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CHAPTER 10 Oily Skin
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Mohamed L Elsaie, MD Leslie Baumann, MD
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Sebum production plays an important role in skin hydration by producing glycerol, which is necessary for an intact skin barrier In addition, sebum supplies lipids to the surface of the epidermis that may aid in preventing transepidermal water loss (TEWL) (see 11) Excess sebum production produces oily skin, and in many cases, contributes to acne With continuing advances in understanding the physiology and molecular biochemistry of sebaceous glands (SGs) and lipid metabolism, dermatologists may soon be able to elucidate the underlying aspects of sebum secretion and oily skin This chapter will focus on the various known causes of oily skin and their implications, a new classification approach for determining the oily skin type, and the available treatments for oily skin as well as the efficacy of these treatments FIGURE 10-1 Oily skin often appears shiny in the T-zone area in photographs
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CHAPTER 10 OILY SKIN
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COSMETIC IMPLICATIONS OF OILY SKIN
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Oily skin is a common complaint,1 7 especially in the adolescent age group2 Those with moderate to severe oily skin complain of having to wash their face several times a day, looking shiny a few hours after washing, frequent streaking of facial foundation, and an inability to find a sunscreen that does not worsen perceived skin oiliness These features of oily skin are disturbing to women and men alike and are perceived to be a serious cosmetic problem leading to a negative self-perception and possibly affecting social interactions Clinically, oily skin presents as lipid-laden secretions resulting in a shiny appearance mostly over the T-zone area (forehead, nose, and chin)4 (Fig 10-1) SGs become large leading to a condition known as sebaceous hyperplasia, which is characterized by 05 to 15 mm umbilicated papules found in the T-zone area of the face (Fig 10-2) In addition, many patients with oily skin complain of large pores8
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FIGURE 10-2 Sebaceous hyperplasias are enlarged oil glands that look like a small papule with a central umbilication They can be confused with basal cell carcinoma
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SEBACEOUS GLANDS
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SGs are uni- or multilobular entities usually associated with hair follicles that, with hair follicles, form a structure known as the pilosebaceous unit The number of SGs remains approximately the same throughout life, whereas their size tends to increase with age SGs vary in size and are located throughout the body except the palms and soles The highest concentration of SGs is found on the face and scalp, but few are found on the lips (This is important because the lips have lower vitamin E levels than the rest of the face because of the lack of sebum) Although they are most frequently associated with hair follicles, SGs are found in some nonhair-bearing or glabrous areas such as the eyelids, where they are called meibomian glands (Table 10-1)
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TABLE 10-2 Sebaceous Gland Functions Production of sebum11 Integrity of skin barrier12 Regulation of steroidogenesis12 14 Expression of pro- and anti-in ammatory properties12,17,18 Selective control on the action of cutaneous hormones13 Regulation of neuropeptides15 Transports antioxidants to skin surface in the form of vitamin E16 Protects keratinocytes against UVB irradiation16 Innate antimicrobial activity10
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TABLE 10-4 Composition of Human Sebum Compared to Epidermal Lipids EPIDERMAL LIPID Triglycerides, diglycerides, and free fatty acids Wax esters Squalene Cholesterol SEBUM WEIGHT (%) 57
SURFACE LIPID WEIGHT
26 12 2
COSMETIC DERMATOLOGY: PRINCIPLES AND PRACTICE
whereas the size tends to increase with age
SG Count
SG count can reach as high as 400 to 900 glands per cm2 on the face and less than 100 glands per cm2 elsewhere in the body19 Several studies have used different techniques to evaluate SG count Early studies that documented SG numbers used either of two techniques: the indirect or the direct Benfenati and Brilliantini,20 in their earliest study in 1939, and Powell and Beveridge,21 in 1970, used the indirect technique The number of lipid-producing orifices per cm2 of skin surface was measured using osmium tetroxide at room temperature to visualize the small areas of lipids on a collecting paper left over the skin surface for 7 minutes Adding the osmium tetroxide produced tiny black spots that were counted under a dissecting microscope The direct technique was used by Cunliffe et al in 1974 using a surface microscope22 They used a technique that involved staining the skin with Oil Red O (a lipophilic stain) and visualizing with a Leitz MZ surface microscope, which had a graticule attached to the eyepiece allowing the diameter of the pilosebaceous duct exit to be measured A summary of the techniques and results is displayed in Table 10-3 As stated above, the number of SGs remains almost constant throughout life,
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