Journal of Clinical and Aesthetic Dermatology

AUG 2017

An evidence-based, peer-reviewed journal for practicing clinicians in the field of dermatology

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49 JCAD JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY august 2017 • volume 10 • number 8 O One of the most 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 as well. each treatment option is analyzed in terms of the proposed mechanism of action, etcacy reported in the literature, and potential adverse esects. KEY WORDS: Oily skin, seborrhea, sebum production, topical retinoids, olumacostat glasaretil, niacinamide, green tea, l- carnitine, isotretinoin, spironolactone, oral contraceptives, botulinum toxin, photodynamic therapy, diode laser a B s t r a c t r e v i e w OILY SKIN: a review of treatment Options by DAWNIELLE C. ENDLY, DO, and RICHARD A. MILLER, DO dr. endly is with advanced dermatology skin cancer and laser surgery center in aurora, colorado. dr. miller is with nova southeastern University/largo medical center, dermatology residency Program and Bay dermatology and cosmetic surgery in largo, Florida. J Clin Aesthet Dermatol. 2017;10(8):49–55 FUNDING: no funding was provided for this study. DISCLOSURES: the authors have no convicts of interest relevant to the contents of this article. AUTHOR CORRESPONDENCE: dawnielle c. endly, dO, dawnielleendly@hotmail.com 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 vuid 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 esective treatment for oily skin. Unfortunately, why some people suser from excessive sebum production while others endure dry skin remains ditcult 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 osered to patients concerned about oily skin. Of note, speciUc over-the-counter products are not reviewed individually due to lack of objective data. rather, individual active ingredients are impartially discussed. SEBACEOUS GLAND ANATOMY AND PHYSIOLOGY aside 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 hair follicle. 1 these glands are highly concentrated behind the ear and on the face, upper chest, and back, which happens to be the same distribution as acne vulgaris. 2 the major cells comprising sebaceous glands are sebocytes, and these cells disintegrate and release sebum via holocrine secretion. sebum is a viscous vuid composed of squalene, wax esters, triglycerides, free fatty acids, cholesterol esters, and free sterols. 3,4 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 diserentiation and proliferation of sebaceous glands as well as sebum production. 5,6 the average rate of sebum production in adults is 1mg/10cm 2 every

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