For some people, retinoids alone are insufficient to treat the impacted sebum that clogs pores. Also, resistant impacted sebum can be an early sign of some conditions like seborrhea, in which the sebaceous glands enlarge abnormally, particularly in the center of the face.

There are effective oral prescription treatments available that act directly to reduce sebum production by the sebaceous glands. However, these medications can have side effects, so your doctor will usually want you to try each of the various retinoids for at least a few months before prescribing them. If none of the retinoids will work, and you still have persistent daily blackheads or whiteheads, your sebaceous glands are abnormally producing too much sebum.

When Oily Skin is a Medical Problem

This is a medical problem, not just a cosmetic one, and your doctor should be willing to consider oral medications. However, you may have to search for a doctor that will take this problem seriously enough to prescribe these. Some doctors also resist prescribing oral medications for excess sebum because they are concerned about potential legal liability for side effects. (There are some patients who sue doctors even after all the risks of side effects are carefully explained to them.)

Sebum production is partially controlled by androgens which stimulate the sebaceous glands. In females, chronic elevated androgen levels can lead to acne, excess body hair, loss of head hair, and menstrual problems. Even androgen levels that are at the upper level of the normal range can cause oily skin. A doctor can reduce sebum production in women with medications that affect androgen production such as anti-androgens, glucocorticoids, or oral contraceptives.

The FDA has approved some oral contraceptives specifically for this purpose (e.g. Ortho Tri-Cyclen). You can discuss this treatment option with your dermatologist, gynecologist, or your regular doctor. However, it is best to see a endocrinologist for this treatment, since they have much more experience in performing the required tests and prescribing the appropriate medications. (An endocrinologist is a physician who specializes in the treatment of hormonal problems; see abms.org for endocrinologists in your area.)

Your regular doctor or dermatologist may not be sensitive to this problem, so you may have to find an endocrinologist yourself. For further information see "Medical Guidelines for Clinical Practice for the Diagnosis and Treatment of Hyperandrogenic Disorders," Endocrine Practice, 7(2), 120-134, 2001 Mar-Apr (full text available on the American Association of Clinical Endocrinologists website at www.aace.com/clin/guidelines/hyperandrogenism2001.pdf).

Excess Sebum Treatments

In adult males, excess sebum production is usually due to increased sebaceous gland sensitivity to androgen stimulation, rather than to elevated androgen levels. Pharmaceutical companies are currently working on medications that can be taken by both men and women which block these effects of androgens on the sebaceous glands.

These experimental medications are similar in concept to prescription finasteride (Propecia and Proscar) which blocks the harmful actions of the hormone dihydrotestosterone (DHT). (DHT causes hair loss and prostate enlargement in men.) You can ask your dermatologist if any of these medications have been approved, or periodically check the newsgroup alt.skincare.acne and websites that discuss acne treatment. If these medications can be perfected, they will revolutionize the treatment of acne and excess sebum.

In rare cases, excess sebum in males may be due to adrenal gland dysfunction and hyperandrogenism. See for example "Acne in the Male Resistant to Isotretinoin and the Responsibility of Androgens: 9 Cases, Therapeutic Implications," Annales de Dermatologie et de Venereologie (France), 126(1), 17-19, 1999 Jan (English abstract available on Medline). This is usually discovered in men after multiple courses of the prescription drug Accutane have failed (see below). In these cases, an endocrinologist should be consulted. These cases require specialized treatment and monitoring, since anti-androgen therapy can cause feminizing effects in males.

The most potent medication available to reduce sebum production is oral isotretinoin, brand name Accutane, a chemical related to vitamin A. It acts directly to shrink the size of the sebaceous glands and reduce sebum production. Sebum production is usually permanently reduced after Accutane is taken for a number of months. It can be taken by both men and women, however, it can have significant side effects similar to those of vitamin A toxicity.

The possible side effects include birth defects in pregnant women, ocular effects (including some reports of cataracts), effects on bones and joints, severe headache and fluid pressure in the head, depression, and increased blood triglycerides or cholesterol. Because of these possible side effects, doctors are generally reluctant to prescribe Accutane except for severe inflammatory acne. However, because sebum production is significantly reduced, Accutane also works very well on blackheads and whiteheads, eliminating them permanently in many people.

So some doctors will now prescribe Accutane for persistent moderate adult acne. See for example "Treatment of Acne With Intermittent Isotretinoin," British Journal of Dermatology, 137(1), 106-108, 1997 Jul; "Roaccutane Treatment Guidelines: Results of an International Survey," Dermatology, 194(4), 351-357, 1997; and "Acne Vulgaris in the Elderly: the Response to Low-Dose Isotretinoin," British Journal of Dermatology; 139(1), 99-101, 1998 Jul. (Note that "Roaccutane" is the European brand name for Accutane or isotretinoin.) You can download abstracts of these papers from the Internet medical index Medline and discuss them with your doctor.

Be aware however, that while most people do not develop severe side effects, you must be willing to accept their risk and not blame your doctor if you have problems. Your doctor may have you sign an informed consent form before prescribing Accutane and will usually want you to have periodic blood tests to check for certain side effects. Women who are pregnant or who may become pregnant during treatment must never use Accutane because of the high probability of serious birth defects. Do not use tetracycline or similar antibiotics while taking Accutane, since the combination may cause increased pressure in the brain. Read More>>>