22 April 2018
Move over glass skin, here comes honey skin- the current #SkinGoals that's trending in Korea. A quick search on 'Honey skin' or "꿀피부" will reveal almost 200 000 results of people flaunting their shiny and dewy faces. Beauty trends come and go; but the thread that is consistent among all of them is having a healthy shine to the face.
However, the gulf between having a healthy glow and looking like an oil slick is wide; and for most of us living in Singapore, oily skin is a big barrier to attaining our #SkinGoals. Looking greasy, clogged pores and acne are the biggest complains in people who suffer from excessively oil skin. But it is not all doom and gloom with oily skin; the silver lining is that oily skin allows your skin to age less quickly. The trick to having your cake and eating is in making the right choices for your skin. In our inaugural Skin Series with Dr Rachel, we will be learning all about oily skin and evidence based treatments and skincare ingredients that work for oily skin.
First, let’s talk about what oily skin really is about.
Oil glands in our skin are called sebaceous glands. These glands are highly concentrated on the face, upper chest and back and produce ‘oil’ or sebum. Sebum has the following important roles1: -
1. Part of the skin’s barrier function against infections
2. Protects the skin from loss of moisture
3. Lubricates the skin for a healthy lustre and texture
4. Transports antioxidants to the skin’s surface
However, too much of a good thing can be a curse for the reasons mentioned above. The rate of sebum production varies between individuals and can be the difference between having a healthy glow and excessive sebum; a condition known as seborrhea.
2) Pore size-larger pore sizes are associated with higher sebum output.
a. Androgens (male hormones) cause the proliferation and maturation of sebaceous glands and increase the output of sebum. During puberty, the surge in androgens is responsible for sexual maturity but also, enlarged pores, increased sebum and teenage acne. Testosterone also peaks before ovulation and this accounts for the cyclical pre-menstrual pimples/acne that many women experience.
b. Estrogen and Progesterone imbalance. Estrogen is the hormone that reduces the size and activity of the sebaceous gland and keep sebum less oily. This effect is more apparent in women; who generally have smaller pores and drier skin compared to men. Progesterone is a hormone that interferes with the action of Estrogen on the skin. After ovulation, progesterone is the hormone that dominates and this is also another factor that accounts for the cyclical premenstrual acne outbreak women experience.
4) Stress- when stressed, our body releases Cortisol, a steroid hormone. This hormone also causes sebaceous glands to proliferate and mature.
5) Living in humid regions
6) Race- Afro-americans have larger pore sizes attributed to higher sebum output. Interstingly, Chinese women have smaller pore size and density in comparison!
The buck does not stop only at looking greasy, unclean and dirty skin (yes, those are actual words from my patients). The other problems associated with oily skin are8: -
· Comedones (clogged pores)- blackheads and whitehead · Acne · Large pores. Both large pores and oily skin go together.
· Less wrinkles
· Skin is more moisturised
· Better skin elasticity
So, this brings me to my point that oily skin can be properly managed without drying the skin out and losing these benefits with the right care.
Avoiding rich creams and looking for non-comedogenic skincare and makeup are obvious but what over the counter (OTC) active ingredients should you include in your skincare if you have oily skin?
Retinoids make up the vitamin A group and compromise of tretinoin, retinols, adapalene…etc. In-vivo studies and clinical experience have made known the effects of retinoids in drying the skin, which results in a less oily sensation9. Tretinoin has also been shown to reduce facial pore size, which has a strong correlation with sebum production6. Do note however that tretinoin requires a prescription and is not suitable for pregnant or breastfeeding mothers.
Other topical active ingredients that have to reduce oiliness/sebum production (mainly in small studies) are10-13:
· Niacinamide (Vitamin B3)
· Green tea emulsions
Do note that using alcohol or astringent products and over-cleansing your face does not reduce seborrhea. In fact, it may even result in skin irritation.
Isotretinoin and tretinoin
Isotretinoin and tretinoin are part of the retinoid group that are prescription medications. Oral isotretinon has been shown to shrink pores and reduce sebum production by as much as 90% but this is not without unwanted effects such as dry skin and chapped lips14.
Oral contraceptives have been used to treat facial oiliness and acne by decreasing the free androgens which stimulate production of sebum- by as much as 60% on the cheeks and 30% on the forehead15. Oral contraceptives typically consist of an Estrogen (which reduce facial oiliness) and Progesterone to balance the hormone levels. Side effects of oral contraceptives include increased risk of venous thromboembolism (blood clots) and breast tenderness.
Spironolactone has been traditionally used in reducing blood pressure but increasingly, it is being used by dermatologists to treat oily skin and acne due to its anti-androgenic activity16.
If you’re looking for faster and longer lasting results for oily skin treatments- good news. Seeing your doctor not only takes the guesswork out of knowing what treatment is suitable for you but also; can potentially give you faster and longer lasting results.
There are three very exciting treatments for oily skin
2) Lasers and/or carbon lasers
Botulinum toxin may be better known for erasing wrinkles and lines (and the cause of stiff, expressionless, “frozen” faces in the hands of less experienced doctors), excessive sweating (hyperhidrosis) and migraines but did you know that Botox can also be used to reduce facial oiliness and shrink pores?
Related post: Botox 101
Better known as Micro-Botox or intradermal Botox, tiny droplets of Botulinum toxin (hence the term “Micro-Botox”) are injected into the skin (“intradermal”) where the sebaceous glands are located- this allows Botox to reduce sebum production without affecting the muscles to affect a change in facial features. Micro-Botox has been introduced as early as 2008 and studies have found a 91% satisfaction rate17,18.
If this sounds familiar; then you are right! I introduced this in my post on Skinboosters (here). In patients with oily skin and large pores, I also add in Botulinum toxin during Skinboosters to reduce oiliness and the size of pores.
Laser and/or carbon lasers19
There are many lasers in the market that can be used to treat oily skin and one of the most common lasers used is the Q-switch Nd-Yag laser as it does not cause any downtime. Lasers work by shrinking the pore and reduce sebum production Additional benefits of laser include lightening of pigmentation and acne scars and suitability for pregnant or breastfeeding women who cannot take use retinoids or Botox.
Carbon lasers or ‘Black doll lasers’ are a variation of traditional Q-switch Nd-Yag laser. Carbon cream is first applied to the skin before laser is performed on the skin. Q-switch Nd-Yag laser works best on pigmentation so the carbon cream is thought to improve the uptake of laser energy by the skin to reduce oiliness and shrink pores
Since the sebaceous gland are the root of the problem- then ablating these sebaceous glands provides a long-term solution to oily skin. A very fine microneedle delivers radiofrequency waves to the sebaceous glands while bypassing the skin. This procedure is also used to treat recalcitrant cases of acne.
One of the biggest advantages of AGNES laser is that it does not cause dry skin, which is a common complaint of treatment for oily skin and acne. AGNES laser allows the doctor to select the sebaceous glands to be ablated- which means that there are specific parts of the face that have hyperactive sebaceous glands, AGNES laser can be used to target these parts of the face without affecting the rest of the face. The other benefit it that AGNES laser can also be performed on pregnant and breastfeeding mothers.
AGNES can also be used to treat eyebags without requiring surgery.
One of the main problems with oily skin is the comedones. Although chemical peel do not reduce the oiliness per se, chemical peels- specifically BHA peels (i.e. salicylic acid peels) are an effective way to remove these comedones.
1. Acne and Sebaceous Gland Function. Clinics in Dermatology. Zouboulis. 2002; 22: 360-3662. Hormones and the Pilosebaceous Unit. Chen, Zouboulis. Dermatoendocrinol. 2009;1:81–86.
3. Mechanisms of Androgen Induction of Sebocyte Diﬀerentiation. Rosenﬁeld et al. Dermatology. 1998; 196:43–46.4. Variations of Skin, Surface pH, Sebum Content, and Stratum Corneum Hydration with Age and Gender in A Large Chinese Population. Man, et al. Skin Pharmacol Physiol. 2009;22:190–199. 10.
5. Seasonal Variability in the Biophysical Properties of Forehead Skin in Women in Guangzhou City, China. Wan et al. Int J Dermatol. 2015; 54:1319–1324.6. Sebum Output as A Factor Contributing to the Size of Facial Pores. Roh et al. Br J Dermatol. 2006;1 55:890–894.
7. Ethnic Diﬀerences in the Structural Properties of Facial Skin. Sugiyama-nakagiri et al. J Dermatol Sci. 2009; 53:135–139
8. New Understandings of the Pathogenesis of Acne. Leyden JJ. J Am Acad Dermatol. 1995; 32: s15–25.
9. Retinoids. in: Bolognia Jl, Jorizza Jl, schaﬀer Jv, Eds. Thielen, Saurat. Dermatology. 3rd ed. Elsevier; 2012:2089–2103.
10. The Eﬀect of 2% Niacinamide on Facial Sebum Production. Draelos et al. J Cosmet Laser Ther. 2006; 8:96–101.
11. Outcomes of 3% Green Tea Emulsion on Skin Sebum Production in Male Volunteers. Mahmood et al. Bosn J Basic Med Sci. 2010; 10:260–264. 36.
12. A Comparison of the Eﬀects of Topical Green Tea and Lotus on Facial Sebum Control in Healthy Subjects. Mahmood et al. Hippokratis. 2013; 17:64–67.
13. Topically Applied L-carnitine Eﬀectively Reduces Sebum Secretion in Human Skin. Peirano et al. J Cosmet Dermatol. 2012; 11:30–36.
14. Management of Acne: a Report From a Global Alliance to Improve Outcomes in Acne. Gollnick et al. J Am Acad Dermatol. 2003;49: s1–37.
15. Eﬀect of a Desogestrel-containing Oral Contraceptive on the Skin. Katz et al. Eur J Contracept Reprod Health Care. 2000;5: 248–255.
16. Spironolactone Directly Inhibits Proliferation of Cultured Human Facial Sebocytes and Acts Antagonistically to Testosterone and 5-alphadihydrotestosterone In-vitro. Akamatsu et al. J Invest Dermatol. 1993; 100:660–662.
17. Use of Intradermal Botulinum Toxin to Reduce Sebum Production and Facial Pore Size. Shah. J Drugs Dermatol. 2008;7(9):847–850.
18. Safety and Eﬃcacty of Intradermal Injection of Botulinum Toxin for the Treatment of Oily Skin. Rose and Goldberg. Dermatol Surg. 2013; 39:443–448.
19. A randomized, controlled, split-face clinical trial of 1320-nm Nd:YAG laser therapy in the treatment of acne vulgaris. Orringer et al. J Am Acad Dermatol. 2007 Mar;56(3):432-8.
20. Selective Sebaceous Gland Electrothermolysis as a Treatment for Acne: A Prospective Pilot Study. Lee et al. Int J Dermatol. 2012 Mar;51(3):339-44.
21. Selective Electrothermolysis of the Sebaceous Glands: Treatment of Facial Seborrhea. Kobayashi and Tamada. Dermatol Surg. 2007 Feb;33(2):169-77.