A cosmetic is defined as an “article intended to be rubbed, poured, sprinkled, or sprayed on the human body for the purpose of cleaning, beautifying, promoting attractiveness, or altering the appearance without affecting the body’s structure or function.” Appropriate skin care contributes to successful management of acne. Skin care needs to be rational, flexible, and adaptive. The objective is to keep the skin and hair (scalp) clean, to control oiliness and prevent excessive dryness, to understand the changing needs of the skin on a daily basis brought about by variations in environmental conditions, physical activities, and the effects of topical and systemic treatments, and to compensate for such changes so as to maintain the skin in a near-ideal state. This is possible to achieve by balancing cleansing, moisturizing, and judicious use of supplemental skin care products.

2. Introduction
A cosmetic is defined as an “article intended to be rubbed, poured, sprinkled, or sprayed on the
human body for the purpose of cleaning, beautifying, promoting attractiveness, or altering the
appearance without affecting the body’s structure or function.” Appropriate skin care contributes to
successful management of acne. Skin care needs to be rational, flexible, and adaptive. The objective
is to keep the skin and hair (scalp) clean, to control oiliness and prevent excessive dryness, to
understand the changing needs of the skin on a daily basis brought about by variations in
environmental conditions, physical activities, and the effects of topical and systemic treatments,
and to compensate for such changes so as to maintain the skin in a near-ideal state. This is possible
to achieve by balancing cleansing, moisturizing, and judicious use of supplemental skin care
products.

3. Daily shaving can irritate the skin. An electric shaver may be better option than hand-held
razor. A shaving gel or cream is better than shaving foam. A moisturizing lotion is better
than conventional after shave lotion.
Shaving
Liberal use of hair oils or oil massages is to be discouraged as this could contribute to
pomade acne. Frequent shampooing is advised to keep scalp free of seborrhea.
Hair Oils
Skin Care Products
Cosmetics with fragrances and photosensitizers should be avoided. Water-based
foundation is safe to use.
Adjuvants Cosmetics

4. Most topical antiacne treatments lead to dryness or desquamation of skin. Appropriate use
of oil-free moisturizers should be permitted or even encouraged. The objective is to correct
dryness to be comfortable in feeling and appearance without causing oiliness.
Moisturizer
Some acne treatments have the potential to cause photosensitivity. Even otherwise, a
parallel objective of treatment is to enhance the skin. Sunprotection and tan prevention is
encouraged. This requires identifying a suitable sunscreen product which is then
incorporated in the daily routine. Most sunscreens are too oily for acne patients and tend
to aggravate it. Lately, some sunscreen gels and oil-free lotions have become available that
are suitable for acne patients.
Sunscreen Products
Skin Care Products

5. These are the products that contain substances like clay, kaolin, or talc, which can absorb
sebum and make the skin temporarily dry.
Mask
These are the products which contain cornedolytics like salicylic acid, glycolic acid, and resorcinol.
They are available as cleansers, washes, leave-on-gels, and scrubs. Exfoliators speed the natural
renewal of skin cells and help in the treatment of acne by alleviating comedones.
Exfoliator
Skin Care Products
They are thick and occlusive and can lead to cosmetic acne. Hence, oil-free foundations are better.
Oils in foundations are substituted by silicone derivatives like cyclometissue or dimethicone.
Foundations

6. Why it happens and what you can do for it
Adult Acne
Acne can be particularly frustrating for adults. A
treatment that worked so well during our teen years
can be useless or even make acne worse. If this
happens, you may wonder whether those blemishes
really are acne. After all, do adults get acne?
This 25-year-old woman has had acne for years.

7. Reasons For Adult Acne
Yes, adults get acne. Some adults continue to get acne well into their 30s, 40s, and even 50s. It is
even possible to get acne for the first time as an adult. Dermatologists call this “adult-onset acne.” It
is most common among women going through menopause.
Women tend to get adult acne more often than men do. If you’re getting acne as an adult, it is likely
due to one or more of the following reasons.

8. Women often experience fluctuating hormones:
 Around their periods
 During pregnancy, peri-menopause, and menopause
 After discontinuing (or starting) birth control pills
Fluctuating hormone levels: An imbalance can lead to breakouts.
Researchers have found a relationship between stress and acne flare-ups. In response to stress, our
bodies produce more androgens (a type of hormone). These hormones stimulate the oil glands and
hair follicles in the skin, which can lead to acne. This explains why acne can be an ongoing problem
when we find ourselves under constant stress.
Stress
Reasons For Adult Acne

9. Does a close blood relative, such as a parent, brother, or sister have acne? Findings from research
studies suggest that some people may have a genetic predisposition for acne. People who have this
predisposition be more likely to get adult acne.
Family History
Reasons For Adult Acne
If you have adult acne, you should read the labels on your skin care and hair care products. Make
sure that you see one of the following terms on every container:
• Non-comedogenic
• Non-acnegenic
• Oil-free
• Won’t clog pores
You want to make sure your moisturizer, cleanser, sunscreen, and all other products contain one of
these terms. These products are least likely to cause acne.
Hair and skin care products

10. Medication side effect: Acne is a side effect of some medicines. If you suspect that a medicine is
triggering your acne or making it worse, continue taking the medicine, but talk with the doctor who
prescribed it. Ask if acne is a possible side effect. If acne is a possible side effect, ask if you can take
a different medicine. If you cannot take another medicine, you may want to see a dermatologist
who can help you control the acne.
Medication Side Effect
Reasons For Adult Acne
Sometimes, acne is a sign of an underlying medical condition. Once the medical condition is
diagnosed and treated, the acne often clears.
Undiagnosed medical condition

11. If nothing clears your acne, you should see a dermatologist. Effective treatment is available. Often a
dermatologist will use two or more treatments. With a dermatologist’s help and a bit of patience,
virtually every case of acne can be controlled.
Effective treatment available for adult acne

12. Acne vulgaris is one of the most common dermatological diseases, and it is known that various
factors are related to triggering this condition in a patient. In particular, although the use of
cosmetics is thought to be associated with the onset of a patient developing acne, there are few
studies that have been conducted to date on this disease and its related factors.
Relationship between acne and the use of cosmetics:
Results of a questionnaire study in 539 Korean individuals
Background
Method
To begin with, a total of 539 patients with acne vulgaris, who visited three dermatologic clinics in
Korea, were asked to complete a questionnaire regarding their condition in relation to clinical
features and exacerbating factors, including the use of cosmetics. The patients all provided an
accurate acne treatment history as well.

13. Among the respondents, 38.1% of patients who failed treatment answered that the condition of
their acne was worsened by the continued use of cosmetics, which was significantly higher than
26.3% of the surveyed treatment-naive patients (P < .05). In this relation, double cleansing
(cleansing twice using oil and water-based cleanser) and the number of cosmetics in use were also
noted in higher numbers than in the treatment-failure patients. As noted, the liquid-type
foundation and concealer were frequently used in this group.
Relationship between acne and the use of cosmetics:
Results of a questionnaire study in 539 Korean individuals
Result

14. OILY SKIN IS A COMMON DERMATOLOGIC concern reported by 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 9,907 products
geared toward treating this very issue. Price ranges for these products vary from just a few dollars
to nearly $1,000 each. One product on the high end of the price spectrum claims to be an “anti-
aging fluid that combines modern technology with traditional knowledge of healing ingredients for
oily or acne-prone skin.” Regardless of whether consumers believe these statements, this scenario
sheds light on the demand for an effective treatment for oily skin.
Oily Skin: A review of Treatment Options

15. Unfortunately, why some people suffer from
excessive sebum production while others
endure dry 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, we review the physiology
of sebaceous glands as well as current and
up-and-coming treatment options that can
be offered to patients concerned about oily
skin. Of note, specific over-the-counter
products are not reviewed individually due
to lack of objective data. Rather, individual
active ingredients are impartially discussed.
Oily Skin: A review of Treatment Options
Acne and larger pores are often attributed to oily skin.

16. The amount of sebum a person produces varies throughout the course of his or her life. sebaceous glands are
present at birth and display relatively high production of sebum at this time. shortly after birth, sebum production
decreases until puberty, at which time it dramatically increases. sebum production does not decline again until after
menopause for women and around the sixth to seventh decade for men.1 Androgens, particularly 5α-
dihydrotestosterone (DHT), play a major role in the differentiation and proliferation of sebaceous glands as well as
sebum production.5,6The average rate of sebum production in adults is 1mg/10cm2 every three hours.7 When rates
are less than 0.5mg/10cm2 every three hours, patients can suffer from xerosis or dry skin. Conversely, when sebum
production exceeds 1.5mg/10cm2 every three hours, it is considered excessive and results in seborrhea or oily
skin.1,7
Oily Skin: A review of Treatment Options
SEBACEOUS GLAND ANATOMY AND PHYSIOLOGY

17. Retinoids
The topical retinoid family comprises vitamin A (retinol); its natural derivatives such as retinaldehyde, retinoic acid,
and retinyl esters; and several synthetic vitamin A derivatives such as adapalene and tazarotene. Their effects on the
skin are mediated by their interaction with specific nucleic acid receptors. In human skin, the nuclear retinoic acid
receptor (RAR) family comprises three forms: RAR-a, RAR-β, and RAR-γ.
Oily Skin: A review of Treatment Options
TOPICAL TREATMENTS FOR OILY SKIN

18. 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
2).This enzyme catalyzes the first rate-limiting step in
the synthesis of fatty acids. Triglycerides and fatty acids
together make up the largest portion of sebum
content; therefore, OG has the potential to decrease
sebum output. Further, when evaluated in animal
models, topical OG consistently reduced sebaceous
gland size.
Oily Skin: A review of Treatment Options
TOPICAL TREATMENTS FOR OILY SKIN
Olumacostat glasaretil (OG) blocks acetyl coenzyme-A carboxylase
in sebocytes to inhibit the production of free fatty acids (FFA)

19. Isotretinoin
Also known as 13-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. As described above in the discussion of
topical retinoids, 13-cis retinoic acid has also been proven to decrease the size and secretion of sebaceous
glands. sebum production decreases by 90 percent during oral isotretinoin therapy and offers some much
needed optimism for patients with severe seborrhea.
Oily Skin: A review of Treatment Options
SYSTEMIC TREATMENTS FOR OILY SKIN
Cosmeceuticals
Numerous cosmeceutical products and ingredients make claims that their use will reduce oily skin, but this
discussion will be limited to evidence-based ingredients. Draelos et al34 conducted a double-blind, placebo-
controlled study of 100 subjects that revealed topical 2% niacinamide significantly lowered sebum excretion
rates after two and four weeks of use. While topical niacinamide may be helpful for those with oily skin, further
studies are needed to outline the mechanism of action and ideal treatment regimen.

20. Oral contraceptives
Oral contraceptives are beneficial for oily skin in that they result in a decrease 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, have been found
to exhibit an inhibitory effect on excessive sebaceous gland activity in vivo. In order to avoid the risk of
endometrial hyperplasia, or even cancer, that can result from unopposed estrogen, it must be used in
combination with a progestin.
Oily Skin: A review of Treatment Options
SYSTEMIC TREATMENTS FOR OILY SKIN
Spironolactone
While this potassium-sparing diuretic has classically been utilized in medicine as an antihypertensive agent, it
has become increasingly employed by dermatologists for the treatment of oily skin, acne, hirsutism, and
androgenic alopecia in women, spironolactone has been shown to directly reduce sebum production when
dosed 50 to 200mg daily

21. Botulinum toxin
Within the last few years, several studies have evaluated the efficacy of botulinum toxin for the treatment of
oily skin with promising results. One 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.
Oily Skin: A review of Treatment Options
SYSTEMIC TREATMENTS FOR OILY SKIN
Photodynamic therapy
Photodynamic therapy (PDT) following the application of δ-aminolevulinic acid (ALA) is used by some to
treat acne vulgaris. ALA is preferentially absorbed by pilosebaceous units, and sebocytes metabolize ALA
to light-sensitive protoporphyrin IX (PplX). When exposed to light at a suitable dose and wavelength, PplX
forms cytotoxic free radicals that result in cell destruction and apoptosis of sebocytes.

22. Lasers
There are countless lasers on the market that may be suitable for patients with oily skin. The 1,450nm diode
laser appears to be one of the more widely studied lasers for this purpose. Perez-Maldonado et al observed an
18-percent reduction in total sebum collected six weeks after three 1,450nm diode laser treatments.
Oily Skin: A review of Treatment Options
SYSTEMIC TREATMENTS FOR OILY SKIN

23. This study showed the influence of cosmetics, especially in acne patients with a history of treatment failures.
These results also show differences according to specific cosmetic types and formulations. Therefore, overall
dermatologists should consider advising about cosmetic use to acne patients along with medical treatment
options for the patients with acne.
Oily skin is a common chief complaint of dermatologic patients. While sebaceous glands play an integral role in
cutaneous function, they are troublesome for some patients when sebum is excessively produced. Numerous
treatment options exist to help tame sebum excretion rates, but a clear 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 treatment can then be personalized to
each patient’s needs. As more knowledge is gained about the complex pathogenesis behind oily skin, more
novel and targeted therapies will hopefully be developed to more satisfactorily treat oily skin.
Dermatologists should acquire sound knowledge and familiarity with skin care products that need to be
recommended or condemned as part of acne management. Skin care products labeled as “noncomedogenic”
or “tested for comedogenicity” help make the job easier. Incorporating cosmetics in acne treatment regimens
supports the concept of the dermatologist as the skin care expert.
Conclusion

24. THANK YOU!