The Good, The Bad & The Oily

Anyone struggling with greasy, shiny, oily skin might argue that the mere existence of sebum (the medical term for skin oils) is a curse. Yet Mother Nature intended for it to serve a beneficial purpose.

The source of all the trouble is the microscopic sebaceous gland, safely hidden beneath the surface of the skin. Sebaceous glands are part of the pilosebaceous unit (hair + oil gland duo). These glands (envision partially inflated balloons) lie deep within the dermis. They connect with the hair shaft and empty their contents onto the surface of the skin through the pores. All skin surfaces, with the exception of the palms and soles, possess sebaceous glands. The area with the most oil-producing ability is the one most crowded with sebaceous glands - it's the notorious T-zone (forehead, nose and chin).

Sebaceous glands produce sebum, a complex blend of varied lipids (an assortment of fats), and dead sebaceous gland cells, (the cells that manufacture the sebum). Fats found in sebum include triglycerides, wax monoesters, squalane and free fatty acids.

The Good

Under normal circumstances, these glands should play a normal role in lubricating the skin and hair, protecting them from environmental challenges like dehydration and maintaining health and luster.

The term acid mantle refers to the protective, acidic environment created by the milieu of sebum, surface cellular debris and sweat bathing the outer layers of the skin (epidermis) and hair. The pH of the acid mantle ranges between 4.5 5.5. The acid mantle forces epidermal and hair cuticle cells to lie flatly in a tight array much like shingles on a roof. Without it, cells can pull apart, leading to dehydration, irritation and sensitivity. Hair can become brittle, dull and prone to breakage. The loss of an acidic environment can also lead to the invasion of bacteria into the skin.

Adequate amounts of sebum are very important in maintaining the protective acid mantle. Conquering oily skin is therefore a challenge. One wants to create a non-greasy, mattified appearance yet avoid over-stripping protective surface oils.

The Bad

Anyone who suffers from oily skin knows when too much sebum is produced, it's a real problem. Oily skin has a terribly negative effect on self-esteem as well as body image. Greasiness and shine often outweigh acne concerns. Oily skin is both uncomfortable and cosmetically unacceptable.

Sebaceous glands working overtime is the cause of excessively oily skin. Too much sebum produces surface oiliness, blocks pores, provides nourishment to bacteria that live upon the skin (P. acnes) and contributes to acne flare-ups.

The Oily

The true cause of oily skin lies in one's genetic makeup - an excess of a hormone called dihydrotestosterone (DHT). Too much of a good thing, this metabolite of testosterone, DHT is responsible for triggering sebaceous glands to produce sebum. Higher than normal levels of this androgenic hormone, or an increased sensitivity of the glands to normal levels of DHT can result in a virtual oil slick.

DHT first appears at puberty in both girls and boys. The menstrual cycle affects DHT levels, paralleling the rise of progesterone (post ovulation). Ever speculate why your skin becomes oilier and acne-prone just before menstruation? Blame rising levels of progesterone (and ultimately DHT).

Perhaps you have been praying your oil-laden T-zone would suddenly vanish overnight and be replaced with a healthy, radiant complexion. The goal is realistic even if the timing is not. However, eliminating extreme oiliness must be done with care. It's vital not to give in to skin-traumatizing temptation.

HOW TO CONTROL OILY SKIN

Topical Mattifying Products

Oil reducing skin care has tended to fall into 3 general categories. Those heavy in fragrance (a major dermatologic no-no), those that are fragrance free but have a strong chemical odor and those which have a pore-smothering, acne-inducing, silicone base. DERMAdoctor Tease Zone Oil Control Gel, however, is a lightweight water-based gel that literally disappears upon application without leaving any residual scent, odor or tackiness.

Tease Zone relies upon polymer technology to absorb and lift away excessive surface skin oils. Oil already present upon the skin or deep within the glands is soaked up and continues to be absorbed as it's formed throughout the day, leaving skin mattified and foundation intact. It eliminates excess surface skin oils which in turn deprives acne-causing Proprionibacterium acnes of nourishment, important factors for reducing acne formation.

The nice thing about this polymer technology is that it's inert. In other words, it won't over-dry skin so it can be applied all over the face without fear of it drying out non-oily areas (such as for anyone prone to combination skin). DERMAdoctor Tease Zone Oil Control Gel can be used simultaneously with other acne products, including topical antibiotics, as well as other oil removers such as glycolic acids, topical retinoids, and make-up.

Because it is dye and fragrance free and has been both dermatologist and allergy tested, those prone to sensitive skin issues, rosacea, seborrheic dermatitis or perioral dermatitis can also benefit from using Tease Zone. It is safe to use while pregnant or nursing.

Synthetic Topical Retinoids

This category includes prescription Retin A, Retin A Micro Gel, Differin, Tazorac and Avita as well as OTC retinols such as Afirm or DERMAdoctor Poetry In Lotion intensive retinol 1.0. Topical synthetic topical retinoid use unquestionably makes a significant improvement for oily skin concerns. However, a sizeable minority of patients still develop redness, flaking and irritation despite appropriate use. For my acne or oil-plagued patients, I always encourage treatments in this category be used sparingly - no more than every other night, at least to start.

Following a gentle "routine" skin care regimen (rather than using multiple oil-reducing options) may help stabilize the situation. Consider cleansing with DERMAdoctor Born To Be Mild Medicated Face & Body Cleanser or MD Formulations Facial Cleanser Sensitive Skin Formula, particularly when using aggressive oil reducing products during cold weather when skin dehydration is more likely. Try moisturizing with MD Skincare Hydra-Pure Oil-Free Moisture or Cellex-C Clear Complexion Seboregulator.

Glycolic Acid

Glycolic acid, a popular form of alpha hydroxy acids (AHAs) can lift away excessive facial oils and I do try to have my acne or oily skin patients incorporate them in to their skin care regimen. Remember, that glycolic acids, while they do help to exfoliate the skin, play more of a role of temporary oil reducer, and help cut through the surface oils and clean out the pores. They are not actually fixing what is happening within the gland. Cleanse with DERMAdoctor Ain't Misbehavin' Medicated AHA/BHA Acne Cleanser once or twice a day. It contains glycolic acid along with salicylic acid, and polymers to soak up surface skin oils. Follow with DERMAdoctor Picture Porefect Pore Minimizing Solution or EI Solutions Bio Sebum Control Serum to treat and/or hydrate the skin. Additionally, the application of glycolic acid to the skin helps to allow acne medications or other skin treatment ingredients to penetrate deeper in to the skin and be more effective.

I DO NOT recommend the application of glycolic acid at the same time as benzoyl peroxide or vitamin A/retinoid containing products. You risk an increase in irritation from doing this. Use them at separate times of the day. The use of a glycolic acid cleanser, however, would certainly be appropriate.

There are certainly individuals in whom glycolic acid still causes too much irritation or exfoliation. Sometimes this can be remedied by switching to a less drying base such as the MD Formulations Continuous Renewal Serum Sensitive Skin Formula or MD Formulations Continuous Renewal Serum. Same levels of glycolic acid in a gentler base. Occasionally less concentrated products may be necessary, in which case DERMAdoctor Wrinkle Revenge Antioxidant Enhanced Glycolic Acid Facial Cleanser 1, Peter Thomas Roth Glycolic Acid 3% Facial Wash and Neova Skin Revealing Treatment may be considered.

Salicylic Acid

Salicylic acid, or as it's more trendily known "Beta Hydroxy Acid" functions in a similar manner as the glycolic acids. However, the FDA has approved it as an OTC drug for an acne indication, making it a commonly included agent in acne cleansers. Salicylic acid helps in the exfoliation process, and helps remove oils present on the skin. However, it does not treat the underlying condition. Salicylic acid may cause dryness or irritation in some people if over used. It can be found in concentrations up to 2%. Many times it's mixed with glycolic acid (hence the term AHA/BHA may be seen). Consider trying cleansers like DERMAdoctor Ain't Misbehavin' Medicated AHA/BHA Acne Cleanser, Peter Thomas Roth Beta Hydroxy Acid 2% Acne Wash or Murad AHA/BHA Exfoliating Cleanser to cut through facial oils.

Astringents & Toners

Astringent agents including Alcohol, Witch Hazel, and Acetone may cut through oils, but this is strictly a function of temporary removal and do not tend to have long lasting results throughout the day. Still, interest in their use as a step in daily grooming remains high. Peter Thomas Roth Conditioning Tonic contains both benzoic acid and BHA (beta hydroxy acid) to help strip away grease and grime and kill bacteria. Neova Balancing Toner contains silica beads which absorb 10 times their weight in oils, leaving skin refreshed. Cellex-C BetaPlex Fresh Complexion Mist contains moderate levels of AHA and BHA to gently remove oils and surface debris. Astringents in general may be prone to causing redness, dryness or irritation, so overuse should be avoided.. Otherwise, astringents while helpful for those with normal skin types, they do not lend themselves to a complete approach on their own merits.

Masques

Masques may effectively reduce the feeling of oiliness on the skin for several days. I recall being in college and wearing a clay masque every few evenings. Not really an attractive approach, but it helped at the time. DERMAdoctor Ain't Misbehavin' Intensive Skin-Correcting Sulfur Acne Mask with Phytosphingosine is a product I really like to use. It contains therapeutic additives to deal with some of the acne causing issues as well. Another oil-reducing masque is MD Formulations Vit-A-Plus Clearing Complex Masque. This masque can help exfoliate materials lodged deep within the glands as well as reduce the presence of oils.

Oil Blotting Papers

Blotting papers blot. It's that simple. There are a variety of oil blotting papers on the market. While some people erroneously think that they may aggravate oily skin conditions (untrue), again, they are simply reducing the shine that may develop on the skin throughout the day. The use of agents to help reduce oil production in the first place will provide a broader fix of the problem. Having blotting papers like Tweezerman Facial Blotting Paper on hand are a life saver for the very oily.

Sunscreen

In addition to following an oil-busting skin care routine as mentioned above, what to do about sunscreen? When answering scads of consumer email, inevitably the biggest resistance from those with oily or blemish prone skin is about sunscreen. Too greasy, too sticky, blocks my pores...the list of reasons to avoid its use is endless. Consider trying Cellex-C SunShade SPF 30+ or DERMAdoctor Ain't Misbehavin' Skin Clarifying & Mattifying Sunscreen SPF 30 PA+++, the first sunscreen created with polymers to soak up unwanted excessive surface skin oils without causing parching or dryness. Your mattified skin won't know what hit it. Appropriate for layering with other anti-oil agents if desired.

Accutane

I personally do not feel that oily skin alone justifies the use of Accutane. Accutane is a great medication for the treatment of severe cystic acne, but has significant side effects associated with its use. The FDA does not indicate the use of Accutane for the control of oily skin. While I do hear from clients that they wish they could take this medication solely for controlling excess sebum production, it's just not a medically indicated use. A topical version of isotretinoin (the generic name for Accutane) has been tried in Canada and Europe for acne treatment but is unavailable in the U.S. I've only had the opportunity to see one patient who has relocated and was using this product. The skin was very parched (over-stripped of oils) and there was little change in the acne.

Systemic Interference With DHT

Less available DHT means less stimulation of the sebaceous gland and ultimately less oil production. Medications currently exist that block the ability of the hormone 5-alpha reductase to convert testosterone into its gland-triggering form, DHT. Currently none of them are prescribed with an FDA approved use to treat oily skin. However, in rare instances, an off-label use may be considered by a dermatologist.

Birth control pills (those that are more estrogen dominant), hair loss medications for men (such as Propecia which cannot be taken by women of child-bearing age/ability ), Spironolactone (a diuretic often given to treat acne, off-label, because of its antiandrogenic effects), and the antiandrogenic cyproterone acetate (not available in the U.S.). The most likely treatments your physician might prescribe would be a the oral contraceptive Ortho Tri-Cyclen or the water pill Spironolactone, both of which are currently used in acne treatment (with the side benefit of oil-reduction).

COMMON MISCONCEPTIONS

• Using oil control products will lead to an increase in sebum production.
  This is absolutely false.
• Blotting facial oils helps to reduce the production of sebum.
  False. While blotting can provide a temporary method of removing the oil, just like topical oil control products, they have no affect on the production of sebum.
• Oily skin is not a concern for those with rosacea.
  Again, false. While rosacea sufferers are more likely to have drier, more sensitive skin due to the natural aging process, I have seen more than my share of significantly oily skinned rosacea patients. DERMAdoctor Calm Cool & Corrected Anti-Redness Tranquility Cream contains NDGA, an ideal botanical for this concern. Combined with sebum sequestering micro-particles, excessive oils are absorbed, yet the product is formulated in a base appropriate for the rosacea patient prone to skin sensitivity. An ideal regimen combines it along with DERMAdoctor Born To Be Mild Medicated Face & Body Cleanser.
• Accutane fully eliminates ("cures") oil production.
  False. While Accutane does normalize the faulty mechanism related to the formation of cells lining the sebaceous glands, which in turn stops cystic acne, sebum production is not entirely eliminated. After treatment, the skin may either remain non-greasy or experience a return of oiliness post treatment.
• You can't wear make-up while using oil control products.
  False. Make-up should be labeled oil-free or "non-comedogenic" and is appropriate for use by those with oily skin. It may also be applied on top of products that help control acne or oily skin conditions. For those more affected by excess oils, despite the use of some oil control products, the use of a powder base may help. Rice powders like those used in T. LeClerc feel light, don't plug pores and help absorb excess oils.
• Oil control products cause unpleasant dryness and irritation.
  While many products which reduce levels of facial skin oils may cause these problems, this is absolutely not true across the board. And product misuse or overuse can also be responsible for skin irritation, not just the product formulation.

Now you know all about how to improve your oily skin condition. There is a wide range of options for you to take advantage of. Remember that when all else fails, your dermatologist is the perfect resource for prescription intervention.

Thank you for taking the time to read my newsletter. I hope you have found it to be informative.

Audrey Kunin, M.D.

(Any topic discussed in this article is not intended as medical advice. If you have a medical concern, please check with your doctor.)

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