularly androgen synthesis), compose the fetal vernix caseosa, and play a central part in the epidermal barrier and innate amnesty.13 – 16 Here, we review current and up-and-coming treatment options that may exist utilized to help patients with oily skin.
TOPICAL TREATMENTS FOR OILY SKIN
Retinoids. The topical retinoid family comprises vitamin A (retinol); its natural derivatives such as retinaldehyde, retinoic acid, and retinyl esters; and several constructed vitamin A derivatives such as adapalene and tazarotene. Their furnishings on the peel are mediated past their interaction with specific nucleic acrid receptors. In human skin, the nuclear retinoic acid receptor (RAR) family comprises iii forms: RAR-a, RAR-β, and RAR-γ. 1 RAR volition partner with a retinoid X receptor (RXR) and make a heterodimer.17 RAR-γ accounts for about ninety percent of RARs in the epidermis, and RXR-a accounts for roughly ninety percent of the RXRs. Thus, the human skin is primarily regulated by paired heterodimers composed of RAR-γ and RXR-a.18 These heterodimers proceed to bind to a specific area in dna (Deoxyribonucleic acid) known as retinoic acid response elements (RARE). Upon binding, transcription of genes encoding proteins necessary for the repair of photodamaged pare, growth and differentiation of keratinocytes, anti-inflammatory deportment, and the suppression of sebum production takes place.19 , 20
As early as the 1970s, the use of topical retinoids for various skin diseases, particularly acne vulgaris, began to exist increasingly reported.21 While the role of retinoids in keratinocyte growth and differentiation has been widely recognized for several decades, their influence on the biological function of sebocytes is at present becoming more known. Retinoid receptors RAR-a, RAR-γ, and RXR-a, β, and γ accept all been identified in human sebocytes.22 In vitro, retinoids have been found to significantly reduce sebocyte proliferation, differentiation, and synthesis of sebum.22 – 24
In-vivo studies and clinical experience with topical retinoids have made known the mutual adverse result of dry pare, just directly evidence of reduction in sebum output is defective. Presumably, the dry skin results from normalization of differentiation and proliferation of the keratinocytes and loosening of their adhesion to one another, thereby resulting in flaky pare.25 Ane tin besides speculate that a topical retinoid would besides bind to the sebocyte's retinoid receptors, resulting in decreased sebum product, but evidence has yet to exclusively illustrate that topical retinoids are sebosuppressive.26
Both tazarotene and tretinoin have been reported to reduce facial pore size. This is pregnant in that larger pores have a directly relationship with larger amounts of sebum production.11 Kang et al27 reported that 42 pct of subjects treated with tazarotene in one case daily for 24 weeks accomplished a reduction in pore size according to a double-blind, 5-signal physician scale. This is pregnant in comparison to but a 20-percent reduction in pore size in those receiving placebo. A different study found a significant reduction in pore size via a dermatoscopic analyzer later on sixty women practical tretinoin 0.025% cream once daily for ninety days.28 While the directly relationship between pore size and sebum production makes this interesting, 1 cannot conclude that topical retinoids decrease sebum product given that studies have not distinctly uncoupled this association. Nonetheless, the above prove and discussion brand topical retinoids a worthwhile consideration for treating oily pare.
Olumacostat glasaretil (DRM01). Dermira, a biopharmaceutical company, recently released hopeful data from a Phase 2b trial conducted for a topical sebum production inhibitor, olumacostat glasaretil (OG, formerly DRM01). This novel small molecule functions by inhibiting acetyl coenzyme-A carboxylase (Figure two).29 – 31 This enzyme catalyzes the commencement rate-limiting step in the synthesis of fatty acids. Triglycerides and fatty acids together make upwards the largest portion of sebum content; therefore, OG has the potential to decrease sebum output.32 Further, when evaluated in fauna models, topical OG consistently reduced sebaceous gland size.33
Olumacostat glasaretil (OG) blocks acetyl coenzyme-A carboxylase in sebocytes to inhibit the product of free fatty acids (FFA)
While this molecule was "designed to inhibit sebum production following topical application," per Dermira'southward website, none of the chief endpoints for the trials directly evaluated sebum output or the appearance of oily skin. Rather, the principal endpoints related merely to acne lesion counts. The Phase 2a and 2b trials revealed a significant reduction of inflammatory and noninflammatory acne lesion counts post-obit 12 weeks of topical OG at both vii.5% twice daily and 4.0% once daily.29 – 31 Topical OG is reportedly well tolerated with no serious treatment-related adverse events and may be an up-and-coming topical agent to care for oily skin. Further studies are warranted to directly evaluate whether topical OG significantly affects sebum production.
Cosmeceuticals. Numerous cosmeceutical products and ingredients brand claims that their use volition reduce oily skin, but this word volition be limited to bear witness-based ingredients. Draelos et al34 conducted a double-blind, placebo-controlled study of 100 subjects that revealed topical ii% niacinamide significantly lowered sebum excretion rates later on two and four weeks of use. While topical niacinamide may be helpful for those with oily skin, further studies are needed to outline the machinery of activity and ideal treatment regimen.
Another cosmeceutical ingredient with some testify behind its application for oily skin is green tea. 1 small study had 10 patients employ a 3% green tea emulsion for eight weeks. When facial skin was evaluated by a sebumeter (a noninvasive photometric device), in that location was a significant reduction in sebum production compared to baseline.35 A slightly larger study with 22 participants also found a significant reduction in sebum secretion after lx days of a topical green tea emulsion.36 Topical cosmeceuticals containing green tea may prove beneficial for patients with oily skin.
L-carnitine has besides go increasingly popular in the discussion of potential ingredients that can decrease the advent of oily pare. Naturally produced in the trunk, L-carnitine functions to augment β-oxidation, the catabolic procedure by which fatty acids are cleaved down. Topical ii% L-carnitine has been shown to significantly decrease intracellular fatty acid content in human being sebocytes and resulted in pregnant sebum reduction.37While further studies evaluating the efficacy of L-carnitine's sebosuppressive properties are warranted, it is a reasonable ingredient to recommend to patients concerned about oily skin.
SYSTEMIC TREATMENTS FOR OILY SKIN
Isotretinoin. Too known as thirteen-cis retinoic acid, isotretinoin is an oral retinoid that has been proven to result in the greatest reduction of sebum among all other mentioned treatment options.38 Equally described higher up in the give-and-take of topical retinoids, xiii-cis retinoic acid has also been proven to decrease the size and secretion of sebaceous glands.23 , 24 sebum product decreases past 90 percent during oral isotretinoin therapy and offers some much needed optimism for patients with astringent seborrhea.38
1 yr afterwards the completion of isotretinoin therapy, sebum excretion rates have been found to remain significantly suppressed for most individuals.39 A lower dose of isotretinoin (<0.5mg/kg/twenty-four hour period) is ofttimes employed when treating oily peel solitary without nodulocystic acne, simply this lower dose is conspicuously associated with a higher relapse charge per unit.40 Overall, upwards to 17 percent of patients will require a second course of oral isotretinoin despite achieving the recommended cumulative dose of 120 to 150mg/kg.41 , 42
Regardless of the severity of their oily pare, all patients should exist reminded that this sizeable reduction in sebum production does not become without adverse effects. Most commonly, patients volition experience generalized dry pare, chapped lips, xerophthalmia, and secondary pare infections.38 Clinicians should educate their patients and provide tips to minimize these common side effects.
One major consideration to hash out with patients prior to starting oral isotretinoin is teratogenicity. This very business dictates the use of the iPLEDGE arrangement, a computer-based adventure direction program designed to assist eliminate fetal exposure to isotretinoin, even if depression doses are being used to care for oily skin. To help foreclose this severe adverse risk, sexually agile women must use two forms of contraception, and pregnancy testing is required for all female patients of childbearing potential at baseline and monthly until completion of therapy.
Spironolactone. While this potassium-sparing diuretic has classically been utilized in medicine as an antihypertensive agent, it has go increasingly employed by dermatologists for the treatment of oily skin, acne, hirsutism, and androgenic baldness in women.43 , 44 spironolactone has been shown to directly reduce sebum production when dosed 50 to 200mg daily.45 In addition to being an alderosterone antagonist, spironolactone also functions every bit an androgen receptor blocker and an inhibitor of 5a-reductase.38 Human being sebocytes contain Blazon 1 5a-reductase, which converts testosterone to the potent androgen 5a-dihydrotestosterone (DHT).46 This androgen plays an important office in inducing sebocyte proliferation. Thus, by inhibiting production of DHT and blocking testosterone and DHT from bounden to sebocytes, spironolactone has been proven to inhibit sebocyte proliferation in a dose-dependent style.47
Prior to starting a female patient on spironolactone for oily skin, several potential side effects demand to be addressed. In an eight-yr follow-up report, no serious immediate or long-term complications attributable to spironolactone for treatment of acne were reported.48 still, mild side effects were nowadays in 59 pct of the subjects, with menstrual irregularity beingness amongst the most mutual.48 Hyperkalemia is often discussed equally a potential concern; all the same, a retrospective written report of 974 healthy women taking spironolactone for acne plant only 0.72 percent of serum potassium measurements were abnormal compared to the 0.76 percent baseline rate of hyperkalemia.49 Considering these results and other like reports, many dermatologists deem routine potassium monitoring as unnecessary for healthy women on spironolactone, but ultimately, lab monitoring is left to each provider'south discretion. Given spironolactone has endocrine furnishings, it is plausible that it could increase the gamble of hormonally dependent cancers, such as breast, ovarian, or endometrial cancers. Contrary to this notion, a large accomplice of more than 74,000 patients treated with spironolactone constitute no evidence of an increased risk of breast, ovarian, or endometrial cancer.50 These results have been supported by several other recent studies that investigated the potential relationship betwixt spironolactone and risk of hormonally dependent cancers.51 , 52 All in all, spironolactone is a safe systemic medication to consider for healthy women seeking treatment for oily skin.
Oral contraceptives. Oral contraceptives are beneficial for oily skin in that they upshot in a subtract in ovarian and adrenal androgens and increase sex hormone-binding globulin, which limits free testosterone. As described above, androgens stimulate sebocyte proliferation and contribute to seborrhea. Estrogens, all in all, take been found to exhibit an inhibitory effect on excessive sebaceous gland activeness in vivo.53 In order to avoid the hazard of endometrial hyperplasia, or fifty-fifty cancer, that can result from unopposed estrogen, it must exist used in combination with a progestin.
It is important to consider which progestin is in the combination oral contraceptive, every bit some progestins take intrinsic androgenic activity. Levonorgestrel, desogestrel, norgestimate, and norethindrone notably have the everyman androgenic activity.54 some newer progestins, such as drospirenone or cyproterone acetate, even antagonize the androgen receptors and display antiandrogenic properties.55 , 56
Several studies have shown that oral contraceptives do indeed reduce facial oiliness. In a double-blind, randomized study of 128 women receiving either an ethinyl estradiol/drospirenone combination or an ethinyl estradiol/cyproterone acetate combination, both preparations significantly reduced sebum product.55 Katz et al57 found a 60-percent relative reduction in sebum output on the cheeks and a thirty-percent relative reduction in sebum output on the brow of 41 women after half dozen cycles of a combination ethinyl estradiol/desogestrel pill. The use of this same combination oral contraceptive was also proven to improve oily skin after just one cycle of treatment.58
An important consideration prior to starting an oral contraceptive is the potential increased adventure of venous thromboembolism. The newer oral contraceptives have lowered the estrogen doses in an effort to eliminate this take a chance.38 some of the more than common just also transient side effects of oral contraceptives include nausea, chest tenderness, and quantum menstrual haemorrhage. Using a combination oral contraceptive that contains the everyman dose of each hormone tin limit or even prevent these common agin effects while still offer the benefit of an improved complexion.59
OTHER TREATMENTS FOR OILY SKIN
Botulinum toxin. Within the concluding few years, several studies have evaluated the efficacy of botulinum toxin for the handling of oily skin with promising results. Ane of the first reports in the literature to mention botulinum toxin's potential to improve oiliness of the skin appeared in 2008. A retrospective study was performed where 20 subjects with oily skin and large pores were evaluated after intradermal onabotulinum toxin A was injected in the T-zone. One month after treatment, 17 of the twenty subjects had photographic improvement in oiliness and pore size and 17 of the twenty subjects also personally noted an improvement in sebum production.lx Li et al61 later performed a double-blind, split up-confront study in 20 individuals and establish a marked subtract in sebum production on the botulinum-treated side. Another significant prospective study evaluated 25 patients with oily skin that received intradermal brow injections of botulinum toxin and revealed significantly lower sebum production per a sebumeter at ane week and i, two, and iii months after the injections.62 Additionally, 91 percent of subjects were satisfied with intradermal botulinum toxin as a treatment for their oily skin.62
In terms of the machinery of action, botulinum toxin cleaves proteins involved in vesicle fusion with the plasma membrane of the presynaptic neuron's axon last. These vesicles contain acetylcholine, and botulinum toxin blocks the release of this neurotransmitter into the synaptic scissure where it would normally bind to a muscarinic receptor on a post-synaptic cell. In sebaceous glands, both immature and mature sebocytes express muscarinic acetylcholine receptors that are important for sebocyte differentiation and sebum production.61 , 63 , 64 Considering the evidence and mechanism of activeness, intradermal botulinum toxin may be a promising treatment option for oily pare.
Photodynamic therapy. Photodynamic therapy (PDT) post-obit the application of δ-aminolevulinic acid (ALA) is used by some to treat acne vulgaris. ALA is preferentially captivated by pilosebaceous units, and sebocytes metabolize ALA to light-sensitive protoporphyrin Ix (PplX).65 , 66 When exposed to light at a suitable dose and wavelength, PplX forms cytotoxic free radicals that result in cell devastation and apoptosis of sebocytes. Despite plentiful evidence showing improvement in acne, several studies take failed to show a significant reduction in sebum output later on PDT with ALA.67 , 68 Nevertheless, one supportive study found that lower sebum excretion persisted fifty-fifty xx weeks afterward multiple PDT sessions, merely not later on a single PDT session. Histologic evaluation acutely afterwards PDT revealed sebocyte devastation and xx weeks later on revealed smaller sebaceous glands.69 PDT may be a valuable tool to offer patients concerned about oily skin.
Lasers. There are countless lasers on the market place that may be suitable for patients with oily pare. The 1,450nm diode laser appears to be ane of the more widely studied lasers for this purpose. Perez-Maldonado et al70 observed an 18-per centum reduction in full sebum nerveless 6 weeks after three i,450nm diode light amplification by stimulated emission of radiation treatments. Some other study found significant comeback in sebum production in 26 subjects afterward four treatments on the face with the one,450nm diode laser.71 On the other manus, Laubach et al72 reported that iii 1,450nm diode laser treatment sessions did non cause significant changes in sebum excretion. The diode light amplification by stimulated emission of radiation is non the most efficacious of the treatment options reviewed, but information technology still offers a unique treatment modality to accost oily skin.
Conclusion
Oily skin is a common principal complaint of dermatologic patients. While sebaceous glands play an integral role in cutaneous office, they are troublesome for some patients when sebum is excessively produced. Numerous handling options exist to assist tame sebum excretion rates, merely a articulate consensus on the preferred treatment regimen is yet to be described. Each treatment option comes with its own inherent advantages and disadvantages that should be discussed with patients at length, and handling can and then be personalized to each patient's needs. As more knowledge is gained about the circuitous pathogenesis backside oily skin, more novel and targeted therapies will hopefully be developed to more satisfactorily treat oily skin.
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Articles from The Journal of Clinical and Aesthetic Dermatology are provided here courtesy of Matrix Medical Communications
Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5605215/
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