A Dermatologist’s Guide to Oily Skin and Acne in Singapore
One’s skin type is largely determined by the genetics of an individual.
The production of oil itself is genetically determined – if one has a family history of having oily skin, it is very likely that one would develop it as well, as this is directly linked to the production of androgens such as the male hormone testosterone at the onset of puberty which affects both males and females. Based on the proportion of patients at the clinic, there is a significant population of people with oily skin types in Singapore. This is because of overactivity of the sebaceous glands which are concentrated over the forehead nose and the chin area, but can also occur on any part of the face, as well as including the chest and back which are also the areas more acne-prone. Although further research needs to be done to prove the common belief that a humid climate like Singapore results in oily skin, what we do know is that climate changes can have an adverse impact on skin that is already diseased such as with underlying acne, facial eczema or rosacea which are the common skin conditions I see in my practice.
Problems associated with oily skin?
Acne is a major issue faced by those with oily skin. The cause of acne itself is multifactorial, involving primarily genetics which causes inflammation exacerbated by the production of oil often driven by hormonal factors, leading to the formation of whiteheads and blackheads. One of the ways of treating acne would include reducing oil production by the means of an oral medication known as isotretinoin or by physical methods, such as chemical peel microdermabrasion as well as laser treatments that will shrink the oil glands. To add clarity, while almost all acne prone patients have oily skin, this is not to say that having oily skin one definitely would suffer from acne.
Oily skin and ageing
One popular belief is that individuals with oily skin do not age as quickly. A desirable side-effect of oily skin perhaps? Or perhaps not.
Skin aging is due to a complex interplay of factors, with the key determining factor being a balance between one’s biology, influenced by genetics (have a look at how your parents are aging), as well as environmental aging, due to the exposure to ultraviolet rays, air pollutants, cigarette smoke as well as a stressful lifestyle. The key thing to note is that unhealthy skin ages poorly and much worse than healthy skin. In patients with facial eczema, for example, with dry dehydrated skin known as asteatosis, they are inherently unable to produce a fatty lipid known as ceramide, which helps to repair and restore the skin barrier. Without this, the skin is unable to protect itself from external allergens or changes in the environment and this can accelerate aging. Dehydrated skin has an unhealthy epidermis and dermis. As a result, this can accelerate aging in the form of wrinkles as well as the loss of volume.
If one has oily skin, the production of oil can form a barrier between the skin and the environment and this is a sort of protection which reduces the formation of fine lines and wrinkles or what cause free radical formation. Nevertheless, if one has an underlying skin condition such as scarred skin due to previous cystic acne, it doesn’t matter that your skin is oily, one would expect skin aging to progress faster than in a normal individual.
There is a study which shows that people with oily skin tend to look younger than their counterparts and this is well-proven in clinical practice. However, I would say that striving to have oily skin is actually not desirable, especially in a very humid climate like Singapore, as a shiny complexion could be quite embarrassing. Long-term overproduction of oil due to overactivity of the sebaceous glands can also lead to irregular skin texture and enlarged pores.
It is best to strive for healthy radiant skin that is well moisturized but not oily. There is a difference between moisturizer and oil, as I have seen many patients with nodular cystic acne and oily skin who also suffer from facial eczema which is dry dehydrated skin. Well moisturized skin is smooth and radiant, and looks healthy – a key component of the skin’s moisture is from molecules such as ceramide and hyaluronic acid which is an abundant water molecule in the second layer skin known as the dermis.
It is a myth that people with oily skin don’t really need moisturizer. In fact, you could have a lot of oil on your face and still have dehydrated skin that’s lacking in the key moisture molecules. Our patients who are on treatment for acne still use a good cosmeceutical moisturizer to lighten their scars, as well as Vitamin C and Hyaluronic acid serum that can restore the correct moisture balance in their skin to prevent excessive oil production known as reactive seborrhea. Reactive seborrhea occurs when one strips skin excessively of its natural oils causing the skin to produce even more oil.
Can someone with oily skin change to having normal skin with diligent skincare alone?
The amount of oil produced by an individual is genetically determined and influenced by the secretion of one’s hormones. It is however possible with proper long term cosmeceutical skincare, that one’s skin becomes adjusted in terms of restoring the normal moisture level.
Using improper skin care such as harsh oily-skin cleansers may strip skin completely dry and this leads to a vicious cycle known as reactive seborrhea.
The key ingredient involved in restoring skin moisture and not oil, is firstly a pure concentrated form of topical hyaluronic acid in our skin care. According to Dr Teo Wan Lin, an accredited dermatologist at TWL Specialist Skin and Laser Centre, “We use a 1% concentrated hyaluronic acid serum freshly-compounded for optimum absorption in a pharmaceutical setting. This is easily a hundred to a thousand times higher than the concentration available in cosmetic skin preparations boasting the same ingredients. Regular use of topical hyaluronic acid has the effect of visually filling and plumping up the dermis (the second layer of skin which tends to sag with dehydration and aging), leading to a poreless, even complexion”
In terms of cleansing, I would recommend using an antibacterial foaming cleanser. The honey cleanser is formulated to remove grime, oil, bacteria and other surface pollutants that tend to settle on the skin at the end of the day. The nature of oily skin is that it tends to be a breeding ground for bacteria as well as a certain type of yeast known as malassezia which thrives in a humid climate like Singapore. This is a non-chemical form of an antibacterial and antiseptic wash, using natural medical grade honey which helps in reducing the amount of grease on one’s face. As honey is a natural humectant, it traps moisture under the skin while cleansing. It thus helps to moisturize the skin and regulates the balance of the oils as well as health of the skin.
For a targeted approach, treating oily skin – medically known as Hyperseborrhea, a visit to a dermatologist is recommended. This would typically involve counselling on the use of appropriate cosmeceuticals as well as a retinoid which can regulate oil production. Our patients would also undergo chemical peels (glycolic, lactic and salicylic acid peels) in combination with laser treatments that can help to shrink the oil glands and reduce oil production. From then on, once the amount of oil production is reduced, it is easier to maintain with topicals alone.
A skincare regime for oily skin
There is a recipe for healthy skin in the same way one is careful to have a healthy diet and lifestyle to prevent illness, rather than change one’s diet only after one gets sick. Whether or not you have dry, oily or combination skin, there is really skincare that is suited for you and the answer lies in dermatologist-tested cosmeceutical skincare. Cosmeceuticals are researched to include potent bioactive ingredients formulated to prevent the onset of aging, as well as to deliver nutrients to your skin.
Such a skincare regimen, is likened to a healthy diet that will prevent skin problems from developing later. If you have an underlying skin condition, cosmeceutical skincare can
also reduce the severity of acne and facial eczema. So it is indeed true, at least for cosmeceutical skincare, that there is a one-size-fits-all for all types of skin, as a recommendation for the basic healthy diet of skin.
The key conundrum in skincare that has been plaguing dermatologists in the last 50 years was really that the dermatologist-tested skincare (which is compatible with aging problem skin types) we advocated for our patients did not provide additional cosmeceutical benefits. These women then went looking for over-the-counter cosmetics skincare which promised them anti-aging, but clearly not without the irritation and side effects. Then the dermatological community turned its attention to clinically proven anti-oxidants in skincare and showed that cosmeceuticals were valid and important in the treatment of aging skin to restore skin health. The advent of cosmeceuticals promises the same level of non-irritating gentle skin cleansing and moisturizing, with all the power molecules antioxidants which can lighten scars, brighten your complexion and retard aging. What’s there not to love?