by Dr Tiina Meder
If you suffer from acne or oily skin don’t despair, we’ve got good news. Recently the awesome Human Microbiome Project revealed that we hadn’t known all about the causes of acne, and the new knowledge opens up amazing possibilities. Let’s revise what we’ve known for a long time now (although for some patients and even a few beauty professionals this appears to be news).
The skin becomes oily when the grease-producing sebaceous glands are overly active.
The sebaceous glands’ key function is in fact to produce sebum, a complex substance consisting of various lipids. Normally, sebaceous glands secrete a small amount of semi-translucent liquid which spreads over the skin surface, soaks up the keratinous layer mixing with the skin’s own lipids and provides protection from external damage. This thin lipid layer shields us from infection, toxic damage and nanoparticles brought about by urban pollution and at the same time it gives the skin comfort and softness. Not enough sebum means the skin is dry and sensitive. Too much sebum though is suffocating.
The activity of sebaceous glands is defined by hormones, mainly testosterone, male sex hormone which women also have. However, to affect the glands, this hormone needs to transform with the help of a clever little enzyme called 5-alpha-reductase. This enzyme grooms and preps the unsophisticated testosterone moulding it into an attractive active form, able to seduce the sebaceous gland cells into an increased sebum synthesis. The more testosterone a person has, the higher the chances of acne and oily skin. Which explains why young men have spots and greasy shine more often than women — their testosterone levels are higher. This is why women are routinely prescribed contraceptive pills as acne therapy: among other things, the pills subdue the male hormones improving the skin condition as a result.
The catch is, activity-provoking enzyme can do the damage without the presence of excessive testosterone, and in this case oral contraceptives won’t work for acne.
Both hormone and enzyme activity can increase during puberty, at the end of menstrual cycle, during pregnancy and menopause, at times of stress or in the course of a disease.
However, oily skin is not in itself a cause of acne. Apparently, it’s a little more complicated than that.
In the mouths of sebaceous glands live good useful bacteria. Day and night, they process the secreted sebum, releasing anti-microbial agents from it and sort of acidulating the skin, which prevents the propagation of harmful bacteria. And on top of this, our little friends produce their own anti-oxidants protecting the sebum from oxidising and the skin — from free radicals and toxins. Don’t you just love them?
When sebum is overproduced, though, what happens is, our bacteria friends panic — it’s too much, we can’t process it in time, oh what do we do?! Well, you up the number game is the evolutionary response and bacteria begins to propagate quite maniacally. When their numbers become excessive, the good bacteria become a cause of inflammation. They were actually discovered as such and given a menacing name: Propionibacterium acnes. Until very recently people wrongly assumed that these bacteria singlehandedly cause acne and are generally harmful for the skin. As it turned out, people with acne simply have more Propionibacterium acnes than they normally should. Besides, these bacteria don’t cause acne directly — but some byproducts of their lifecycle, another 2 enzymes, can destroy sebaceous glands from within bringing about pain and inflammation. Inflammation, in its turn, leads to a speedier skin cell renewal, which makes the skin thicker, dead cells are not shed in time and seal the mouths of sebaceous glands, where our former friends, the bacteria, are still having their reproduction orgy.
Basically, the mechanics of acne are a series of events with more and more visible consequences, sort of like The House that Jack Built.
This is the overly active enzyme — too much sebum in too short a time, and these are bacteria multiplying away, and their own enzymes are in the glands to stay, soon inflammation is on its way; and inflammation stacks up dead cell after cell closing up glands and making them swell, so more bacteria multiply — and troubled with acne are you and I.
(Sorry, I couldn’t help myself).
On a serious note, Human Microbiome Project revealed that we are living in a close symbiosis with billions of microorganisms, most of which are good for us (unless for some reason they are out of control).
The traditional acne therapy employes 2 key strategies: first, the decontamination of the skin and extermination of Propionibacterium acnes. Poor little buddies are cleansed away from the skin with antiseptics, such as benzoyl peroxide and various acids, mostly salicylic acid. This would of course cause death and destruction on massive scale of all other, friendly or neutral civilian bacteria, and the improvement was usually short-lived and followed by a new flare of acne. The second acne treatment strategy is fairly recent: the use of retinol and its derivatives helps control the activity of 5-alpha-reductase, eventually decreasing the sebum production. Less sebum produced means worsening of Propionibacterium acnes’ living conditions, so acne-inducing processes slow down and inflammation eases. However, retinoids irritate the skin and significantly reduce its barrier functions, while their anti-acne effect is not necessarily permanent.
The newest strategy is based on the restoration of the skin’s micro-community, or the ecoflora as microbiologists put it. The beneficial bacteria take control over acne bacteria’s hysterical multiplication, drive away harmful bacteria species, and produce anti-inflammatory agents, effectively suppressing not only the overzealous 5-alpha-reductase, but inflammatory enzymes as well. The skin’s ecoflora is restored by more or less the same solutions that people now use to rebalance their gut bacteria: prebiotics and probiotics.
Probiotics are live beneficial bacteria, like the ones that live in yoghurt. Cosmetic use of these is complicated though: just to keep them alive in a bottle of face cream (and not break a dozen cosmetic safety regulations at the same time) is an almost impossible task at this time. Prebiotics, on the other hand, are very usable: they are agents and substances that serve as nutrients to friendly bacteria and are sometimes also toxic to the harmful ones.
One of the most well-studied and effective prebiotics is a small saccharide molecule, called BioEcolia. It has been demonstrated repeatedly, that its application to the skin causes the friendly bacteria to multiply and the perpetrators to die. At the same time, Propionibacterium acnes, who as we now know is in fact a friend and ally, is simply slowed down to a healthier propagation rate, and in the space of just a few days the normal numbers of this bacteria are able to go back to their routine beneficial work, inflammation is suppressed without a trace, the skin is calm, all is good in the world.
It is very important to remember that microbiome-friendly acne treatment will not work in combination with antibiotics, disinfecting and antibacterial agents, such as alcohol, acids, benzoyl peroxide. As cosmetic ingredients these will interfere with the propagation and activity of our bacterial allies and eventually destroy them along with the harmful flora.
Retinoids also hinder the restoration of microbiome — while still possible it will take a lot longer and may prove more complicated.
The use of prebiotics is not limited to oily skin or acne. Prebiotics reduce skin sensitivity, calm down irritation, help avoid complications in healing after skin injury and even reduce the skin’s UV sensitivity. Consistency is key here, prebiotics must be applied continually for a few weeks.
For Meder Beauty Science solutions, we recommend at least a 5-week course.
Net-Apax Prebiotic Cleanser — a gentle cleansing gel with prebiotics for sensitive and inflamed skin.
Eu-Seb Concentrate — prebiotic concentrate for acne and oily skin therapy.
Equa-Derm Cream — prebiotic face cream for oily skin suppresses the activity of 5-alpha-reductase and reduces sebum production by 30% in the first few weeks of use. Equa-Derm Cream helps decrease hormone-related skin sensitivity, tightens pores and reduces redness and swelling.
Salva-Derm Cream — prebiotic face cream for normal and sensitive skin moisturises, soothes, evens out the complexion, quickly reduces redness.
Derma-Fill Cream is a special moisturising solution which can be applied before any face cream. Derma-Fill has an instant moisturising effect, softens and calms the skin, accelerates healing and recovery after injury. This one is a perfect after-shave as well.
Enzy-Peel Mask — enzyme peeling mask with probiotics contains a bacterial complex able to destroy dead cells selectively and cleanse the skin deeply. Enzy-Peel Mask is suitable for all skin types, including sensitive, irritated and damaged. Use 1–2 times a week.
Blepharo-Rich Eye Cream is a nourishing and stimulating eye cream with probiotics — a complex of processed bacteria from Polynesian atolls. These ocean dwelling bacteria help restore the skin’s elasticity and resilience, build back up its protection and reduce wrinkles.