It has been reported that aging causes an increase of pore areas and morphological changes in facial pores, from a round form to an elliptical form, along with sagging. These changes are supposed to occur with the formation of nasolabial folds and jawlines, and with loss of skin elasticity. Although there have been some reports about morphological changes of facial pores with aging, the underlying mechanisms remain unknown. We measured skin elasticity and some parameters related to facial pores such as pore areas, depth and aspect ratio (short axis/long axis) using skin replicas in the middle of the cheek in the sitting position, and also analyzed sagging scores such as the severity of nasolabial folds and jawlines by using photographs of 23 Japanese individuals in the twenties-to-sixties age group. We revealed that skin elasticity in the middle and lower cheeks decreased and pore depth increased significantly with aging. Aspect ratio and pore depth were found to be correlated with some parameters such as skin elasticity and sagging. In the dorsal position, pore areas and depth significantly decreased in the same region of the cheek compared to those in the sitting position. Similar results were obtained for both men and women because of the possibility of the decline in the effect by gravity downward of the face. Aspect ratio of some individuals increased in the dorsal position, while it decreased for others. Increase in aspect ratio was especially prevalent among women. Ratio of pore areas (dorsal position/sitting position) tended to decrease with aging. These results suggested that morphology of facial pores on cheek is possibly affected not only by aging and related parameters such as sagging and skin elasticity, but by change of posture.
Sebum production and secretion in sebaceous glands play important roles in the formation of a thin lipid layer as a physiological barrier on the skin's surface. The secretion of sebum is considered to be controlled in concert with the regulation of sebum production, in which insulin/insulin-like growth factor 1, 5α-dihydrotestosterone, corticotrophin-releasing hormone, and eicosanoids are involved under physiological and pathological conditions. In addition, environmental stimuli such as ultraviolet (UV) irradiation and temperature change have been reported to influence sebum secretion as well as its production. Furthermore, the abnormalities of sebum production and secretion are likely to disrupt the skin barrier functions and to cause sebaceous gland disorders such as acne, seborrhea, and xerosis. On the other hand, the regulation of sebum secretion has been generally defined to be due to a holocrine mechanism, which may contain apoptosis of sebaceous gland cells (sebocytes). In contrast, the apoptosis-independent sebum secretion by polymethoxy flavonoids and UVB has been reported in differentiated hamster sebocytes. Therefore, in addition to sebocyte-specific lipogenetic mechanisms, another unique sebum secretion pathway distinct from the holocrine mechanism is likely to exist in sebaceous glands.
Acne is a chronic skin condition that affects patient quality-of-life. More than 90% of the Japanese population experiences acne at some point in their lifetime. Comedones, which are caused by excess sebum secretion and hyperkeratosis in the infundibulum, appear in the first stage of acne. The second stage involves inflammatory eruptions mainly caused by Propionibacterium acnes. Benzyl-peroxide (BPO), and fixed combination products of BPO and clindamycin, became available in Japan in 2015. BPO acts on both comedones and inflammatory eruptions, and it can be used for maintenance therapy because it does not induce antibiotic-resistant P. acnes. To achieve early results and to prevent the emergence of antibiotic-resistant bacteria, the revised guidelines for the treatments of acne in Japan recommend combination therapy with adapalene, antibiotics, and BPO, including fixed-combination topical agents, in the acute inflammatory phase. Once inflammation has improved, comedones treatment should be continued with adapalene and/or BPO in the maintenance phase to achieve further improvement and to prevent recurrence. The acute phase lasts approximately 3 months, and antibiotics should not be used for maintenance therapy. Sometimes, inflammatory eruptions can result in hypertrophic and atrophic scars that cannot be treated completely. Early aggressive treatment is important to prevent scars. Skin care and cosmetics are also important in the treatment of acne as well as to avoid aggravation. The guidelines recommend twice-daily face washing with a suitable cleanser. Non-comedogenic moisturizers should be used by patients who have dry skin and by those who need to avoid the adverse effects of adapalene and BPO. There is no reliable evidence connecting certain foods and acne, and we should not uniformly restrict specific foods. There is compelling evidence demonstrating the efficacy of azelaic acid and chemical peels with glycolic acids in the treatment of acne. Camouflage also helps acne patients improve their quality of life. To improve acne treatments, more evidence is needed regarding the integration of treatments and skin care.
So-called ‘red face’ is observed as physiological responses to environmental and emotional changes in healthy individuals. ‘Red face’ is also caused by broad spectrum of conditions including certain diseases and symptoms, such as contact dermatitis, photo dermatitis, collagen disease, etc. The precise differential diagnosis for ‘red face’ is essential to choose proper medical treatments or skin cares for each case. Rosacea is a skin disease representing as a red face and exacerbated by environmental changes. An aberrant innate immunity system of TLR2 and cathelicidin antimicrobial peptides may be the factors affecting the rosacea and may be the reason why the individuals with rosacea often feels sensitive skins in environmental changes. Treatments for rosacea depend on conditions causing and exacerbating redness, erythema, flushing and telangiectasia, etc. The combinations of the medicine and skin care products including cosmetics are essential for rosacea treatments because the medical treatments show limited effect for rosacea and skin care products such as moisturizers and sunscreens are effective to prevent symptoms exacerbated by dryness and ultraviolet exposure. To treat and resolve ‘red faces,’ proper observation of the cause of ‘red faces’ and accumulated knowledge for the skin function, innate immunity, medication and skin care are required.