How To Treat Oily Acne-Prone Skin

Oily skin (seborrhea) is a common condition that can cause you to feel self-conscious. Excessively oily skin can look shiny and greasy and make pores appear enlarged. Makeup may run off your skin or cake. Oily skin can feel unclean or dirty, even when it has recently been washed. Excessively oily skin can also cause acne.

There are many skincare products that claim to treat or control oily skin. Read on to find out what causes oily skin and what you can safely and effectively use to treat or prevent it.

What is oily skin?

To understand what oily skin is and what causes it, you need to know a little about the normal physiology and anatomy of the skin.¹

Healthy skin contains sebaceous glands which produce sebum. Sebum is an oily, viscous fluid composed of:

• Squalene

• Wax esters

• Triglycerides

• Free fatty acids

• Cholesterol esters

• Free sterols

The function of sebum is to lubricate your skin and hair and to help maintain the barrier function of your skin.

Sebum is secreted from the sebaceous gland into the hair follicle (pore) and from there it is released onto the skin’s surface. Sebaceous glands are highly concentrated on your face, behind your ears, on your chest, and on your upper back.

The level of sebum production changes throughout your life, peaking during adolescence and then only significantly declining after menopause for women and in about the sixth or seventh decade for men.¹ This is why oily skin is often synonymous with teenage years.

The average rate of sebum production is 1mg per 10cm² of skin every three hours. Skin is classified as oily when the rate of sebum production is more than 1.5mg per 10cm² of skin every three hours.¹

What causes oily skin?

We don’t yet fully understand why some people have excessively oily skin and others don’t. There are likely various contributing factors that cause such a highly variable rate of sebum production between individuals.¹

Some causes of oily skin are:

Androgen levels

These play a role in how much sebum your sebaceous glands produce and also in the proliferation of your sebaceous glands. The higher your androgen levels, the oilier your skin is likely to be.¹

Testosterone levels

Testosterone increases sebum production. Men often have oilier skin than women because they have higher levels of testosterone.¹

Raised progesterone levels

Increased progesterone levels during ovulation can cause increased sebum production in women.¹

Underlying diseases

Excessively oily skin can be caused by medical conditions such as Parkinson's Disease, acromegaly, polycystic ovarian syndrome, and congenital adrenal hyperplasia.²

Climate

Higher rates of sebum production have been associated with warmer weather (spring and summer months) as well as a more humid climate. Your skin may well be oilier if you’re living in the tropics rather than the North Pole.¹

Genetics

Your genes are likely a factor in influencing how oily your skin is. Twin studies have shown that genetics plays a role in determining sebum production.³

Ethnicity

African Americans appear to have larger pore size, which has been linked to increased sebum production.¹

How does oily skin cause acne?

Acne is caused by the blockage of hair follicles or pores by dead skin cells, sebum, and bacteria. The bacteria associated with the formation of acne is Cutibacterium acnes (until recently called Propionibacterium acnes).

Excessively oily skin can cause acne.⁴ Not only does excess sebum production contribute to blocked pores, but Cutibacterium acnes thrives in an environment with high sebum levels.³ There is also some evidence that the specific composition of sebum may influence acne formation.⁵

What can you do to treat or prevent oily skin?

Solutions for treating or preventing oily skin can range from a simple skincare routine to systemic prescription medications. The best solution for you will depend on how oily your skin is.

Let’s take a look at some ways to manage excessively oily skin.

1. Establish a good skincare routine

A good skincare routine can help to keep your skin oil under control. Washing your face twice daily, and after exercise, with lukewarm water and a gentle cleanser can remove excess oil.

If you have very oily skin, you may be tempted to wash your face multiple times daily with an astringent cleanser or to scrub your face excessively. Avoid doing this as it can aggravate any acne.⁶

When you select products to use on your face, make sure they are:

• Oil-free

• Non-comedogenic (won’t block your pores)

• Non-acnegenic (don’t worsen pimple formation)

This applies to face washes, moisturizers, makeup, and sunscreens.

Gels are usually water-based and oil-free, so it may be worth looking for gel formulations of your usual facial products.

2. Topical retinoids

Topical retinoids are derived from vitamin A. Although there is no evidence to suggest that topical retinoids directly suppress sebum production, they are recognized to reduce facial pore size.¹ This is significant because larger pores have higher rates of sebum production.

You may want to consider getting a prescription for a topical retinoid if you are struggling with enlarged pores and oily skin.

3. Topical 2% niacinamide

There is evidence that topical 2% niacinamide can reduce sebum levels after two to four weeks of use. Therefore, selecting a skincare product that contains topical niacinamide may reduce the oil on your skin.

4. Green tea

Two studies have shown a decrease in sebum production after the use of green tea emulsion.¹ This suggests that products containing green tea may be beneficial if you have oily skin.

5. Topical L-carnitine

There is evidence to suggest that topically applied products containing 2% L-carnitine can reduce sebum production.¹ Therefore, using products containing L-carnitine may reduce the oiliness of your skin.

6. Oral isotretinoin

Oral isotretinoin is a systemic retinoid that has been proven to significantly decrease sebum production.¹ Oral isotretinoin decreases both the size of sebaceous glands and the amount of sebum they produce. It is highly effective, resulting in a 90% reduction in sebum production.

The sebum production levels of most people who complete a course of isotretinoin remain reduced a year after treatment. If you are struggling with very oily skin and acne, it may be worthwhile talking to your dermatologist about this option.

It is important to note that oral isotretinoin does have significant side effects.⁷ Apart from dry skin and dry eyes, it can cause fatigue, depression, abnormal cholesterol levels, liver toxicity, and muscle aches. Most importantly, oral isotretinoin is highly teratogenic (has the potential to cause defects in a fetus). If there is the possibility you could become pregnant, ensure that you are taking two forms of contraception before starting oral isotretinoin.

Because of the severity of the side effects, you should always take oral isotretinoin under the guidance of a dermatologist.

7. Spironolactone

Spironolactone is an anti-androgenic drug that can be used to decrease skin oil production in females.¹ It shouldn’t be used by males as it can lead to feminizing side effects. If you are a woman with moderately oily skin, this may be a relatively safe option for you to consider.

8. The combined oral contraceptive pill

Combined oral contraceptives have an anti-androgenic effect and have been used to treat oily skin successfully.¹ Since androgens increase sebum production, anti-androgenic drugs decrease its production.

Choose a combined oral contraceptive that contains levonorgestrel, desogestrel, norgestimate, norethindrone, or drospirenone as the progestin, as these have the lowest androgenic activity.

It’s best to speak to your doctor when selecting a combined oral contraceptive to treat your oily skin or acne.

9. Photodynamic therapy

There is some evidence that photodynamic therapy (PDT) can result in the destruction of sebum-producing cells and lead to decreased sebaceous gland size.¹

Studies suggest that it may take multiple sessions of PDT to achieve results. This may be a good option if you don’t like the idea of taking medication.

10. Laser therapy

There is some evidence to suggest that laser therapy may reduce sebum production if you struggle with oily skin.¹

When to see a doctor

Oily skin isn't dangerous in itself, but it can leave you feeling self-conscious and can cause acne. Acne can lead to depression, social withdrawal, and, if severe, permanent skin scarring.⁸

You can initially try to manage your oily skin with a good skincare routine and topical cosmetics containing green tea or L-carnitine. If these don’t work, you may want to consider seeing your doctor for prescription medication.

The lowdown

Oily skin can look and feel unpleasant and has been linked to acne formation. The causes of oily skin are not fully known, but there are likely multiple factors at play. Hormones play a large role, as do genetics. Hot, humid climates can also increase skin oil production.

There are a wide variety of treatments for oily skin.

A good starting point is to wash your face twice daily with a gentle cleanser and make sure that any products you use on your skin are oil-free. Natural remedies that have been shown to decrease skin oiliness are:

• Topical niacinamide

• Green tea emulsion

• L-carnitine

If skin hygiene and natural remedies don’t reduce skin oil, you may need to see your doctor for prescription medication. Options could be a topical or oral retinoid, spironolactone, or a combined oral contraceptive pill if you are female. Photodynamic therapy and laser treatment may also be effective in managing oily skin.

It’s important to see a doctor about your oily skin if it is negatively affecting your self-esteem or causing acne.