Understanding my skin

Sebum: the no. 1 problem for oily, acne-prone skin

People with combination or oily skin have problems with sebum quantity and quality, which means their skin is more likely to have pimples and other blemishes. But blemishes can also be linked to other diseases like eczema, for example, which makes them more difficult to treat. Finally, acne is very common during adolescence, affecting 80% of young people. But it can also impact adults, both men and women, taking other specific forms in this case. Its psychological repercussions are often significant and proper management is necessary, especially since acne disappears with appropriate treatment in the vast majority of cases.

Oily skin generally has a thicker texture, dilated pores, and a dull, greasy and shiny appearance. This appearance is due to excess sebum, which promotes the appearance of skin blemishes such as “blackheads” and “pimples”.

For combination skin, blemishes are usually located on the T-zone: the forehead, nose and chin. The rest of the face and body may have normal or even dry skin. Combination skin is imbalanced and easily damaged.

What causes acne?

Acne is an inflammatory skin condition affecting the pilo-sebaceous follicle. Three related factors are responsible for acne:

Hyperseborrhoea

hyperkeratinisation and bacterial proliferation. This is excess production of sebum resulting from hormonal activity triggered during puberty. The skin becomes oily and shiny. In addition, there is a risk of a qualitative sebum abnormality, meaning that sebum composition differs from that of healthy sebum. It is thicker and has a more difficult time flowing out of the follicle, which increases the risk that comedones will form.

Hyperkeratinisation

the excessive multiplication of skin cells in the follicle duct wall clogs the pore and keeps sebum from evacuating. This causes comedones to appear, which are small skin wheals that are either skin-coloured (closed comedone or microcyst), making skin look granular; or have a black centre (open comedone) indicating melanin (skin pigment) is present on the comedone’s surface.

Bacterial multiplication

sebum is an ideal nutrient medium for certain bacteria, particularly Propionibacterium acnes which is naturally present on everyone but that in acne cases will multiply in the pilo-sebaceous follicle and cause inflammation. The comedone then turns into a painful red pimple called a papule (inflammatory lesion).

What are the various types of skin blemishes?

Acne has several types of lesions, often with increased seborrhoea (called hyperseborrhoea).

The condition lasts several years, with inflammatory flare-ups, as long as the retentional lesions (comedones) persist.

Comedonal lesions

Closed comedones or microcysts
Open comedones or “blackheads”, and sometimes larger cysts (more than 5 millimetres) called macrocysts.

Inflammatory lesions

Inflamed lesions: papules, pustules and nodules due to retentional lesion inflammation.

Scars from possible lesions

Hyperpigmented spots secondary to inflammation on olive or black skin.

In rare cases, acne can affect newborns — due to the mother’s androgen hormones — or older infants. Acne is an adolescent dermatosis. It takes on a polymorphic aspect that combines the different types of lesions.
The condition generally begins around the ages of 12 to 14 years and affects the oiliest areas of the skin such as the face, and often the chest and back to a variable degree. Acne is caused by an imbalance in hormonal secretions during puberty.

In women, particularly after the age of 30, acne appears more on the lower face (jaw) and neck. There is often a hormonal component added to the traditional causes of acne.

Mother and daughter sitting and together

What is different about acne in women?

The factors that promote the appearance of acne in adulthood are:

External factors

unsuitable cosmetics, sun, diet, etc.

Smoking

also promotes this phenomenon: over 41% of smokers have acne versus 9% of non-smokers.

Genetics

may also play a role. Indeed, when there is a family history, it is common to see this type of skin problem appear in adulthood.

Some medicated treatments

such as contraceptives, hormones and anti-depressants can cause pimples and other blemishes to appear.

Unlike an adolescent’s skin, the skin of an adult woman is less seborrhoeic, meaning that it produces less sebum.

Blemishes are mainly located on the lower face (chin, neck and lower jaw). They are chronic and recurring inflammatory (pimples) and comedonal (blackheads) lesions. To correct these skin problems, it is necessary to use appropriate treatments, which are not the same as those used for adolescent acne.

Key points

Problems with skin blemishes:

50% of women over the age of 25 have problems with skin blemishes.
40% of these women did not have acne in adolescence.

Strictly follow the treatment

Acne treatments don’t work the first time they are applied so you must be patient. However, you will see results quite quickly if you stick with your programme every day: cleansing tailored to acne-prone skin + medicated treatment morning and night. Depending on the person and the type of acne, a sharp improvement is generally observed after 4 to 6 weeks.

Avoid the sun

It’s true that it may dry out your spots and hide your blemishes through tanning, making your skin look clearer and smoother. But it will amplify your blemishes (or comedones) later by increasing the thickness of the horny layer, which promotes the retention of cells and sebum in the pilo-sebaceous follicle. This increase in the number of comedones inevitably triggers significant blemish eruptions as soon as the tan fades. To avoid this rebound effect and keep unpleasant surprises from occurring when your holidays are over, protect your skin with a specific SPF 30 photoprotection product. Opt for non-greasy sprays or fluid textures made for oily or acne-prone skin.

Don’t touch your blemishes

The more you handle spots, the more you will aggravate the inflammation (increase the number and size of pimples), the more likely it is that these spots will become pustular (pimples with pus) and the higher the risk of scars appearing.

Be sure to use non-aggressive cleansing products that do not strip the skin or alter lipids in the hydrolipidic film or horny layer. You can use scrubs, but only if you are not using an associated medicated treatment, which generally already exfoliates skin. Micellar waters work very well for cleansing oily skin.

Removing make-up or cleansing skin each evening is essential, even if you don’t wear make-up. This removes dirt particles, pollutants and all kinds of other residue that settles on the skin throughout the day

Woman with acne-prone skin cleaning her face

Once to twice a day, delicately apply a targeted treatment to your blemishes, using a product from a dermo-cosmetic range created for oily, blemish-prone skin.

If you are using a medicated product prescribed by your doctor, apply it regularly according to the directions.
If you are taking a local or oral dermatological treatment that dries out your skin, you should apply a complementary treatment tailored to combination or oily skin on a daily basis in order to moisturise your skin and lips. Non-comedogenic correctors, BB creams and foundations can also help you hide imperfections.