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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50 JCAD JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY august 2017 • volume 10 • number 8 r e v i e w three hours. 7 when rates are less than 0.5mg/10cm 2 every three hours, patients can suffer from xerosis or dry skin. conversely, when sebum production exceeds 1.5mg/10cm 2 every three hours, it is considered excessive and results in seborrhea or oily skin. 1,7 the rate of sebum production among different individuals is highly variable, and the explanation as to why this is remains to be fully elucidated. several factors have been described and can be used to help explain to some patients why their skin might be more oily than others (table 1). men in general have higher sebum output attributed to higher testosterone levels, although sebum production does increase during ovulation in women, likely secondary to increased progesterone. 8 sebum also varies according to one's environment and the time of year. several studies have described an increase in sebum production during the spring and summer and in more humid climates. 9 ,10 in general, in terms of race, chinese women display notably smaller pore size and lower density while Black individuals have enlarged pore size that can be attributed to higher rates of sebum output. 11,12 despite the pessimistic view of sebaceous glands as a result of their role in oily skin, they do play a vital role in the skin's well being. sebaceous glands display endocrine function (particularly androgen synthesis), compose the fetal vernix caseosa, and play a key role in the epidermal barrier and innate immunity. 13–16 Here, we review current and up-and-coming treatment options that may be utilized to help patients with oily skin. TOPICAL TREATMENTS FOR OILY SKIN 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 esects 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-α, rar-β, and rar-γ. One rar will partner with a r etinoid X receptor (rXr) and make a heterodimer. 17 rar-γ accounts for about 90 percent of rars in the epidermis, and rXr-α accounts for roughly 90 percent of the rXrs. thus, the human skin is primarily regulated by paired heterodimers composed of rar-γ and rXr-α. 18 these heterodimers go on to bind to a specific area in deoxyribonucleic acid (dna) known as retinoic acid response elements (rare). Upon binding, transcription of genes encoding proteins necessary for the repair of photodamaged skin, growth and diserentiation of keratinocytes, anti-invammatory actions, and the suppression of sebum production takes place. 19,20 as early as the 1970s, the use of topical retinoids for various skin diseases, particularly acne vulgaris, began to be increasingly reported. 21 while the role of retinoids in keratinocyte growth and diserentiation has been widely recognized for several decades, their invuence on the biological function of sebocytes is now becoming more known. retinoid receptors rar-α, rar-γ, and rXr-α, β, and γ have all been identiUed in human sebocytes. 22 In vitro, retinoids have been found to signiUcantly reduce sebocyte proliferation, diserentiation, and synthesis of sebum. 22–24 In-vivo studies and clinical experience with topical retinoids have made known the common adverse esect of dry skin, but direct evidence of reduction in sebum output is lacking. Presumably, the dry skin results from normalization of diserentiation and proliferation of the keratinocytes and loosening of their adhesion to one another, thereby resulting in vaky skin. 25 One can also speculate that a topical retinoid would also bind to the sebocyte's retinoid receptors, resulting in decreased sebum production, but evidence has yet to exclusively illustrate that topical retinoids are sebosuppressive. 26 Both tazarotene and tretinoin have been reported to reduce facial pore size. this is FIGURE 1. acne and larger pores are often attributed to oily skin. image used with permission from visualdx. TABLE 1. Risk factors for oily skin male sex Premenopausal women during ovulation spring or summer seasons Humid climate african american conditions with elevated androgens (i.e., congenital adrenal hyperplasia, androgen secreting tumors of the ovaries or adrenal glands)

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