Acne is one of the most common skin diseases

Acne (acne) is one of the most common skin diseases in the practice of a dermatologist.

It occurs more often in young people during puberty, but can affect the skin at a more mature age, often leading to the formation of cosmetic defects (spots, scars) and emotional discomfort. According to statistics, acne affects up to 80% of the population aged 12 to 25 years, and approximately 30-40% of people over 25 years of age.

The disease is based on chronic inflammation of the sebaceous glands, resulting from their blockage, increased sebum production (seborrhea) and exposure to the bacteria Propionibacterium acnes.

Where is increased fat content possible?

The content of the article

Problem areas:

• upper back;
• facial part, especially the chin, forehead and cheeks;
• cervical and thoracic parts of the body;
• genitals in both sexes;
• peripapillary zone.

These are the most common and most common, but there may be others. The only places on the body where acne cannot appear are the palms and feet. Due to the too thick and rough layer of the epidermis, incapable of this kind of inflammation.

How do changes in the functioning of the sebaceous glands affect the condition of the skin?

Changes in sebum secretion are one of the factors in the development of acne. Sebocytes in the sebaceous glands synthesize free fatty acids even without the participation of propionibacteria. This makes it likely that aseptic inflammation will develop without the presence of a bacterial component.

With hyperseborrhea, not only the amount of sebum produced changes, but also its composition, in particular, the content of linoleic acid in it decreases. Its deficiency can cause follicular hyperkeratosis40. This is due to the ability of linoleic acid to regulate keratinocyte differentiation10.

Regulation of the level of sebum secretion is also entrusted to hormones. Estrogens suppress, and progesterone and androgens, on the contrary, stimulate the process of sebum production.

Against the background of hyperseborrhea and increased keratinization of the skin, inflammation and blockage of the sebaceous gland channels occurs. Since it becomes impossible for air to get inside them, conditions are created for the proliferation of P. Acnes10.

Causes

• Dry skin;
• Hormonal changes in the whole body;
• Infection;
• Too much sebum production.

In addition to these reasons, there is another factor that was recently established by scientists - heredity.

Let's look at each reason in more detail.

Dry skin

One of the most common reasons. Due to dryness, the skin exfoliates and its particles clog the pores, which causes inflammation. It is very important to consider several points that cause excessive dry skin:

• Age. Over the years, the skin gradually loses many of its important properties, which include moisture retention.
• Environment. Dry and cold air, low humidity, and so on.
• Shower with hot water. Leads to the destruction of the protective layer of the skin.
• Allergic diseases.
• Hygiene products. Using regular soap on sensitive areas of the skin: facial skin, intimate areas, can cause dryness and cause acne.

Hormonal background

The reason lies in the incorrect proportion of sex hormones in the blood. Androgens (male hormones) play a very important role here. If their level is exceeded, then excess secretion begins from the sebaceous and sweat glands, which is the reason for the appearance of acne. You can also isolate progesterone, a hormone secreted in pregnant women. Leads to clogging of pores and, as a result, sebaceous inflammation appears.

Lack of estrogen can also cause excessive oily skin.

What do people with oily skin suffer from?

If you have oily skin, it means that the sebaceous glands on your face produce too much sebum. In addition, they can expand and become clogged with comedones. Such skin appears to be covered with mini-craters and looks unaesthetic. At the same time, the oiliness of the skin surface itself does not indicate that you will definitely have acne.

In some cases, after washing, a feeling of tightness may occur, this indicates a violation of the lipid barrier of the epidermis - a lack of ceramides in it, which are responsible for creating a protective film on the skin.

The lipid barrier could be damaged as a result of improper care, for example, frequent use of aggressive lotions containing alcohol.

Sebum production

There are 3 factors that can affect the amount of sebum production. Androgen, or rather its excess in the blood, is one of the reasons. Rarely, but still there is a special disease called “seborrhea”. And of course, a very common cause in the 21st century is poor nutrition.

Here is a list of products that promote the active secretion of sebum:

• carbonated drinks;
• alcoholic drinks;
• products in the production of which dyes were used;
• caffeinated drinks (black tea, coffee;
• sweet and flour;
• spicy, smoked food.

What are sebaceous glands?

Each hair is equipped with a sebaceous gland, and sometimes more than one. Their excretory ducts open in the hair follicle and release about 20 g of sebum per day. The composition of sebum includes29:

• fatty acid;
• glycerol;
• alcohols;
• wax esters;
• cholesterol;
• metabolites of steroid hormones, etc.

Sebaceous glands are located almost throughout the body, but their largest number is on the face, back, and scalp. These zones are called seborrheic. At the same time, their smallest number is on the border of the lips, the back of the hands, but on the soles and palms there are none at all. 29

In seborrheic areas, the density of sebaceous glands can reach 900 per 1 cm2. The sebaceous glands begin to manifest their functions as actively as possible in adolescence; this period can last up to 25 years. 29

When secretory function is disrupted, skin problems begin. If there is not enough sebum secreted, it flakes off, and signs of aging appear faster. And when too much content of the sebaceous glands is secreted, rashes may appear. 29

Sebocytes (cells of the sebaceous glands) are sensitive to sex steroid hormones. The cytoplasm of their cells contains enzymes that convert androgens into dihydrotestosterone, which promotes the secretion of more sebum. 29

Treatment and prevention

It would be best and safest to contact a competent doctor - an endocrinologist, so that further treatment takes place under his strict supervision. You will have to start with a healthy diet that limits the consumption of foods that are harmful to good skin condition. And it won’t hurt to start special cosmetic skin care.

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The mechanism of acne

When there is too much secretion, the duct of the sebaceous gland becomes clogged with a plug
made of particles of keratin, the building material of hair, adhered to the sebum, exfoliated in the hair follicle.
As the process of cell division in the gland continues, and the outflow of secretions worsens due to the keratin plug, the gland begins to overflow. Sebum accumulated in the gland attracts bacteria
living on the surface of the skin and in the sebaceous glands of any person. Usually there is not enough food for their active reproduction, and the bacteria do not cause any harm. But the clogged sebaceous gland becomes an ideal food supply for them. As a result, bacteria begin to multiply rapidly. The immune system responds to the appearance of a large colony of bacteria with an inflammatory reaction - which is precisely what is observed in the form of acne.

How to fight?

One of the most common methods of dealing with acne is squeezing it out. Beauty salons even provide deep facial cleansing services, which supposedly helps get rid of acne forever. However, such procedures do not affect any of the factors in the formation of acne. The improvement is only temporary
and does not affect the further development of the disease.
Some cosmetic products allow you to gently remove the keratin plug from the sebaceous gland duct, improving the outflow of secretions and preventing the proliferation of bacteria. There are also products with an antibacterial effect that continue to act even when inflammation has already begun in the sebaceous gland. A qualified dermatologist will select products
suitable for your specific skin type and severity of symptoms. But if these measures are not enough, then the treatment of acne requires serious medical intervention and the use of special medications.

Acne severity

The severity of the disease is most often assessed using the Cook method - mild, moderate and severe.

- mild degree is diagnosed mainly in the presence of non-inflammatory elements - closed and open elements. With this degree of severity, it is possible to have less than 10 papulopustular elements on the facial skin.

- moderate severity of acne is characterized by the presence of papulopustular elements on the face and / or torso in an amount of more than 10, but less than 40.

- severe degree is characterized by the presence of more than 40 papulopustular elements, as well as conglobate and cystic acne.

How to prevent it?

Despite the fact that the level of gland secretion is genetically determined, the appearance of acne can be reduced by reducing risk factors
. First of all, by reducing the intake of substances into the body that provoke an increase in the secretion of the sebaceous glands. The main ones are: - large amounts of spicy and salty foods, - added sugar and chocolate, - nicotine and other toxic substances from tobacco smoke. - alcohol. This is another reason why teenagers should avoid drinking and smoking. But the hygiene factor in the prevention of acne is far from leading. Bacteria will remain on the skin in any case, no matter how thoroughly a person washes his face.

Clinical picture of acne

Acne rashes are divided into non-inflammatory (open or closed comedones), inflammatory (papules, pustules, nodes) and post-inflammatory (scars, hypo- and hyperpigmentation).

Comedones are non-inflammatory elements resulting from blockage of the mouths of hair follicles. Slightly expressed comedones are a physiological phenomenon. At the beginning of the development of acne, microcomedones transform into so-called “closed” comedones, that is, those that do not have free communication with the surface of the skin. They are non-inflammatory nodules with a dense consistency, up to 2 mm in diameter, consisting of sebum, horny scales and bacterial bodies. “Open” comedones look like yellowish-black dots. The black-colored tip of an open comedone is made of melanin, not debris.

Papules are a red inflammatory element, rising above the surface of the skin, of a hard consistency with a diameter of up to 0.5 cm.

Pustules are an inflammatory element with purulent contents, having a hemispherical shape. Typically resolve without scar formation, post-inflammatory hyperpigmentation may occur.

Nodes are convex, painful formations of a red-violet color, filled with contents of pus and sebum. They often leave scars.

Most patients have comedonal and papulopustular forms of acne. All others are relatively rare, but also deserve attention.

Conglobate acne is a severe form of acne, most common in men aged 20 to 30 years. They are localized mainly on the back, less often on the face and chest. It is characterized by the gradual appearance of multiple extensive, deeply located nodular cystic elements. They can merge. Some of them retain a dense consistency, others soften during development and open with the release of purulent exudate. After healing, stagnant bluish-colored spots persist for quite a long time and scars remain.

Excoriated acne - this form occurs mainly in patients against the background of constant attempts to remove any, even minimal, manifestations of acne. It is characterized by a small number of typical acne formations on the skin and a large number of wounds covered with crusts.

Introduction

One of the most common problems in dermatology is oily skin, for which there is always a demand for effective treatment options. This review article focuses on numerous topical treatment options such as retinoids, olemacostat-glosatril, and various cosmeceuticals. Several systemic and procedural methods are also discussed and include isotretinoin, spironolactone, oral contraceptives, botulinum toxin, photodynamic therapy, and lasers. Each treatment option is analyzed in terms of its proposed mechanism of action, effectiveness reported in the literature, and potential side effects. Oily skin is a common dermatological problem that affects a variety of patients, including non-acne patients with enlarged facial pores and greasy skin. . Even a quick search for oily skin care products on Amazon.com offers 9,907 products to treat oily skin. The price range for these products ranges from a few dollars to almost $1,000. One of the more expensive products is marketed as "an anti-aging lotion that combines modern technology with traditional knowledge of healing ingredients for oily or acne-prone skin." Regardless of whether consumers agree with these statements, the need for effective treatment for oily skin remains. Unfortunately, it is difficult to explain why some people suffer from excessive sebum production and others from excessively dry skin. Many factors have been proposed to play a significant role in the pathogenesis of oily skin. This makes creating any one effective treatment challenging. This article reviews the physiology of the sebaceous glands and current and emerging treatment options that can be offered to patients suffering from oily skin. It should be noted that specific generic products are not reviewed individually due to a lack of objective data. Rather, the individual active ingredients are discussed impartially.

Structure and physiology of the sebaceous gland

In addition to the free sebaceous glands on the lips (Fordyce granules), eyelids (meibomian glands), areolas of the mammary glands (Montgomery tubercles), labia minora and foreskin (tysonian glands), the canal of the remaining sebaceous glands connects to the funnel-shaped hair follicle. These glands are highly concentrated behind the ear, on the face, chest and back, which coincides with the location of acne. The main cells containing the sebaceous glands are sebocytes, the breakdown of which releases sebum according to the type of holocrylic secretion. Tallow is a viscous liquid consisting of squalene, wax esters, triglycerides, free fatty acids, cholesterol esters and free sterols. The amount of sebum a person produces varies throughout their life. Sebaceous glands are present at birth, when there is already a relatively high production of sebum. Shortly after birth, sebum production decreases until puberty, when it increases sharply again. Subsequently, sebum production does not decrease until the onset of menopause in women and until the sixth or seventh decade in men. Androgens, especially 5α-dihydrotestosterone, play an important role in the differentiation and proliferation of the sebaceous glands, as well as in the production of sebum. The average rate of sebum production in adults is 1 mg/10 cm2 every three hours. When the level of sebum production decreases to less than 0.5 mg/10 cm2 every three hours, patients show signs of xerosis or dry skin. Conversely, when sebum production exceeds 1.5 mg/10 cm2 every three hours, it is regarded as excessive and leads to seborrhea or oily skin. The rate of sebum production varies greatly between individuals, and the explanation for why this occurs remains to be seen. Several factors have been described and can be used to explain to some patients why their skin may be oilier than others (Table 1). Men have higher sebum production due to higher testosterone levels, although production sebum increases during ovulation in women, which is likely secondary to increased progesterone. Sebum production also varies depending on the environment and time of year. Several studies have described an increase in sebum production during spring and summer and in wetter climates. Overall, in terms of race, Chinese women have noticeably smaller pore sizes and lower sebaceous gland density, while black women have larger pore sizes, which explains their higher rates of sebum production.

Table 1. Risk factors for oily skin

Topicals for oily skin

Retinoids. Topical retinoids contain vitamin A (retinol), its natural derivatives such as retinaldehyde, retinoic acid and retinyl esters, or synthetic vitamin A derivatives such as adapalene and tazarotene. Their effects on the skin are mediated by their interaction with specific nucleic acid receptors. In human skin, the retinoic acid receptor (RAR) family consists of three forms: RAR-a, RAR-β and RAR-γ. RAR receptors interact with the retinoid X receptor (RXR) to form heterodimers. RAR-γ constitutes approximately 90% of the RARs in the epidermis, and RXR-a constitutes approximately 90% of the RXR. Thus, human skin is primarily regulated by paired heterodimers consisting of RAR-γ and RXR-a. These heterodimers continue to bind to a specific region in deoxyribonucleic acid (DNA) known as retinoic acid response elements (RAREs). Upon binding, transcription of genes encoding proteins necessary for the restoration of photomemorable skin, growth and differentiation of keratinocytes, anti-inflammatory effects and suppression of sebum production occurs. Already in the 1970s, reports of the use of topical retinoids for various skin conditions, especially acne, began to appear more frequently. Although the role of retinoids in the growth and differentiation of keratinocytes has been widely recognized for several decades, their influence on the biological function of sebocytes continues to be studied. Retinoid receptors such as RAR-a, RAR-γ and RXR-a, β and γ have been identified in human sebocytes. In vitro, retinoids significantly reduce the proliferation and differentiation of sebocytes and the synthesis of sebum. In vivo studies and clinical experience with topical retinoids have shown their ability to cause dry skin, but there is no direct evidence of a reduction in sebum production. Dry skin is hypothesized to result from normalization of keratinocyte differentiation and proliferation and decreased adhesion of keratinocytes to each other, leading to the formation of flaky skin. skin. It can also be hypothesized that retinoids also bind to retinoid receptors on sebocytes, resulting in decreased sebum production. Both tazarotene and tretinoin have been reported to reduce facial pore size. This is important because larger pores have a direct connection with increased sebum production. Kang et al reported that 42% of patients treated with tazarotene once daily for 24 weeks achieved pore size reduction on a scale of 5. This is significant compared to a 20% reduction in pore size in patients receiving a placebo. Another study found a significant reduction in pore size using a dermoscopic analyzer after 60 women used thyretinoin 0.025% cream once daily for 90 days. The above evidence and discussion make topical retinoids viable for treating oily skin.

Olumacostat glasaretil (DRM01). Dermira. The biopharmaceutical company recently published encouraging data from a phase 2b study conducted for the topical sebum inhibitor, olumacostat glasaretil (OG, formerly DRM01). This new small molecule functions by inhibiting acetyl coenzyme A carboxylase in sebocytes. This enzyme catalyzes the first stage of fatty acid synthesis. In addition, in animal studies, the topical drug Dermira gradually reduced the size of the sebaceous glands. Although this molecule was "designed to inhibit sebum production when applied topically," it was able to reduce the incidence of inflammatory and non-inflammatory acne after a 12-week course. Dermira is reported to be well tolerated with no serious treatment-related side effects and can be used as a topical treatment for oily skin

Cosmeceuticals. Numerous cosmetic products and ingredients are suggested for use in reducing oily skin, but only evidence-based research will be reviewed in this discussion. Draelos et al conducted a double-blind, placebo-controlled study of topical niacinamide 2% significantly reducing sebum excretion levels after 2 and 4 weeks of use. Although topical niacinamide may be beneficial for people with oily skin, further research is needed to explore the mechanism of action and develop the optimal treatment regimen.

Green tea is another cosmeceutical ingredient with some evidence of use for oily skin. In one small study, 10 patients used a 3% green tea emulsion for 8 weeks. When assessing facial skin using a sebemeter (a non-invasive photometric device), there was a significant reduction in sebum production compared to baseline. A slightly larger study with 22 participants also found a significant reduction in sebum secretion after 60 days of using a topical green tea emulsion. Topical cosmeceuticals containing green tea may be beneficial for patients with oily skin.

L-carnitine is also becoming increasingly popular in discussions of potential ingredients that can reduce the appearance of oily skin. Naturally produced in the body, L-carnitine is capable of increasing β-oxidation, the catabolic process by which fatty acids are broken down. Topical 2% L-carnitine has been shown to significantly reduce intracellular fatty acids in human sebocytes and lead to a significant reduction in sebum. Although further research is needed to evaluate the effectiveness of L-carnitine's sebum suppressive properties, it is justified to recommend it to patients with oily skin.

Systemic preparations for oily skin

Isotretinoin. Also known as 13-cis-retinoic acid, isotretinoin is an oral retinoid that has been proven to produce the greatest reduction in sebum of any other treatment option mentioned. As described above, when considering topical retinoids, 13-cis-retinoic acid has also been shown to be able to reduce the size and secretion of sebaceous glands. During oral isotretinoin therapy, sebum production is reduced by 90%, making the drug effective even in patients with severe seborrhea. One year after completion of isotretinoin therapy, the amount of sebum excretion was found to remain significantly suppressed in most people. A lower dose of isotretinoin (<0.5 mg/kg/day) is often used in the treatment of oily skin alone without nodulocystic acne, but this lower dose is clearly associated with a higher recurrence rate. Overall, up to 17% of patients require repeat courses of oral isotretinoin despite achieving the recommended cumulative dose of 120 to 150 mg/kg. Regardless of the severity of oily skin, all patients should be reminded that significantly reducing sebum production does not come without side effects. Most often, patients will experience generalized dry skin, dry and cracked lips, xerophthalmia, and secondary skin infections. Clinicians should educate their patients and provide advice to minimize these common side effects. One of the main side effects that the patient should be informed about before starting oral isotretinoin is teratogenicity, the risk of which cannot be excluded even at low doses. To avoid this risk, sexually active women should use two forms of contraception and undergo pregnancy testing at the beginning and one month before ending therapy.

Spironolactone. Although this potassium-sparing diuretic has been classically used medically as an antihypertensive agent, it is increasingly used by dermatologists to treat oily skin, acne, hirsutism, and androgenetic alopecia in women. Spironolactone has been shown to directly reduce sebum production at dosages of 50 to 200 mg per day. In addition to being an alderosterone antagonist, spironolactone also functions as an androgen receptor blocker and a 5a-reductase inhibitor. Human sebocytes contain 5a-reductase type 1, which converts testosterone to the powerful androgen 5a-dihydrotestosterone (DHT). This androgen plays an important role in inducing sebocyte proliferation. Thus, by inhibiting DHT production and blocking testosterone and DHT from binding to sebocytes, spironolactone has been shown to inhibit sebocyte proliferation in a dose-dependent manner. Before prescribing spironolactone to a patient with oily skin, it is necessary to consider its side effects. The eight-year study reported no serious ongoing or long-term complications associated with spironolactone in the treatment of acne. However, minor side effects were reported in 59% of subjects, with menstrual irregularities among the most common. Hyperkalemia was frequently observed. However, a retrospective study of 974 healthy women taking spironolactone for acne found that hyperkalemia was reported in only 0.72% of analyzes compared with 0.76% of controls. Given these results and other similar reports, many dermatologists consider routine potassium monitoring unnecessary for healthy women taking spironolactone, but ultimately laboratory monitoring remains at the discretion of the individual physician. Given that spironolactone has endocrine effects, it is likely that it may increase the risk of developing hormone-dependent cancers such as breast, ovarian or endometrial cancer. Contrary to this notion, a large cohort of more than 74,000 patients treated with spironolactone showed no evidence of an increased risk of breast, ovarian, or endometrial cancer. These results were confirmed by a number of other recent studies that examined the potential relationship between spironolactone and the risk of hormone-related cancers. Overall, spironolactone is a safe systemic drug for healthy women seeking treatment for oily skin.

Oral contraceptives. Oral contraceptives are beneficial for oily skin because they lead to a decrease in ovarian and adrenal hormones and increase sex hormone-binding globulin, which limits free testosterone. As described above, androgens stimulate the proliferation of sebocytes and promote seborrhea. Estrogens have been found to have an inhibitory effect on sebaceous gland overactivity in vivo. In order to avoid the risk of endometrial hyperplasia, or even cancer, which may result from estrogens, they must be used in combination with a progestin. It is important to consider which progestin is in combined oral contraceptives, as some progestins have their own androgenic activity. Levonorgestrel, desogestrel, norgestimate and norethindrone have the lowest androgenic activity. Some newer progestins, such as drospirenone or cyproterone acetate, are even androgen receptor antagonists and exhibit antiandrogenic properties. Several studies have shown that oral contraceptives actually reduce facial oiliness. In a double-blind, randomized study of 128 women receiving either the ethinyl estradiol/drospirenone combination or the ethinyl estradiol/cyproterone acetate combination, both drugs significantly reduced sebum production. Katz et al found a 60% relative reduction in cheek sebum production and a relative reduction in forehead sebum production in 41 women after six cycles of the ethinyl estradiol/desogestrel combination. Using this same combination of oral contraceptives has also been shown to improve oily skin after just one cycle of treatment. Before starting an oral contraceptive, be aware of the potential increased risk of venous thromboembolism. Newer oral contraceptives have reduced the dose of estrogen in an attempt to eliminate this risk. Some of the most common side effects of oral contraceptives include nausea, breast softening, and menstrual irregularities. Using a combination of oral contraceptives that contains the lowest dose of each hormone can limit or even prevent these common side effects while maintaining improved facial skin.

Other treatments for oily skin

Botulinum toxin. Over the past few years, several studies have evaluated the effectiveness of botulinum toxin for the treatment of oily skin with promising results. One of the first reports in the literature regarding the effectiveness of botulinum toxin for oily skin appeared in 2008 .

A retrospective study was conducted in which 20 patients with oily skin and large pores were evaluated after intradermal botulinum toxin A in the T-zones. One month after treatment, 17 of 20 patients had a photographic improvement in oily skin and a reduction in pore size, and also reported a subjective decrease in sebum production . Li et al later performed a double-blind, split-face study in 20 individuals and found a marked reduction in sebum production on the botulinum toxin-treated side. Another significant prospective study evaluated 25 patients with oily skin who received intradermal injections of botulinum toxin into the frontal area and showed significantly lower sebum production. Additionally, 91% of subjects were satisfied with intradermal botulinum toxin as a treatment for their oily skin. The mechanism of action of botulinum toxin is its ability to cleave proteins involved in the fusion of vesicles with the plasma membrane of the axon terminal of the presynaptic neuron. These vesicles contain acetylcholine, and botulinum toxin blocks the release of this neurotransmitter into the synaptic cleft, where it normally binds to the muscarinic receptor in the postsynaptic cell. In the sebaceous glands, both immature and mature sebocytes have muscarinic acetylcholine receptors, which are important for sebocyte differentiation and skin production lard 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 δ-aminolevulinic acid (ALA) is used by some to treat acne. ALA is preferentially absorbed by hair follicles, and sebocytes metabolize ALA to photosensitive protoporphyrin IX (PplX). When exposed to light, cytotoxic free radicals are formed, which lead to cell destruction and apoptosis of sebocytes. Despite extensive evidence showing improvement in acne, several studies have failed to demonstrate a significant reduction in sebum production after PDT with ALA. However, one study found that lower sebum excretion persisted even 20 weeks after multiple PDT sessions, but not after a single PDT session. Histological evaluation after PDT revealed destruction of sebocytes and revealed smaller sebaceous glands at 20 weeks. PDT can be a valuable tool to offer to patients with oily skin.

Lasers. There are many different lasers on the market that may be suitable for patients with oily skin. For this purpose, the 1450 nm diode laser is one of the most widely studied lasers. Perez-Maldonado et al observed an 18 percent reduction in total sebum collected six weeks after three 1450 nm diode laser treatments. Another study found a significant reduction in sebum production in 26% of patients after 4 facial treatments using a 1450 nm diode laser. On the other hand, Lauby et al reported that 3 treatments with a 1450 nm diode laser did not lead to significant changes in sebum excretion. Diode laser is not the most effective of the treatment options reviewed, but it still offers a unique treatment option for eliminating oily skin.

Conclusion

Oily skin is a common complaint among dermatological patients. While the sebaceous glands play an integral role in the skin, they create problems in some patients when they are over-functioning. Numerous treatments exist to reduce sebum production, but a clear consensus on the preferred treatment regimen has not yet been described. Each treatment option has its own inherent advantages and disadvantages that should be discussed with patients as a whole, and treatment can be personalized for each patient. We hope that as knowledge about the complex pathogenesis of oily skin increases, newer and targeted treatments will be developed to more optimally treat oily skin.

How to prevent oily skin

Carefully re-read the main and probable causes of increased oily skin. If necessary, consult a specialist (general practitioner, endocrinologist or gastroenterologist).

Independent steps to correct oily skin:

1. Don't sunbathe!

Exposure to direct sunlight activates the sebaceous glands, because... the skin is protected from their aggressive effects.

UV rays have a temporary bactericidal effect, and subsequently a sharp relapse of the rash. Even if you were not previously prone to rashes, UV rays lead to a decrease in local immunity and activation of opportunistic microflora, which can trigger the appearance of acne.

1. Regular application of day cream with mineral protection factor

It is imperative to use a cream with SPF, the main thing is that the protection factor is physical and not chemical.

Chemical photo filters convert the energy of UV rays into heat, which has a detrimental effect on the functioning of the sebaceous glands.

Physical photo filters simply reflect UV rays without causing an increase in skin greasiness.

Tone cream SPF30 with zinc for the face DermaQuest - for those who do not like pale skin color. A cream based on micronized zinc oxide 18.6%, which contains pigments that give the skin a light tan.

1. Do not overdry the skin!

The use of aggressive cosmetics and procedures increases the risk of dehydration, which means a response from the sebaceous glands in the form of hyperproduction of sebum.

Daily use of cleansers with high percentages of acids, peelings with AHAs that activate the sebaceous glands, tonics with alcohol are enemies for skin with increased sebum production.

Use specialized toners for oily skin:

• Complete the cleansing process
• Restores skin pH – reduces the risk of new sebum production
• They have a sebum-regulating and at the same time moisturizing effect (which is also necessary - see the next point).

Spray serum for oily and problem skin “White willow and juniper” Circadia for daily care of oily skin with a serum effect. Regulates the functioning of the sebaceous glands, makes the skin matte, has a moisturizing and regenerating effect on the skin.

Teenagers can use the product as a moisturizing serum.

1. Regular skin moisturizing

Moisturizers are needed to avoid skin dehydration and compensatory release of sebum. Use moisturizers based on hydrants (substances that attract water), such as hyaluronic acid.

Serum B5 moisturizing mattifying for oily skin DermaQuest is a unique gel serum designed specifically for skin with an oily sheen. Micronized hyaluronic acid moisturizes and restores the skin, while Lilac Stem Cells and sebum regulators normalize sebum production.

The result is instantly hydrated and matte skin!