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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53 JCAD JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY august 2017 • volume 10 • number 8 r e v i e w of the more common but also transient side effects of oral contraceptives include nausea, b reast tenderness, and breakthrough menstrual bleeding. Using a combination oral contraceptive that contains the lowest dose of each hormone can limit or even prevent these common adverse effects while still offering the beneUt of an improved complexion. 59 OTHER TREATMENTS FOR OILY SKIN 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 Urst 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. One month after treatment, 17 of the 20 subjects had photographic improvement in oiliness and pore size and 17 of the 20 subjects also personally noted an improvement in sebum production. 60 li et al 61 later performed a double- blind, split-face study in 20 individuals and found a marked decrease in sebum production on the botulinum-treated side. another signiUcant prospective study evaluated 25 patients with oily skin that received intradermal forehead injections of botulinum toxin and revealed signiUcantly lower sebum production per a sebumeter at one week and one, two, and three months after the injections. 62 additionally, 91 percent of subjects were satisUed with intradermal botulinum toxin as a treatment for their oily skin. 62 in terms of the mechanism of action, botulinum toxin cleaves proteins involved in vesicle fusion with the plasma membrane of the presynaptic neuron's axon terminal. these vesicles contain acetylcholine, and botulinum toxin blocks the release of this neurotransmitter into the synaptic cleft where it would normally bind to a muscarinic receptor on a post-synaptic cell. in sebaceous glands, both immature and mature sebocytes express muscarinic acetylcholine receptors that are important for s ebocyte differentiation and sebum production. 61,63,64 considering the evidence and mechanism of action, intradermal botulinum toxin may be a promising treatment option 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 (PpiX). 65,66 when exposed to light at a suitable dose and wavelength, PpiX forms cytotoxic free radicals that result in cell destruction and apoptosis of sebocytes. despite plentiful evidence showing improvement in acne, several studies have failed to show a signiUcant reduction in sebum output after Pdt with ala. 67,68 However, one supportive study found that lower sebum excretion persisted even 20 weeks after multiple Pdt sessions, but not after a single Pdt session. Histologic evaluation acutely after Pdt revealed sebocyte destruction and 20 weeks later revealed smaller sebaceous glands. 69 Pdt may be a valuable tool to offer patients concerned about oily skin. 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 70 observed an 18-percent reduction in total sebum collected six weeks after three 1,450nm diode laser treatments. another study found signiUcant improvement in sebum production in 26 subjects after four treatments on the face with the 1,450nm diode laser. 71 On the other hand, laubach et al 72 reported that three 1,450nm diode laser treatment sessions did not cause signiUcant changes in sebum excretion. the diode laser is not the most etcacious of the treatment options reviewed, but it still offers a unique treatment modality to address oily skin. CONCLUSION Oily skin is a common chief complaint of d ermatologic 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. REFERENCES 1. schaller m, Plewig g. structure and function of eccrine, apocrine, and sebaceous glands. in: Bolognia Jl, Jorizza Jl, schaser Jv, eds. Dermatology. 3rd ed. elsevier; 2012:539–544. 2. leyden JJ. new understandings of the pathogenesis of acne. J Am Acad Dermatol. 1995;32:s15–25. 3. camera e, ludovici m, galante m, et al. comprehensive analysis of the major lipid classes in sebum by rapid resolution high-performance liquid chromatography and electrospray mass spectrometry. J Lipid Res. 2010;51:3377–3388. 4. nikkari t. comparative chemistry of sebum. J Invest Dermatol. 1974;62:257–267. 5. chen w, Zouboulis cc. Hormones and the pilosebaceous unit. Dermatoendocrinol. 2009;1:81–86. 6. rosenUeld rl, deplewski d, kentsis a, ciletti n. mechanisms of androgen induction of sebocyte diserentiation. Dermatology. 1998;196:43–46. 7. Plewig g, kligman a. Acne and Rosacea. 3rd ed. springer; 2000:58–67. 8. kim By, choi Jw, Park kc, youn sw. sebum, acne, skin elasticity, and gender diserence- which is the major invuencing factor for facial pores? Skin Res Technol. 2013;19:e45–53. 9. man mQ, Xin sJ, song sP, et al. variations of skin

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