Collection: Oily, combination skin, with acne

Each of us has experienced some form of acne-related change on our face at least once in life. Blackheads, pimples, and nodules are characteristic changes that appear in common acne. Sometimes sporadic - after eating chocolate or before menstruation, and sometimes accompanying our skin for many years. For a long time, acne was trivialized by many, treated as an obvious element of maturation. Unfortunately, a plethora of clinical research indicates the negative impact of chronic acne on self-esteem and well-being. Therefore, although it affects around 75-95% of adolescents, this inflammatory skin disease cannot be underestimated.

The basis for the development of common acne is multifactorial and not entirely explained. First and foremost, it's essential to understand the mechanism of sebum production and characteristics of oily skin.

Sebaceous glands play an excretory role - producing lipids (commonly known as sebum), and when they accumulate a sufficient amount (mature), they rupture and release their contents (sebum). Sebaceous glands, along with hair follicles, form a common pilosebaceous unit. It's the muscles around the follicle that contract and aid sebum in reaching the skin surface. The process of sebum production and its "journey" to the skin's surface takes about a week (this process takes a little longer as we age). Knowing how long the glands need to respond to stimuli stimulating sebum production makes it easier to understand why, after a weekend full of unhealthy snacks, we experience new acne changes or excessive skin oiliness only after a few days.

What influences sebum secretion?

• Ambient temperature (higher temperatures result in intensified secretion)
• Age (especially during adolescence)
• Gender (more in males, more intense in the second phase of the menstrual cycle in females)
• Body area (more on the face, chest, and interscapular area)

Oily, seborrheic skin

Oily skin becomes noticeable when:

• It has a yellowish or earthy coloration.
• Skin shines in the "T-zone" (forehead, nose, and chin).
• Sebaceous gland openings are enlarged (commonly called pores).
• Closed comedones (follicles filled with sebum, forming nodules).
• Open comedones (blackheads, oxidized sebum visible at the hair follicle opening).

Seborrhea, or intensified sebum secretion by sebaceous glands, can be caused by various factors. Sebum production depends on various hormones, particularly male sex hormones (androgens). The most influential hormone is 5-alpha-dihydrotestosterone (DHT), which is derived from testosterone. This is why acne is more common in men – androgens also exist in women but in smaller amounts. Other hormones affecting sebum production are prolactin, insulin, adrenaline, thyroid hormones, growth hormone, and stress hormone cortisol. Retinoids and estrogens (female sex hormones) reduce sebum production. Understanding these relationships makes it easier to comprehend why menopause and thyroid hypofunction often result in drier skin.

Why do I have acne?

The development of acne is linked to:

1. Genetic factors - a predisposition to severe forms of acne is inherited.
2. Excessive sebaceous gland activity and the influence of hormones on them.
3. Changes in the hair follicle keratinization process - see: comedogenesis.
4. The presence of bacteria and fungi in hair follicles - particularly, Propionibacterium acnes bacteria (currently named Cutibacterium acnes) and the lipophilic yeast-like fungus Pityrosporum ovale play a significant role.
5. Immunological processes - inflammatory areas contain T lymphocytes, which produce inflammatory substances and attract other inflammatory cells.

What exacerbates common acne? What to avoid?

Many factors affect sebum production and the development of acne changes:

• Stress: Increased cortisol production (stress hormone) intensifies sebum production.
• Diet: Attention is drawn to the influence of high glycemic index foods on acne severity; consuming such foods raises insulin and insulin-like factors, leading to increased androgen synthesis and consequently increased sebum production.
• Smoking: There's a proven positive correlation between nicotine and excessive skin keratinization (see: comedogenesis).
• Climate: Overly sweaty individuals with diagnosed acne experience intensified changes in hot, humid climates; also, in the summer, there's the emergence of follicular nodules after sun exposure.
• Inadequate skincare: Improper makeup products, excessive or insufficient skin cleansing, using inappropriate skincare products.
• Potentially comedogenic substances (promoting the formation of blackheads): paraffin, vaseline, silicones, some natural oils, carrageenan, fragrances; some auxiliary substances used for emulsification and stabilization of cosmetics.
• Synthetic compounds: Dyes, purines, hydrocarbons, chlorine, bromine, and iodine compounds can intensify acne changes.
• Medications and chemicals: Steroid-based drugs (glucocorticosteroids, testosterone medications), antidepressants and tranquilizers, antiepileptics, and vitamin B12, chlorine.
• How should we deal with acne? Primarily, understand its root causes and try to eliminate factors predisposing to acne changes. If, with a clear conscience, we admit that we're doing everything in our power but changes still occur, seek advice from a specialist. Dermatologists can conduct appropriate examinations and propose treatment, while cosmetologists can perform procedures to calm inflammation and reduce acne changes like scars and discoloration. Additionally, specialists can advise on selecting appropriate cosmetic products and proper home care. If acne is distressing and diminishes the quality of life, don't hesitate to seek help.

What is comedogenesis? Epidermal cells (keratinocytes) migrate from lower, living layers to the surface. As they move to the most superficial part, they gradually lose their vitality, become cornified, and then shed, being replaced by subsequent cells. When these cells within hair follicle ducts proliferate excessively, excessive follicular cornification occurs (which, combined with sebaceous glands, forms the pilosebaceous unit). This is comedogenesis – a non-inflammatory process, typically a prelude to acne development. Due to excessive keratinization and increased sebum production, the hair follicle openings become blocked, leading to the creation of microcomedones. These are precursors to closed and open comedones, which are still non-inflammatory changes. However, from these, inflammatory changes might arise - nodules, pimples, cysts, and infiltrates, symptoms of fully developed common acne.

Symptoms of common acne: Primary eruption: microcomedone (visible only under a microscope) ↓ non-inflammatory changes: closed and open comedones (visible to the naked eye) ↓ inflammatory changes: papule, pustule, nodule, cyst with sinus, scar