Treatment Options for Oily Skin
Wednesday, April 16, 2008
Oily skin results from large quantities of sebum, filling the
follicular reservoir and leaking onto the body
surface.1 Although the presence of excessive sebum
on the face is the subjective impression of the patient, it is
generally considered unaesthetic and cosmetically undesirable,
contributing to facial shine and imparting an unclean, greasy feel
to the skin.2,3
Sebum is secreted by the sebaceous glands, which are most
numerous on the face,2 particularly on the T-zone.
Sebaceous glands are present at birth, with sebum production being
relatively high during the first 6 months of life. After this
period, sebum production declines and remains low until puberty,
when sebaceous gland activity increases dramatically, as a result
of increasing androgen output, and remains stable through
adulthood. The number, size, and activity of sebaceous glands are
thought to be inherited. Throughout life, their number remains
stable, their size increases, and the sebum secretion rate declines
Clinically, the presence of sebum on the face is associated with
facial shine, formation of comedonal and inflammatory acne lesion,
and large pore size.2
The Sebumeter® and Sebutape® methods are
photometric devices universally used to measure sebum
Most of the therapies used for oily skin have been studied in
acne, and the same treatment principles hold for oily skin.
Some topical treatments have been published as being useful for
oily skin. The cleansers recommended for oily skin must be simple
solutions of surfactant containing no oils, waxes, or any fatty
agents that could aggravate the oily condition. Moisturizers,
sunscreens, and other topical products must have the formulations
with nonocclusive, noncomedogenic, and oil-free
agents.5 We recommend gel-cream and powder
presentations as topical products for oily skin.
Astringent agents such as alcohol, witch hazel, and acetone may
cut through oils on the skin surface, but this is strictly a
function of temporary removal and these agents do not tend to have
long lasting effects. However, skin cleansers and astringents
should be considered a first-line approach in the treatment of oily
Draelos et al. conducted a randomized,
double-blind, clinical trial, evaluating the effect of 2%
niacinamide on facial sebum production. They concluded 2%
niacinamide might aid in an improved cosmetic appearance for facial
shine reduction, but further studies are necessary to characterize
its mechanism of action.2
Dobrev reported the successful use of a cream containing
polyphenol-rich extract from saw palmetto, sesame seeds, and argan
oil in reducing the greasiness and improving the appearance of oily
Grimes reported that superficial salicylic acid peels are safe
and efficacious for the treatment of acne and oily skin in patients
with skin types V and VI.7
Isotretinoin is an extremely effective drug if given
systemically for severe forms of oily skin and acne. It's the only
retinoid with potent sebostatic properties. Systemic isotretinoin
is the regimen of choice today in severe oily skin, since it
reduces sebocyte lipid synthesis by 75% with daily doses as low as
0.1 mg/kg after 4 weeks.8 In a study with a small
number of patients, the influence on oily skin was measured during
oral isotretinoin treatment with 5 mg/d, 2.5 mg/d, or 2.5 mg 3x
weekly. The authors showed that the sebum production was reduced by
up to 64%, and the biopsies revealed a 51% reduction in sebaceous
gland size. Good results were achieved in all patients, but there
was a tendency toward better results with the 2 higher
doses9. Multiple mucocutaneous and systemic side effects
have been described with isotretinoin use and the observed side
effects are usually dose dependent and
reversible.4 Isotretinoin crosses the placenta and
is recognized as a strong teratogenic compound.8 It
should be used with a secure contraception in women of childbearing
age. Oral isotretinoin is the only remedy for men. In women, oral
isotretinoin is the most effective remedy, followed by
Oral antiandrogens also proved to affect the sebaceous glands.
Spironolactone is an aldosterone antagonist used as a diuretic and
as an antihypertensive drug. It also acts as an androgen receptor
blocker and has been used for over 20 years for the treatment of
acne and hirsutism. The antiandrogen effects of spironolactone
result in a 30% to 50% decrease in sebum excretion rate. The usual
dosage for the treatment of acne is 50 to 200 mg daily. However,
lower daily doses may be effective in controlling acne with the
advantage of having a reduced side-effect
profile.4 There are no studies evaluating the
effect of spironolactone only for oily skin.
Another antiandrogen, cyproterone acetate (CPA) is a progestin
that acts as an androgen receptor blocker and inhibits ovulation.
It can be used as a sole agent or in a combination with an oral
contraceptive. It is used in doses ranging from 2 to 100 mg/day and
is most commonly used in the form of an oral contraceptive with 35
micrograms of ethinyl estradiol (EE) and 2 mg of CPA. Its effect on
oily skin is seen after 2 to 3 cycles.10
Flutamide is a potent nonsteroidal inhibitor of androgen
receptors. It was introduced for the treatment of prostatic cancer
but is also used in the therapy of hirsutism, androgenic alopecia
and acne. Its main problem has been the possible appearance of
hepatic toxicity, which seems to be
dose-dependent.10 There are no studies evaluating
the effect of flutamide only for oily skin.
The beneficial effect of oral contraceptives is related to a
decrease in ovarian and adrenal androgen precursors; to an increase
in sex hormone-binding globulin (SHBG), which limits free
testosterone; and to a decrease in 3a-androstenediol glucuronide
conjugate, the catabolite of dihydrotestosterone (DHT) formed in
peripheral tissues. The oral contraceptive 35 microg EE/2 mg CPA is
used worldwide as a hormone treatment for acne and oily skin. A new
oral contraceptive that contains a unique progestogen,
drospirenone, and that has both antiandrogenic and
antimineralocorticoid activity has results on acne comparable to 35
microg EE/2 mg CPA. The combined oral contraceptive containing EE
and the selective progestogen, desogestrel, has been shown to
reduce facial oiliness.11 The use of this
contraceptive appears to improve oily skin after just 1 cycle of
Recently, new modalities targeting the sebaceous glands have
been developed for the treatment of acne and have been shown the
selective necrosis of the sebaceous glands. These are photodynamic
therapies,13 diode laser
devices,14 and nonablative radio frequency
A study evaluated the sebum excretion by sebum-absorvent tape
method after 31,450 diode laser treatments. The maximal observed
effect was a reduction by 18% in number of sebum producing
follicles at 6 weeks.16 The same method was used in
another study to evaluated the effect of topical aminolevulinic
acid-photodynamic therapy (PDT) on sebaceous glands. Multiple PDT
caused far lower sebum excretion than single PDT at the longest
follow-up time (20 weeks). On histology, sebaceous glands showed
acute damage and were smaller 20 weeks after
PDT.17 This study obtained a prolonged suppression
of sebaceous gland function.
A recent uncontrolled clinical assessment study evaluated the
efficacy of selective electrothermolysis of the sebaceous glands to
the treatment of facial oily skin and showed a mean reduction rate
of skin surface lipids of 31.5%.18
Therapeutic options for oily skin should target the sebaceous
glands. As more knowledge is gained about the complex function of
the sebaceous gland, novel therapies will hopefully be developed to
more effectively treat oily skin and reduce side effects.
- Roh M, Han M, Kim D, et al. Sebum output as a
factor contributing to the size of facial pores. Br J
- Draelos ZD, Matsubara A, Smiles K. The effect of 2% niacinamide
on facial sebum production. J Cosmet Laser Ther.
- Youn SW, Na JI, Choi SY, et al. Regional and
seasonal variations in facial sebum secretions: a proposal for the
definition of combination skin type. Skin Res
- Clarke SB, Nelson AM, George RE, et al.
Pharmacologic modulation of sebaceous gland activity: mechanisms
and clinical applications. Dermatol Clin.
- Baran R, Maibach HI, eds. Textbook of Cosmetic Dermatology. 3rd
ed. Spain: Taylor & Francis 2005.
- Dobrev H. Clinical and instrumental study of the efficacy of a
new sebum control cream. J Cosmet Dermatol.
- Grimes PE. The safety and efficacy of salicylic acid chemical
peels in darker racial-ethnic groups. Dermatol Surg.
- Orfanos CE, Zouboulis CC. Oral retinoids in the treatment of
seborrhoea and acne.Dermatology.
- Geissler SF, Michelsen S, Plewig G. Very low dose isotretinoin
effective in controlling seborrhea. J Dtsch Dermatol
- Haroun M. Hormonal therapy of acne. J Cutan Med
- Katz HI, Kempers S, Akin MD, et al. Effect of a
desogestrel-containing oral contraceptive on the skin. Eur
J Contracept Reprod Health Care.
- Prilepskaya VN, Serov VN, Zharov EV, et al.
Effects of a phasic oral contraceptive containing desogestrel on
facial seborrhea and acne. Contraception.
- Horfelt C, Funk J, Frohm-Nilsson M, et al.
Topical methyl aminolaevulinate photodynamic therapy for treatment
of facial acne vulgaris: results of a randomized, controlled
study. Br J Dermatol.
- Lloyd JR, Mirkov M. Selective photothermolysis of the sebaceous
glands for acne treatment.Lasers Surg Med.
- Ruiz-Esparza J, Gomez JB. Nonablative radiofrequency for active
acne vulgaris: the use of deep dermal heat in the treatment of
moderate to severe active acne vulgaris (thermotherapy): a report
of 22 patients. Dermatol Surg.
- Perez-Maldonado A, Runger TM, Krejci-Papa N. The 1,450-nm diode
laser reduces sebum production in facial skin: a possible mode of
action of its effectiveness for the treatment of acne
vulgaris. Lasers Surg Med.
- Hongcharu W, Taylor CR, Chang Y, et al. Topical
ALA-photodynamic therapy for the treatment of acne
vulgaris. J Invest Dermatol.
- Kobayashi T, Tamada S. Selective electrothermolysis of the
sebaceous glands: treatment of facial seborrhea. Dermatol