Are There Any Safe and Effective Treatments for Seborrhea (Oily Skin)?
Nonprescription Treatments Are Better for Mild and Moderate Cases of Seborrhea since Their Side Effects Are Less Severe
The Essential Information
Oily skin, known by its medical name, seborrhea, is a condition caused by an increase in the production of skin oil (sebum), leaving the skin feeling greasy and looking shiny.
Sebum has several uses, including lubricating the skin, protecting it from damage, and providing antibacterial properties. However, sometimes the production of sebum goes into overdrive, causing the skin to become excessively oily. Although oily skin is not a disease, people with oily skin are more prone to develop acne. And in some cases, people have very oily skin without suffering with acne, and look for treatments to cut down on oily and greasy skin.
Prescription treatments: Prescription treatments that significantly curb skin oil also come with major side effects, making their use controversial at best, and radically irresponsible at worst, when it comes to simply cutting down on "shiny" skin.
Nonprescription treatments: Nonprescription treatments are less worrisome and come with fewer side effects, but some can still present complicated challenges in determining whether their use is justified to simply cut down on unwanted shine.
There are several factors that control the production of sebum. The most significant of these factors are hormones, both male and female, which interact with sebum-producing cells called sebocytes and can increase or suppress sebum production. Androgens are the most well-studied hormones that stimulate sebum production. These hormones are produced in the adrenal glands, gonads, and in sebaceous glands, where sebum is produced. The two most active androgens are testosterone and dihydrotestosterone (DHT), which can interact with sebocytes and stimulate sebum production. There is some evidence pointing toward the possibility that sebum production may also be affected through lifestyle factors, such as excess sugar or caloric consumption.1 As seborrhea is not a disease, milder cases are not usually treated with a prescription medication. Only severe cases of seborrhea, in conjunction with other true diseases, are treated with prescription medications. Depending on whether seborrhea is severe or mild, there are two types of treatments for oily skin. For severe cases of seborrhea, prescription treatments are available. People with mild seborrhea may benefit from nonprescription treatments like topical green tea, Botox® injections, or electrothermolysis.
Prescription Treatments for Oily Skin
People with oily skin are also more likely to suffer from acne, so some prescription acne treatments may be useful in the treatment of seborrhea. Scientists have developed two main prescription treatments for acne that can also be used to treat oily skin. These treatments are isotretinoin and hormonal therapies.
Isotretinoin (13-cis-retinoic acid) is an oral medication that doctors prescribe for people with severe acne. Commonly known by its brand name, Accutane, isotretinoin belongs to a class of chemical compounds called retinoids. Retinoids comprise several naturally occurring molecules, including vitamin A (retinol) as well as synthetically produced molecules, such as isotretinoin. In the cell, retinoids like isotretinoin can stop cell division and growth, reduce the size of the sebaceous glands, and suppress sebum production. In fact, isotretinoin is the most powerful prescription medication that suppresses the secretion of sebum. Although it is effective in reducing the size of sebaceous glands and suppressing the production of sebum in as little as eight weeks of treatment, isotretinoin causes severe side effects and is the number one birth defect-causing medication on the market.
A 2003 study published in the Journal of Deutsche Dermatologische Gesellschaft examined how well isotretinoin can reduce sebum production. The researchers performed this study by providing 11 patients with various amounts of isotretinoin daily for six months and then monitoring sebum production during that time period. They concluded that even the lowest dosage of isotretinoin (2.5mg three times per week) resulted in a decrease in sebum production, skin lesions, and size of sebaceous glands. In fact, isotretinoin caused the average size of sebaceous glands to reduce by approximately 50%. Although this study was performed on a small number of patients, it proved that even low doses of isotretinoin can be effective in the treatment of seborrhea.2,3
Hormones are the main regulators of sebum production, so hormonal treatments can be used to reduce sebum production. There are three basic types of therapies to reduce sebum secretion: antiandrogens, inhibitors of androgen synthesis in the ovaries and adrenal glands, and inhibitors of androgen synthesis in the skin. Although hormonal treatments help with seborrhea, they are recommended only to women because hormonal therapies usually cause men to develop feminine characteristics like enlarged breasts.4,5
Androgens are male sex hormones found in both males and females that can cause an increase in sebum production. Antiandrogens are compounds that block androgen function, which then causes a reduction in sebum production. There are several approved oral prescription antiandrogens, including cyproterone acetate (CPA), spironolactone, and flutamide.4
- CPA works by suppressing the production of DHT, which reduces sebum production and changes the composition of sebum, usually by increasing the amount of the lipid, linoleic acid. Doctors usually prescribe CPA at a 2 - 100mg daily dosage and combine it with an oral contraceptive (a birth control pill). Side effects of CPA include nausea, vomiting, fluid retention, swelling of the legs, headache, tiredness, liver dysfunction, shortness of breath, and blood clotting disorders.
- Spironolactone works by suppressing the production of DHT to reduce sebum production by 30 - 50% in dosages of 50 - 100mg, taken twice daily. Doctors usually prescribe spironolactone to be taken as a twice daily dosage of 25 - 100mg. Side effects of spironolactone include breast tenderness and menstrual irregularities.
- Flutamide is a potent antiandrogen that reduces sebum production. Doctors prescribe it at a 250mg twice-daily dosage to treat a variety of conditions, including prostate cancer, acne, excessive hair growth, and male baldness. However, flutamide comes with serious side effects, including liver damage, which limits its use.
Inhibitors of androgen synthesis in the ovaries and adrenal glands
Androgens are produced in the ovaries and the adrenal glands. Oral contraceptives, glucocorticoids, and gonadotropins are three treatments that can be used to block androgen synthesis in these regions and therefore reduce sebum production.5
- Oral contraceptives (OCs) are used to suppress ovulation and to treat moderate acne. OCs contain two types of hormones called estrogen and progestin. High doses of estrogen can inhibit the production of androgen in the ovaries, which then causes a reduction in sebum production. However, the dose of estrogen required to suppress sebum production is much higher than the dose needed to suppress ovulation, meaning specific OCs like Diane® or Dianette®--which contain the appropriate doses of sebum-suppressing hormones--are highly effective to suppress sebum and treat acne. However, OCs come with potentially serious side effects, including blood clots, stroke, and heart attack.
- Glucocorticoids are steroid hormones that can suppress androgen synthesis within the adrenal glands. The two most common steroids used for sebum suppression include prednisone at a 2.5 - 5mg daily dosage and dexamethasone at a 0.25 - 0.75mg daily dosage. Glucocorticoids can cause adverse side effects like increased bone loss, delayed wound healing, muscle weakness, and increased risks of infection. Because glucocorticoids are steroids, they are inadvisable to take in the long term.
- Gonadotropins, such as buserelin, nafarelin, and leuprolide, work to block ovulation and prevent androgen production in the ovaries. Although these hormones are effective in the treatment of acne through the reduction of androgens, these hormones also decrease the production of estrogens. As estrogens possess a natural ability to suppress sebum production, gonadotropins may not be the best treatment for oily skin. They also come with side effects that include limiting the ovarian function of patients, which could lead to early menopausal symptoms. Because of these severe side effects, long-term usage of these hormones is not recommended.
Inhibitors of androgen synthesis in the skin
Currently no Food and Drug Administration (FDA) - approved drugs exist that inhibit androgen synthesis in the skin. However, scientists are working to develop new androgen-processing inhibitors. Drugs within this class of androgen inhibitors work by targeting proteins within the skin that are responsible for producing androgens. By targeting androgen synthesis in the skin, researchers hope that they will be especially useful in the treatment of seborrhea. However, more research will need to be performed before these drugs can be released for public use.4
Nonprescription Treatments for Oily Skin
Several research groups have found that some naturally occurring compounds like topical green tea and botulinum toxin (Botox®) injections as well as a medical procedure called electrothermolysis can also reduce sebum production.
A 2010 study published in the Bosnian Journal of Basic Medical Science found that a three percent green tea extract decreased sebum production. Researchers performed this study by topically applying a three percent green tea extract to the cheeks of 16 healthy volunteers daily for eight weeks. They found that green tea extract decreased sebum production by blocking the formation of DHT.
A separate 1995 study published in the journal of Biochemical and Biophysical Research Communications also found that green tea extracts suppress sebum production by inhibiting the synthesis of DHT. They found that the green tea compound responsible for blocking DHT synthesis is called epigallocatechin-3 gallate (EGCG). Without the potent androgen DHT, much sebum could not be produced.6,7
A 2013 study published in the journal of Dermatologic Surgery investigated the effect of botulinum toxin, which is used for Botox® injections on sebum production. Botulinum toxin works by interacting with and blocking nerve impulses from nerve cells. These nerve impulses normally signal the cells within the sebaceous glands to produce sebum, so the researchers wanted to see if blocking these nerve impulses with botulinum toxin would result in decreased sebum production. To perform this study, botulinum toxin was injected 10 times in a linear arrangement across the foreheads of 25 patients with oily skin.
Before and after the injections the researchers measured facial sebum levels. One week following the injections, sebum production had decreased by 75%. One month after the treatment was an 80% decrease in sebum production. Even three months following the injections the production of sebum was 59% lower than before the treatment. Therefore, the researchers concluded that botulinum toxin injections may be a promising new treatment for oily skin.8
Electrothermolysis is a procedure that involves inserting a long, thin needle into the skin pore and zapping a small electric current to the pore repeatedly. Overall, this procedure involves nearly 700 needle injections into enlarged pores, acne lesions, and throughout the cheek and forehead skin. The purpose of electrothermolysis is to damage the sebaceous glands and therefore reduce sebum production.
A 2007 study published in the journal of Dermatologic Surgery examined the effect of electrothermolysis on sebum production in 15 women over the course of six months. After the women received four treatment sessions of electrothermolysis at one- or two-month intervals, the researchers found that sebum production had decreased by 31.5%.9
Seborrhea (oily skin) is a condition of increased sebum production that causes enlargement of skin pores and a greasy skin appearance. Although a balanced amount of sebum is crucial for proper skin health, people with oily skin are predisposed to develop acne. Many factors are involved in the production of sebum, but hormones are the dominant mechanism. Therefore, many, but not all, of the main prescription treatments for seborrhea work by targeting the hormones responsible for the production of sebum. The prescription treatments available to treat seborrhea include isotretinoin and hormonal therapies like androgen blockers, oral contraceptives, and glucocorticoids. Other nonprescription options like green tea extract, botulinum toxin injections, and electrothermolysis treatments also exist to treat oily skin. Although both the prescription and nonprescription treatments present side effects, the prescription medications' side effects are much more severe, preventing long-term use of these treatments. So until scientists can develop newer, safer pharmaceutical therapies, these nonprescription options may be safer for people with mild to moderate seborrhea.
- Makrantonaki, E., Ganceviciene, R. & Zouboulis, C. C. An update on the role of the sebaceous gland in the pathogenesis of acne. Dermatoendocrinol 3, 41 - 49 (2011).
- Geissler, S. E., Michelsen, S. & Plewig, G. Very low dose of isotretinoin is effective in controlling seborrhea. J Dtsch Dermatol Ges 19, 952 - 958 (2003).
- Zouboulis, C. C. Retinoids - Which Dermatological Indications Will Benefit in the Near Future? Skin Pharmacol Appl Skin Physiol 14, 303 - 315 (2001).
- Thiboutot, D. & Chen, W. C. Update and Future of Hormonal Therapy in Acne. Dermatology 206, 57 - 67 (2003).
- Katsambas, A. D. & Dessinioti, C. Hormonal therapy for acne: why not as first line therapy? Facts and controversies. Clin Dermatol 28, 17 - 23 (2010).
- Mahmood, T., Akhtar, N., Khan, B. A., Khan, H. M. & Saeed, T. Outcomes of 3% green tea emulsion on skin sebum production in male volunteers. Bosn J Basic Med Sci 10, 260 - 264 (2010).
- Liao, S. & Hiipakka, R. A. Selective inhibition of steroid 5α-reductase isozymes by tea epicathecin-3-gallate and epigallocatechin-3-gallate. Biochem Biophys Res Commun 214, 833 - 838 (1995).
- Rose, A. E. & Goldberg, D. J. Safety and Efficacy of Intradermal Injection of Botulinum Toxin for the Treatment of Oily Skin. Dermatol Surg 39, 443 - 448 (2013).
- Kobayashi, T. & Tamada, S. Selective Electrothermolyis of the Sebaceous Glands: Treatment of Facial Seborrhea. Dermatol Surg 33, 169 - 177 (2007).
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