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Interestingly, sebum production is also affected by genetic make up In 1989, Walton et al suggested in one study that acne development is mediated by genetic factors and only modified by environmental factors58 Their study of 20 pairs of homozygous twins versus 20 pairs of heterozygous twins demonstrated equal sebum excretion in the 20 identical pairs; however, the identical twins exhibited different acne severity showing an environmental influence in acne development Conversely, the acne severity and sebum excretion parameters in the 20 nonidentical pairs of twins were significantly different This study suggested that sebum excretion is under genetic control, but that environmental factors play a role in acne development In 2002, a study that examined 458 pairs of monozygotic twins and 1099 pairs of dizygotic twins implied a strong genetic component in acne59 This study did not consider sebum secretion rates; however, many studies have demonstrated increased sebum rates in acne patients60
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In early 1972, stress was shown to be associated with an increase in the amount of free fatty acids on the skin53 Since then, much work has been accomplished to evaluate the role of stress in sebum production and acne Corticotropin-releasing hormone (CRH), also known as a stress hormone, has been found in the SGs as has its receptor CRH-R54 CRH directly induces lipid synthesis and enhances the conversion of DHEAS to testosterone in sebocytes13,15 It is thought to play an impor-
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Predominance of an allele of the gene cytochrome P450 has been recently reported in patients with hyperseborrhea Cytochrome P450 is a large supergene family of enzymes involved in the metabolism of a wide range of endogenous and foreign compounds A mutation of cytochrome P450 could lead to accelerated degradation of natural retinoids, which could cause disordered SG maturation and secretion leading to oily skin61 More recently, B lymphocyte-induced maturation protein 1 (Blimp1), a transcription factor, was identified within the cells of the sebaceous glands One study revealed that Blimp1 acted by repressing c-myc gene expression in mice Mice without Blimp1 c-myc expression demonstrated an increased number of sebaceous gland-containing cells that divided more frequently Moreover, these SGs were enlarged, which in turn enhanced the numbers of sebum-producing sebocytes The Blimp1-containing cells were shown to be the progenitors for the entire sebaceous gland, and Blimp1 somehow controls this progenitor population, regulating how many cells are allowed into the gland Blimp1 is thought to act as an inhibitor for SG formation and secretion through repressing the c-myc gene This study strongly supports the genetic basis of sebum secretion rates62,63
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sonal variations in sebum secretion can confuse the issue65 Simple characterization, such as oily, dry, combination, and sensitive, based on subjective assessments is not a very useful tool for classifying skin types The data available on the various skin types by the early skin classification systems have been inconsistent No one system of classification was able to identify any prevalence or characterization of a specific skin type1 In 2005, a novel approach for assessment and categorization of skin types was published This method utilizes a validated questionnaire, known as the Baumann Skin Type Indicator (BSTI), to determine skin type66 (see 9)
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The BSTI is a comprehensive, selfadministered questionnaire divided into four parts The first part of the questionnaire determines the occurrence and severity of oily skin based on historical data Answers for each of the 11 questions are translated into a point system and accordingly the skin type is designated as either an oily (O) or a dry (D) type and assigned a score that determines severity of oiliness or dryness (Fig 10-5)
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When consumers shop for skin care products, they are often faced with choosing among products designed and marketed for oily, combination, or dry skin They are obligated to determine their skin s barrier status and sebum secretion rates without any available objective measurements In other words, they are forced to guess their skin type Such subjective classification is often incorrect One study enrolled 94 women for skin-type evaluation and compared the findings with the subjects own preconceived skin types The results showed that the subjective skin type does not match the amount of sebum secreted The amounts of sebum secretion measured by the Sebumeter were relatively higher than what was expected by the study subjects Moreover, for those who preconceived their skin type as dry, their skin type was determined to be oily by using the Sebumeter64 As mentioned above, patients estimation of their skin type is subject to many biases In addition, sea-
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