The dermatologist advises: Oily skin and acne

Dr. Lorena Manea, Dermatologist
Colentina Clinic, Bucharest

How many of us have faced problems caused by acne at some point in our lives? Probably very few have not had to overcome such challenges.

As a rule, the first signs of acne appear during puberty, after which – in most cases – it disappears forever. However, sometimes pimples and imperfections settle permanently on the skin and remain even in adulthood.

What are the causes of acne?

It is believed that acne is mainly caused by several factors. The oily secretion produced in the skin, called sebum, can be strongly influenced by hormones in the body to the extent that excessive oiliness appears – a condition known as seborrhea. This abnormality, together with the accumulation of dead skin cells, leads to blockage of the hair-sebaceous follicles, or in other words – the channels of the pores where the “bags” of the sebaceous glands are located.

Clogged pores, in turn, can easily become inflamed and create an ideal environment for the rapid multiplication of the so-called Cutibacterium acnes (a specific type of bacteria formerly known as “Propionibacterium acnes”). During this process, persistent inflammation characteristic of acne as a dermatological condition is established.

It is important to note that despite the presence of the mentioned bacteria, acne is actually not an infectious disease. It is not contagious – a person cannot “catch” it from someone else, nor can they transmit it to another. As mentioned earlier, the role of this bacterium is limited to the inflammatory process underlying the appearance and persistence of acne lesions.

Diet is also often cited as a factor contributing to acne. There is indeed some evidence suggesting that the consumption of foods with a high glycemic index, dairy products, and saturated fats (the so-called “Western diet”) may be somehow related to acne. However, the exact mechanism of this relationship still needs to be clarified.

Types of acne lesions

The usual areas affected by acne are the face, neck and décolleté, and back – these are all areas where the skin is particularly rich in sebaceous glands.

From a clinical point of view, acne can manifest in different types of lesions:

• blackheads (open comedones) – these are oxidized “plugs” of the follicles, which occur when sebum reaches the skin surface and darkens due to a chemical reaction with oxygen from the air;
• whiteheads (closed comedones) – as their name suggests, these are follicles blocked by a layer of skin cells – in this case, sebum remains trapped inside the channels without reaching the surface. These lesions appear as small white subcutaneous bumps;
• papules are pink to reddish-brown bumps, often accompanied by visible redness and swelling;
• pustules are lesions (pimples) containing pus;
• nodules are deeper pus-filled deposits in the skin.

In mild acne, usually only isolated papules, pustules, and/or comedones are observed. In moderate acne, there is a larger number of acne lesions. Severe acne, in turn, is characterized by many comedones, papules, and pustules, but often also nodules, which can be inflamed and painful.

Oily and acne-prone skin requires special care throughout life

Undoubtedly, consultation with a specialist dermatologist and proper treatment are of primary importance. It is also true that a comprehensive routine for preventing new lesions is key to long-term control of acne. In this regard, it can indeed be said that acne-prone skin requires special care throughout life.

Here are some useful tips:

• for cleansing the skin morning and evening, use a gentle cleansing product, avoiding irritating and aggressive alcohol-based formulas;
• do not use oily products for both the face and scalp;
• optimally hydrate the skin, especially if you need to apply active products with drying effects;
• choose products labeled as non-comedogenic or oil-free – these are usually well tolerated by acne-prone skin.

For milder forms of acne, there is a wide variety of medicinal products that can be helpful for treatment. To achieve the desired effect, they must be used strictly according to the instructions of the treating dermatologist.

One such popular medication is benzoyl peroxide. It has an intense drying effect, and the doctor is the one who should determine the concentration to be applied for each individual case. It is also important to know that benzoyl peroxide discolors materials on contact – bed linen, towels, etc.

Exfoliating agents such as azelaic and salicylic acid or alpha-hydroxy acids (glycolic, lactic, pyruvic, citric) are also used in the fight against acne. They often have a drying effect on the skin and therefore should be combined with an appropriate moisturizing product.

When is it necessary to consult a dermatologist?

Moderate and severe acne require special medical treatment – the sooner, the better! With timely therapy, the prognosis for complete healing is better, and the risk of permanent scars is lower. The latter is especially important because scars are the most severe and difficult consequence of the disease to treat.

What treatment can a dermatologist prescribe?

Topical treatment (medications for external use) includes medical gels/creams, usually containing antibacterial or antibiotic ingredients, such as:

• benzoyl peroxide, clindamycin, erythromycin, sulfur, azelaic acid;
• retinoids: vitamin A derivatives such as tretinoin, tazarotene, and adapalene.

Depending on the type and stage of acne, the dermatologist may also decide to prescribe systemic treatment (oral medications), which can include:

• Antibiotics such as tetracycline, minocycline, doxycycline, erythromycin;
• oral contraceptives and spironolactone, for which there is evidence of beneficial effects, especially in treating hormonal acne;
• isotretinoin – a last-line treatment drug used for resistant disease that does not respond to any of the previously mentioned medications.

As an addition to medications (for external or oral use), the doctor may also select the most suitable moisturizing product. This is important because – contrary to expectations – excessive drying of the skin actually leads to increased sebum production.

Using sun protection is another essential aspect when it comes to acne – both during and after treatment. It is known that some medications have photosensitizing potential – this requires strict application of sun protection to prevent burns and post-inflammatory pigmentation.

Whatever the therapeutic protocol, treatment results are usually seen only after weeks, and often after months. Therefore, patience and persistence can rightly be considered key factors for successful treatment outcomes.