ENLARGED SKIN PORES- how to treat successfully?
Skin pores is a lay term that is also not clearly defined in the medical literature. Nevertheless, it is a condition affecting the confidence of many people. It does not have any clinical implication. Being such a frequent condition and a huge cosmetic concern, it drives us, aesthetic doctors, to constantly look into new possibilities to treat this condition successfully.
Let’s first understand where enlarged pores are coming from?
Skin pores can not be seen as true “Pores” but rather slight depressions of the skin surface that contain many oil(sebaceous) and sweat openings. The assumption that higher sebum production positively correlates with enlarged pores, and that actually is causing it, has not been supported by many studies. However, it is true that the shines from higher sebum production makes enlarged pores more visible to our eye. Most concentrated pores are around nose, forehead, and chin and oily skin types are more likely to have enlarged pores then dry skin.
Skin pores first appear during puberty, and the fact that they are not seen in children up to the age of 10, suggests that hormones and pubertal changes play an important role in their appearance. Sebum production and pore size increase significantly during the ovulation phase of the female menstrual cycle, possibly due to progesterone affecting sebaceous gland activity.
According to some studies, enlarged skin pores can be a sign of skin photodamage. It is well known that chronic photodamage causes a change in the collagen and elastin structure. Intact collagen and elastin allow the skin to maintain its durable properties and pore size can be one of them. However, the fact that enlarged pores are seen in younger girls where photodamage is not a big issue suggests that multiple mechanisms in forming enlarged pores are involved.
Pore density and size seem to have a big variation in different ethnicities. For example, Indian women have higher pore density and size comparing to Chinese women who have a minimal presentation of enlarged pores. That supports a theory about genetic predisposition for enlarged skin pores.
There is contradictory evidence about pore size and their increase with age. In one study it was confirmed that pore size with aging also depends on ethnicity. In French and Japanese women, the pore size did not change with age but rather stagnated, and in Indian and Brazilian women increased with age. Understanding that enlarged pore size is more often seen in women than a man is under significant questions, as it could be that women are just more observant and they seek help more often than a man.
However, it is clear that the pathogenesis and causes of enlarged facial pores are multifactorial and therefore we have to have a similar approach to treatments and interventions.
How can we treat enlarge pores?
Evidence-based studies are limited, and treatments that have been used with an anecdotal improvement can not satisfy today’s patient. Some patients presume that washing the face with cold water can diminish and “close” pores or by using hot towel can remove debris and make them smaller, but there is no scientific proof of this. Therefore, we should only recommend and use treatments that showed improvement in scientific studies.
1.Topical Retinoids, vitamin A derivatives, are well-documented therapies in reversing the collagen and elastin damage happening during chronological aging and photoaging. All vitamin A derivates have shown efficacy in skin rejuvenation, skin wrinkling, facial pores hyperpigmentation, skin sagging, and, sebum production, therefore it should be used. Skin irritation, redness, flakiness, peeling, and so on, are usual side effects and the reason why so many patients are reluctant to use it. 1
2.Glycolic acid peel has documented study that decreases pore size. I can see that very well on my skin. In the study, 30% glycolic acid peel was used five times, two weeks apart and in 70% women documented improvement of 34% and more. Enlarged skin pores improvement was documented by dermatoscopic and software analysis and not just by the subjective improvement.2
3.Non- Ablative fractional Q-Switched 1,064-nm Nd: YAG laser is a safe and efficient method for improving signs of mild-to-moderate photodamaged skin irregularities with no downtime and, in many studies showed to be effective in treating enlarged pores. It is certainly my experience. And we recommend four treatments two weeks apart. It can be done in all skin types, and it is a painless treatment without a downtime. 3
4.Twice daily application of Triple Lipid Restore 2:4:2cream From Skin Ceuticals showed 44% improvement of enlarged skin pores after eight weeks of treatment. A dermatologist-controlled 8-week clinical study was done using 55 females aged 55-75 with moderate wrinkles, uneven skin tone, skin dullness, skin roughness, and, enlarged pores using twice daily application of Triple Lipid Restore 2:4:2Because almost 50% pores can be gone after regular use of this cream for eight weeks, triple lipid restore is a part of my protocol for enlarged pore size, and I use it every day on my skin. It is however designed for more mature skin as it targets loss of cholesterol, ceramides and fatty acids in the skin barrier.In general, it is believed that any treatment and preventive measure against skin photo- aging and collagen and elastin loss can be beneficial for decreasing enlarged skin pores too.
In general, it is believed that any treatment and preventive measure against skin photo- aging and collagen and elastin loss can be beneficial for decreasing enlarged skin pores too.
The best way to get improvement for this challenging cosmetic condition is a personalized evaluation of each patient and use of combination treatments described above.
1.Efficacy of 0.1% Tazarotene Cream for the Treatment of PhotodamageA 12-Month Multicenter, Randomized Trial Tania J. Phillips, MD; Alice B. Gottlieb, MD, PhD; James J. Leyden, MD; et alNicholas J. Lowe, MD; Deborah A. Lew-Kaya, PharmD; John Sefton, PhD; Patricia S. Walker, MD, PhD; John R. Gibson, MD
2.https://www.researchgate.net/publication/257751371 Effects of glycolic acid chemical peeling on facial pigment deposition Evaluation using novel computer analysis of Digital camera-captured images
3Effects of various parameters of the 1064 nm Nd: YAG laser for the treatment of enlarged facial pores Mi Ryung Roh, Hye Jin Chung & Kee Yang Chung Pages 223-228 | Received 28 Oct 2008, Accepted 06 Nov 2008, Published online: 12 Jul 2009