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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51 JCAD JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY august 2017 • volume 10 • number 8 r e v i e w significant in that larger pores have a direct relationship with larger amounts of sebum p roduction. 1 1 k ang et al 2 7 r eported that 42 percent of subjects treated with tazarotene once daily for 24 weeks achieved a reduction in pore size according to a double-blind, 5-point physician scale. this is significant in comparison to just a 20-percent reduction in pore size in those receiving placebo. a different study found a significant reduction in pore size via a dermatoscopic analyzer after 60 women applied tretinoin 0.025% cream once daily for 90 days. 28 while the direct relationship between pore size and sebum production makes this interesting, one cannot conclude that topical retinoids decrease sebum production given that studies have not distinctly uncoupled this association. nonetheless, the above evidence and discussion make topical retinoids a worthwhile consideration for treating oily skin. 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). 29–31 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. 32 Further, when evaluated in animal models, topical Og consistently reduced sebaceous gland size. 33 while this molecule was "designed to inhibit sebum production following topical application," per dermira's website, none of the primary endpoints for the trials directly evaluated sebum output or the appearance of oily skin. rather, the primary endpoints related only to acne lesion counts. the Phase 2a and 2b trials revealed a significant reduction of invammatory and noninvammatory acne lesion counts following 12 weeks of topical Og at both 7.5% twice daily and 4.0% once daily. 29–31 topical Og is reportedly well tolerated with no serious treatment-related adverse events and may be an up-and-coming topical agent to treat oily skin. Further studies are warranted to directly evaluate whether topical Og significantly affects sebum production. 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 al 34 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. another cosmeceutical ingredient with some evidence behind its application for oily skin is green tea. One small study had 10 patients apply a 3% green tea emulsion for eight weeks. when facial skin was evaluated by a sebumeter (a noninvasive photometric device), there was a significant reduction in sebum production compared to baseline. 35 a slightly larger study with 22 participants also found a significant reduction in sebum secretion after 60 days of a topical green tea emulsion. 36 topical cosmeceuticals containing green tea may prove beneficial for patients with oily skin. l-carnitine has also become increasingly popular in the discussion of potential ingredients that can decrease the appearance of oily skin. naturally produced in the body, l- carnitine functions to augment β-oxidation, the catabolic process by which fatty acids are broken down. topical 2% l-carnitine has been shown to significantly decrease intracellular fatty acid content in human sebocytes and resulted in significant sebum reduction. 37 while further studies evaluating the etcacy of l-carnitine's sebosuppressive properties are warranted, it is a reasonable ingredient to recommend to patients concerned about oily skin. SYSTEMIC TREATMENTS FOR OILY SKIN 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. 38 as described above in the discussion of topical retinoids, 13-cis retinoic acid has also been proven to decrease the size and secretion FIGURE 2. Olumacostat glasaretil (Og) blocks acetyl coenzyme-a carboxylase in sebocytes to inhibit the production of free fatty acids (FFa)

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