Can Acne Medications or Treatments Age the Skin?
We Still Do Not Know If Acne Medications and Treatments That Permanently Decrease Sebum (Skin Oil) Might Accelerate Aging
The Essential Information
Some common acne medications and treatments work by decreasing skin oil production, particularly these:
Isotretinoin (Accutane®) - An oral medication that is well-known to permanently shrink skin oil glands and decrease skin oil production.
Photodynamic therapy - A light-based therapy that may permanently damage skin oil glands and decrease skin oil production.
Laser therapy - Might also permanently damage skin oil glands and decrease skin oil production.
Since skin oil is such an integral part of skin health, it is important to know whether permanently impairing the skin's ability to produce skin oil can lead to undesirable effects, such as premature aging.
We know that as people age, the amount of skin oil that they produce decreases. The composition of the skin oil itself also changes. Due to a lack of long-term follow-up studies, scientists do not know whether medications like isotretinoin or procedures like photodynamic therapy or laser therapy will lead to premature aging, but it is something to consider when choosing an acne treatment.
The Bottom Line: Because we do not know if these medications and procedures will lead to premature aging or other problems, proceed cautiously when looking into how to treat your acne. If you have severe, widespread, and scarring acne, the side effects of these treatments may be worth it, but if you have mild-to-moderate acne, or severe acne that is not causing scars, other treatments may offer clear skin without sacrificing the health of your skin in the long term.
Skin Oil (Sebum) and Aging
The medical term for skin oil is sebum. Sebum is important when it comes to acne because, generally speaking, more sebum means more acne. This is why some acne medications and procedures aim to permanently reduce sebum production. However, permanently altering the body can lead to unintended consequences. In this case, the concern is that permanently impairing the skin's ability to produce sebum might age the skin.
To get to the bottom of this, we need to examine the two changes that happen naturally to sebum as people age, and see if certain acne medications and treatments enhance these natural changes:
- The amount of sebum produced can decrease:
- Isotretinoin: It is well-known that isotretinoin reduces sebum on a long-term basis.
- Photodynamic therapy: May also reduce sebum on a long-term basis.
- Laser therapy: Might also reduce sebum on a long-term basis.
- The composition of the sebum can change:
- Isotretinoin: It is well-known that isotretinoin causes sebum composition changes on a short-term basis, but we need more research that looks into the long-term composition of sebum in people who took isotretinoin in the past.
- Photodynamic therapy: It is unknown whether photodynamic therapy changes sebum composition.
- Laser therapy: It is unknown whether laser therapy changes sebum composition.
As we can see, there is a strong possibility that isotretinoin mimics some of the changes that happen to sebum as people age. When it comes to photodynamic therapy and laser therapy, the evidence is weaker, but it is still a possibility. So what does this mean? Unfortunately, the science on this topic is not robust enough to draw any conclusions. Until we see long-term follow-up studies on people who used isotretinoin or underwent photodynamic therapy or laser therapy, we will not know whether these medications and treatments do in fact cause the skin to age prematurely.
Now let's look more closely at the two changes that happen naturally to sebum as people age.
Amount of sebum produced can decrease
Research has found that as both men and women age, the amount of sebum their skin produces decreases. However, the age at which this occurs differs between men and women.
- In men, the skin produces a steady amount of sebum until around 80 years of age, and then begins to produce less slowly.
- In women, the skin starts to produce less sebum during menopause, which occurs around 50 years of age. By the sixth decade of life, the amount of sebum the skin produces is only 40% of what it was before menopause, but it remains at this level at least until the seventh decade of life.1,2
Composition of sebum can change
Sebum is made of various fats, oils, and waxes, and the chemical makeup changes as we age, specifically when we look at the fats in sebum.
There are two main classes of fats in sebum:
- Branch-chain fatty acids: Does change with age.
- Straight-chain fatty acids: Does not change with age.
From birth to age 20, the amount of branch-chain fatty acids decreases. At age 20, in both men and women, the levels begin to increase again until around 50 years of age. It is unclear whether these changes impact skin aging.2,3
As people age, the amount of sebum the skin produces can decrease, and the composition of sebum can change. These changes lead us to wonder if acne medications and treatments that either reduce sebum production or change sebum composition can result in premature skin aging. Because the answer to this question is unclear, so it is an important factor to consider when choosing a medication or treatment.
- Pochi, P. E., Strauss, J. S. & Downing, D. T. Age-related changes in sebaceous gland activity. J Invest Dermatol 73, 108 - 11 (1979).
- Zouboulis, C. C., Jourdan, E. & Picardo, M. Acne is an inflammatory disease and alterations of sebum composition initiate acne lesions. J Eur Acad Dermatol Venereol 28, 527 - 532 (2014).
- Yamamoto, A., Serizawa, S., Ito, M. & Sato, Y. Effects of Aging on Sebaceous Gland Activity and on the Fatty Acid Composition of Wax Esters. J Invest Dermatol 89, 507 - 512 (1987).