Friday, May 28, 2010

Twitter Q & A "Oily skin?"

I know its been long over due for me to answer the second part of the twitter question that was submitted to me a while ago "Oily skin?"
I myself have oily skin and that makes me more of an insider expert on how to care for it because I suffered and still suffer from it. But now as a dermatologist and from personal trial and error as a patient my self I learned how to manage it or even learn how to live with it at times. I have used many products over the years to try to deal with the constant shine especially while living in a very humid hot weather city like Jeddah, which makes it worse.

In this post I will not discuss the skin care regimens on caring for oily skin during harsh winter seasons which we do not experience here in Jedddah. My focus for this post will be for the group living in these areas or in similar weather. But I will place more references that you can look up at the end of the post with a link.

In my posts I usually try to tackle it the way I explain things to my patients in my clinic. I usually start with daily regimens, including possible prescription medications that I might add to it, then weekly regimens, last but not least what can be done in a medical office and medical skin care spa.

Daily regimens

I have noticed in the past that many of my patients have fallen into the assumption that excessive cleansing with drying facial washes is whats needed to control oily skin, that the more the better, right?.. wrong!.. After I became a dermatologist I learned that the more you try to dry your oily skin the more your skin will try to compensate for it by increasing the sebum production ( which gives the oily complexion and shininess). So with that we stop right here. Minimize cleansing your face to only twice daily routine, morning and night unless you got splashed with dirt on your face then don't say DrLillian told me not to :) It should be enough with a cleanser that is especially labeled for oily skin something with low pH to neutral PH (this has been debatable to exactly which one as mentioned in some resources) what I use and prescribe is a diluted form of a cleanser with very low concentrations of AHA, Glycolic acid ,1% Salicylic acid (maximum concentration in very humid hot weather 2% salicylic on mornings only if the patient is not been given a drying topical treatment which then I would use a more Neutral PH), or a non-oily and non-drying cleanser which to me is the ideal cleanser. Try to avoid soaps as much as possible, most try to strip away the natural fat barrier that our skin has which we all need.

Matting/Anti-shine Lotions:
I have used and suggested a matting lotion or fluid that is available in some of the over the counter cosmeceutical companies products. Some are even tinted to act as a base for makeup or as a foundation (tints range from green which help to reduce the facial redness if present in some people, and others are tinted with skin tones). I usually prefer suggesting these matting lotions and fluids more than toners and astringents which I found some that are especially made for oily skin can a bet too drying.

Astringent and toners:
It can help control oily over production during the hot humid day. I recommend using it not more than twice through out the day and it doesn't necessarily has to be used right after cleansing as suggested by beauticians it can be used later on in the day as needed. These especially can be used on the T-zone area of the face as its is the most oily and shiny. It removes excess oil, tightens pores and smooth the appearance of the skin.

Oily skin type people should minimize using topical moisturizers even if it is oil free. It should only be used if the person has combination skin and only to the areas that are dry. Because how ever light the moisturizer is in my personal opinion and from personal experience it has caused clogging of pores and development of comedones in acne prone skin types if used regularly. I use moisturizers when my topical treatment has gone a little too drying and only till my skin is re-hydrated again and then I would stop. I recommend using it as needed and only to rough dry patches till they resolve.

If you will not be exposed directly under the sun (or indirectly through a window, glass, or as a reflection from sand, sea, or other surfaces) I would try to minimize its use, but there are some really good ones out there that are suitable for oily skin that are noncomedogenic. Choose a fluid or liquid base form labeled specifically for oily skin, never use the ones that are excessively cream base.

Make up and foundation:
The new makeup in the market for oily skin mostly have a matting effect it addresses the shine problem (I have to mention that they mostly do, but it doesn't mean it goes along with the different make up trends of each fashion session, as of this spring the glowing complexion is more the trend than a matted complexion as has been mentioned in People magazine style watch periodic), I recommend using a powder foundation with a SPF of at least 15-20 which has been integrated in many formulations of make up. It will substitute according to the patients extent of exposure to the sun from using added sunscreen in most cases. Jeddah is a sunny city but with the cultural habits we have, sun exposure to most women (not so much for men especially while driving their cars) on a daily bases isn't a real problem.
Blotting powdered paper is a quick rescue that a person can carry around even in their wallet that can be used as a quick fix for that extra shiny nose, forehead, and chin.

Weekly regimens:

Masks and scrubs:
Clay and mud masks can be done once to twice weekly it helps with reducing oily skin by absorbing excessive oil and clearing out pores. There is also a new mask that contains sulfa, it can be helpful to patients that also have acne or rosacea.
Scrubs have to be really gentle or you will run the risk of damaging the skin. I never recommend harsh scrubs only gentle dissoluble beads types that don't damage the skin. It can be used once to twice weekly to clean up oily pores and decrease clogging.

Prescriptions by dermatologist

Topical treatment:
Vitamin A derivative topical creams such as adapalen, tretinion cream or gel, isotretinoin, even OTC creams with retinol that can be suggested by a dermatologist can help. These are all off label uses that have shown to help in some practices by experience.

Oral prescriptions:
Another possible prescription is Tretinoin (Roaccutane) which has to be strictly prescribed and monitored by a dermatologist, it can be given in small weekly doses and sometimes daily doses, but that can only be decided by the physician. You can discuss that option with them and they will explain the risks and benefits of its use.

Clinic treatments:

AHA or Glycolic acid peels have helped in my own practice. Also Salicylic acid peels have been used in other practices. Peels removes dead skin, uncloggs pores, and generates new skin production.

Medical facial treatments:
Sessions can be done by the beautician in which they can use a much lower concentration preparations of GA or AHA in small percentages. They can perform deep cleaning and toning of the skin with special techniques. Finish of with a proper mud or clay mask. This gives an instant satisfactory result to the patient of glowing skin after removal of the dead skin and cleaning up of the pores and absorbing the excessive oiliness on the skin.

There has been reports in the literature as well as discussions among dermatologist regarding the effectiveness of using laser or light treatments specifically for oily skin to shrink the sebaceous gland and thus decreasing sebum (oil) production. Two types have been mentioned ALA PDT treatment with a 1450nm diode laser that targets the dermis where the sebaceous glands lie causing its shrinkage. Other mentions are pulsed light and heat energy therapy,and photopneumatic therapy. Other wise laser and PDT have been used most effectively to treat Acne as it destroy es the P. acnes organism that contributes to the flares of acne but not specifically to reduce oily skin by it self.


People with oily skin should be careful to avoid too much oil or fat in their diet as this can create excess sebum. I always recommend for healthy skin to increase the intake of green leafy vegetables, fruits and lots of water at least 8 glasses a day especially in our hot weather because they supply vital nutrients and help flush toxins from the skin.

Mentioned but not widely practiced in Jeddah

Taken from
Oily Skin: Solutions That Work -- No Matter What Your Age
"One very new remedy for oily skin uses topical preparations containing the B vitamin niacinamide.  Early studies have found that these preparations reduce oil production, but the results have been modest to date.
In still another study, a group of Japanese researchers found that topically applied spironolactone (the oral version is available in this country and is used to treat high blood pressure) was also found to reduce the rate of oil production in young women. This product is not available in the United States, however."

The list that you should take with you when go to over the counter pharmacy section:

1- Cleanser for oily skin low-neutral PH gel form (look for Salicylic acid 1% (Max 2%), AHA, Glycolic acid in the wash) avoid soaps. Wash twice daily.
2- Matting/ anti-shine gel, fluid or lotion in the morning after wash or mid day. Especially to the T-zone area.
3- Astringent/ toner for oily skin once -twice per day as needed.
4- Sunscreen for oily skin in liquid form for oily skin (SPF 30-50) if there is daily direct exposure to the sun
5- Water base moisturizer noncomedogenic for oily skin only to rough patched and dry areas on the face as needed. Avoid the T-zone area.

1- Mud or clay home care mask for oily skin. Once to twice weekly.
2- Di-solvable beads non irritating exfoliating scrub for oily skin and unclogging pores. Once or twice per week.
Once-twice per week wash face with gentle exfoliating gel wash rubbing very gently. Do not scrub harshly so that you don't damage the skin. Wash off with luke warm water. Pat dry. With cotton pad apply a toner. Finish off with mask. Leave on as suggested by the package which usually ranges from 10-20 min. Beauticians always suggest applying the proper moisturizer at the end, I don't unless there are some dry areas or rough patches.

At the make up counter:
1- Foundation has to be oil free and non comedogenic.
2- Preferable powder base foundation with SPF at least 15. Mineral base is better.
3- Blotting powder paper packets to keep with you for a quick fix when you are on the run.

To discuss with a dermatologist at the clinic:
Topical vitamin A derivative creams or gels, oral medications, peels, medical facial treatment sessions, lasers, and light therapy.

With that I come to the end of my post. I hope that it is helpful.

The information in this post is strictly for educational purpose only. Any skin condition and proper skin care regimens should be evaluated by a dermatologist and then according to their evaluation of the skin can a proper suitable regimen be advised.

If you are pregnant, breast feeding, or have any medical condition you should check with your doctor before using any medication.

If you have any questions and comments please leave them at the end of this post.... till then...

Write to you soon...
Bookmarked in this link:
DrLillian delicious "Oily Skin" references bookmarks link

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