Oily skin: specic features in Chinese women

S. Nouveau-Richard
1
, W. Zhu
2
, Y. H. Li
3
, Y. Z. Zhang
4
, F. Z. Yang
5
, Z. L.Yang
6
, S. Lian
2
,
B. Y. Qian
6
, Y. P. Ran
4
, C. Bouillon
1
, H. D. Chen
3
and O. de Lacharrie`re
1
1
LOreal Recherche, Clichy, France,
2
Xuanwu hospital Capital University of Medical Science, Beijing, China,
3
China Medical University, Shenyang,
China,
4
Sichuan Medical University, Chengdu, China,
5
Harbin Medical University, Harbin, China, and
6
Suzhou Medical University, Suzhou, China
Background/Purpose: Inconsistent data are available on
the various types of skin, their prevalence and characteriza-
tion, particularly regarding Asian skins. This observation
prompted to conduct a large study in China to assess the
prevalence of oily skin and identify the specic factors
related to that type of skin.
Methods: The multicentre trial involved 1787 Chinese wo-
men in Shenyang, Harbin, Beijing, Chengdu and Suzhou,
between 18 and 65 years of age. Data on history of acne, the
presence of environmental factors and a detailed self-eva-
luation of the skin were collected using a standardized
questionnaire. A clinical evaluation of facial skin oiliness
was carried-out by a dermatologist at each centre. Sebum
secretion was measured on the forehead using Sebumeter
s
SM810. Statistical analysis (multiple correspondence ana-
lysis) of typology was conducted based on self-evaluation
data.
Results: According to self-evaluation data, oily skin preva-
lence in the overall Chinese population of the study was
25.6%. Self-evaluation results were quite consistent with
sebum measurements and with clinical assessment by
dermatologist. Parameters associated with oily skin were
(i) shiny skin and a past history of acne, (ii) irregular
menstruation, and (iii) highly reactive or sensitive skin.
Moreover, a clear and signicant link was noted between
oily skin and the ingestion of spicy or sweet food. Lastly,
sebum levels were found to be twice as high in Beijing as in
the other cities and were correlated to higher oily skin
prevalence.
Conclusion: The study demonstrated the capacity of wo-
men for proper self-evaluation of their skin type. It also
suggests a potential link between nutritional factors such as
spicy and/or sweet diets and oily skin as well as between
sensitive and oily skin in this population.
Key words: skin oily Chinese typology
& Blackwell Munksgaard, 2006
Accepted for publication 3 January 2006
M
ANY PEOPLE complain about oily skin-related
problems, particularly teenagers and
young adults (1). There are no published descrip-
tive studies on the clinical and biophysical char-
acteristics of oily skin as such; however,
generalized unreferenced clinical observations
on the subject can be found in dermatological
and cosmetological books (2). Oily skin is often
described as a thickening of the skin and an
increased sebaceous secretion, resulting in a
shiny appearance of the face, notably on the
nose and the forehead (3). It is frequently asso-
ciated with hyperkeratosis, as reected by dilated
pores and by a rough and thick horny layer
giving the skin a deceivingly dry aspect. The
skin is called combination skin when sebor-
rhoeic plaques (thick dermis, shiny appearance
and slight hyperkeratosis) are combined with dry
skin plaques (epidermal atrophy and slight des-
quamation). Acne and seborrhoeic dermatitis are
frequent complications of oily skin (2).
The impact of environmental factors, particu-
larly dietary, on skin condition has often been
touched on. Many recent (4, 5) and older (6, 7)
publications have searched for links between diet
and persisting seborrhoea or the presence of acne.
As dietary habits vary from one country to
another, it is not unlikely that they may inuence
skin condition. To our knowledge, there is no
paper specically describing skin oiliness in
Asian women, particularly in China.
This prompted us to undertake the present
multicentre study to evaluate oily skin preva-
lence in a population of Chinese women living
in different regions. A further aim of the study
was to identify the specic factors related to
the oily skin type, be they endogenous or
environmental.
43
Skin Research and Technology 2007; 13: 4348 Copyright & Blackwell Munksgaard 2006
Printed in Singapore All rights reserved
Skin Research and Technology
doi: 10.1111/j.1600-0846.2006.00185.x
Materials and Methods
Subjects
One thousand seven hundred and eithty-seven
healthy women randomly selected from six me-
tropolitan areas (northern cities: Harbin n5360,
Shenyang n 5358, Beijing n 5353; southern ci-
ties: Chengdu n 5360, Suzhou n 5356) were
included in the trial after giving their informed
consent. Attention was given to have the same
age-balanced sub-groups for each centre, by
comparing groups of 10-year-interval (1825
years, n 5329; 2635 years, n 5379; 3645 years,
n5384; 4655 years, n 5428; 5665 years,
n5277). There were about 70 women per center
and per age group. The mean age was 40 13
years.
Evaluation criteria
Each volunteer underwent a three-step proce-
dure: an interview using a standardized ques-
tionnaire, clinical skin assessment and non-
invasive measurements. In order to limit investi-
gator-related biases as much as possible, we
selected and trained only one investigator per
centre. Furthermore, the study was carried out at
all centres during the same period, that is No-
vember and December 2001. On the morning of
the examination, all the volunteers were re-
quested to wash their face with water only and
to use no cosmetics.
The interview included four parts: (1) demo-
graphic data were recorded (age, native province,
smoking habits). Attention was focused on diet-
ary habits as very different kinds of cuisine exist
in China, mainly salty, sweet, or spicy food. A
three-point scale (none or few, rather and
very) was used to assess the level of consumption
of each kind of cooking. (2) Global skin type
self-evaluation (dry, oily or combination skin)
was performed, followed by a detailed self-
evaluation of dryness and oiliness intensity
(using a three-point grading scale: none, moder-
ate, severe) on the forehead, nose, chin and
cheeks. (3) Skin sensitivity to sun exposure
(sunburn frequency and sun exposure habits in
terms of the average number of hours
spent outside per day), skin reactivity to various
environmental factors (wind, cold, spicy food,
alcohol beverages, cosmetics, and stress) and
related signs (tingling, stinging, burning, itching).
(4) History of acne and atopy (personal or in
the family).
Skin dryness was assessed by clinical examina-
tion focusing on the forehead and cheeks for skin
roughness and scaling and on the lips for scaling
intensity. Skin oiliness evaluation was based on
how shiny the skin appeared, on the degree of the
seborrhoeic condition as perceived by touching
the forehead, nose and cheeks, and also by the
presence of open skin pores in these areas. The
presence, intensity and localization of acne and
seborrhoeic dermatitis were also noted, in addi-
tion to any sign of residual post-inamma-
tory acne scars. All clinical evaluations used a
four-point grading scale (none, mild, moderate
or severe).
Non-invasive measurements were carried out
in order to quantify surface skin sebum using a
Sebumeter
s
(SM810
s
, Courage & Khazaka, Elec-
tronic GmbH, Ko ln, Germany) on the forehead,
20 min after cleaning the skin (8). In this photo-
metric method, the transmitted light is related to
the sebum content on the measured surface, a
given opacity to light becoming translucent when
its surface is covered with lipids; results are
expressed in microgram sebum per centimetre
squared of the skin.
Statistical analysis
A multiple correspondence analysis (MCA) was
performed on the dry skin and oily skin para-
meters, as assessed by the women themselves on
the different facial sites, in order to formulate a
skin typology per skin type (active variables:
detailed skin-type self-evaluation parameters; il-
lustrative variables: other items on the question-
naire such as age, city of residence, clinical
parameters, non-invasive measurements . . .).
Then, a hierarchical cluster analysis was carried
out on the factorial components determined by
the MCA. Cluster characterization was based on
the Value-test (V-test), a suitable method to de-
termine statistical signicance. This test is used as
a statistical criterion to measure the signicance
of discrepancies arising between two percentages
(qualitative variables) or means (quantitative
variables) in two populations. The criterion is
derived from the hypergeometric distribution
that measures the discrepancy between percen-
tages or means as a number of SDs of a Gaussian
distribution. Variables with V-tests higher than
2.0 are judged statistically signicant at the 5%
level (non-adjusted) and potentially discriminate
between items of the variable to be characterized.
44
Nouveau-Richard et al.
Statistical analysis was carried out using SPAD
(version 4.00, CISIA, Montreuil, France).
Results
Self-evaluation of the skin condition rst estab-
lished the overall skin type, and then the degree
of the dry or oily skin severity (none, moderate,
severe) for various anatomical areas of the face
(forehead, cheeks, nose, chin).
MCA on the detailed self-evaluation answers
allowed us to identify four groups of women
corresponding to four types of skin: oily skinned
women represented 25.6% of the total study
population; dry-skinned women 30.8%; combina-
tion skin, 27.4%; and women whose skin was
neither dry nor oily, 16.2%.
Women placed in the oily skin group according
to the statistical analysis of their answers to self-
evaluation questionnaire were distributed as fol-
lows: 11.5% had a moderately oily skin (forehead,
nose and cheeks), 9.4% had a severely oily skin at
the nose and forehead level, and 4.7% had an oily
skin at the cheek level.
Demographics
Compared with the overall study population, the
women belonging to the oily skin group were
younger, with a mean age 35 vs. 39.9 years for the
whole study population (po0.001). More had a
rather spicy diet (51% vs. 45.3%, po0.003) or a
rather sweet diet (49.9% vs. 45.2%, po0.02) (cf.
Fig. 1). They were also slightly more numerous to
have irregular menses (18.9% vs. 15.4%,
po0.012). Lastly, more women in this group
reported a past history of acne (49.2% vs. 25.8%,
po0.001), including severe acne (8.5% vs. 3.2%,
po0.0001).
Women living in Beijing, were highly over-
represented in the oily skin group: 32.2% of this
group lived in Beijing whereas the population of
this city only represented 19.6% of the overall
study population. A signicantly higher propor-
tion of women in the oily skin group lived in the
North of China (po0.001): 67% lived in a north-
ern city whereas the population of northern cities
only represented 59.2% of the overall study
population.
Clinical assessment of facial skin
Compared with the overall study population,
more women in the oily skin group had shiny
skin on the nose (61.8% vs. 24.9%, po0.001),
forehead (37.5% vs. 12.4%, po0.001) and cheeks
(18% vs. 5.2%, po0.001). They also more often
had dilated pores on the cheeks (29.1% vs. 11.3%,
po0.001), ongoing acne (22.1% vs. 8.4%, Po
0.001) and acne scars (22.3% vs. 9.9% po0.001).
Seborrhoeic dermatitis was also more frequent in
this group (8.7% vs. 4.3%, po0.001).
Sebumetry
Compared with the overall population, women
in the oily skin group had signicantly higher
sebum levels (74 vs. 47.4 mg/cm
2
, po0.001).
When comparing answers for overall skin type,
women who assessed themselves as having an
oily skin had a signicantly higher sebum level
than those who judged their skin as being dry or
combined (po0.001) (cf. Fig. 2).
Sebum level, based on results from the
Sebumeter
s
, was also higher in women self-as-
sessed as having a very oily skin than in those
who thought they had a moderately oily skin,
irrespective of the anatomical site considered
(po0.001) (cf. Fig. 3a). Similarly, sebum level
was signicantly higher in women whose skin
20
40
60
spicy food sweety food
%

o
f

w
o
m
e
n
"oily skin" women all women
p < 0.003
p < 0.02
Fig. 1. Prevalence of women in the oily skin group vs. women of the
overall study population according to diet (rather spicy or rather sweet
diet).
52.3
32.5
70
0
20
40
60
80
oily skin combination skin dry skin
s
e
b
u
m

(

g
/
c
m

o
f

s
k
i
n
)
Fig. 2. Non-invasive sebum measurement (Sebumeter
s
) according to
self-evaluated skin type (tendency towards a dry, oily or combination
skin).
45
Oily skin in Chinese women
had been clinically assessed as the most shiny
(po0.001, cf. Fig. 3b).
Lastly, sebum levels were signicantly higher
in Beijing women (100.1 vs. 47.4 mg/cm
2
,
po0.001).
Facial skin characteristics
Compared with the overall study population,
more oily skinned women had a highly reactive
skin when menstruating (11.9% vs. 4%, po0.001)
or when they ate spicy foods (15% vs. 6.4%,
po0.001). Reactive and sensitive skins were also
more frequent in this group (31.9% vs. 24%,
po0.001).
Discussion
The large size of our study population allowed us
to determine the prevalence of oily skin in a
Chinese population living in various geographical
areas of China. We chose to base our study on self-
evaluation, and therefore on the actual apprecia-
tion of the women, in order to improve our knowl-
edge of this population in whom very few
systematic studies have been conducted. Similarly,
we conducted a study of the prevalence of dry skin
and related factors in the same population (9).
MCA of the answers obtained from self-eva-
luation established that a quarter of the women in
the study had oily skin on most of their face. The
accuracy of this self-evaluation was conrmed by
clinical examination of the skin: compared with
the overall study population, women in the oily
skin group more often had a shiny skin on the
nose, forehead and cheeks and more had dilated
pores. Similarly, data from sebum measurements
were highly correlated to self-evaluation results.
Women who had evaluated their skin as being
very oily did have higher sebum levels than
those who dened themselves as having a mod-
erately oily skin. Not only were the oily skin
groups very well characterized but the degree of
skin oiliness reported from self-evaluation was
consistent with the measured sebum levels too.
This observation contradicts the conclusions of a
Korean study published in 2002 where self-eva-
luation had also been compared with biophysical
sebum measurements using Sebumeter
s
on dif-
ferent facial sites (10). The authors stated that
there were discrepancies between self-evaluation
and objective measurements. The different results
obtained in that study and compared with ours
could be explained by the self-evaluation criteria
used and more particularly by the statistical
processing we carried out. In the Korean study,
self-evaluation concerned a single criterion: do
you have a dry, oily or normal skin? In our study
on the other hand, self-evaluation included sev-
eral anatomical sites on the face (nose, cheeks,
forehead and chin) and the women were re-
quested to qualify the intensity of the phenom-
enon for each site (none, moderate, severe). MCA
of this set of self-evaluation data allowed us to
establish a ne classication; four specic skin
groups were thus determined according to the
following criteria: dry, oily, combination, neither
dry nor oily. The relevance and interest of this
typology are emphasized by the consistency of
the results: self-evaluation data were perfectly
consistent with Sebumeter
s
biometric measure-
ments and with clinical assessment carried out by
a dermatologist.
The statistical approach used in this study,
based on self-evaluation, is thus validated and
justied.
Independent of ethnic origin, there are few
data on skin-type prevalence. Results from the
few existing studies are contradictory and most
often compare white skins with black skins (11).
There are a few studies on acne, particularly in
50
60
70
80
90
100
severe moderate
clinical shiny skin intensity
s
e
b
u
m

(

g
/
c
m

)
forehead
nose cheeks
50
60
70
80
90
100
severe moderate
self-assessed oily skin intensity
s
e
b
u
m

(

g
/
c
m

)
forehead cheeks chin
b
a
Fig. 3. Non-invasive sebum measurement (Sebumeter
s
) according to
skin-oiliness intensity, as assessed by subjects (a) and according to
clinical scores of skin shininess, as determined by the dermatologist (b).
46
Nouveau-Richard et al.
subjects of African descent in whom acne scars
are more frequent and marked (12). Few data
concerning Asian populations are available. The
only study of sebum excretion in subjects of
various ethnic origins, including Asian subjects,
found no differences (13). Only one paper re-
ported a positive correlation between sebum
production and skin pigmentation in a Japanese
population (14). The available reported data are
not consistent and not substantial enough to
support a reliable comparison of prevalence rate
according to ethnic origin or geographical area.
Our study revealed a higher prevalence of oily
skin in women living in Beijing; this was con-
rmed by a higher mean value of sebum levels.
An inuence of the place of residence has already
been demonstrated by a Chinese study, which
compared the facial skin of young women living
in Suzhou city (China) with those living in the
neighbouring countryside (15). This work did not
demonstrate any signicant difference of oily skin
prevalence in the two populations but it did,
however, show that oily skin tended to be more
frequent in women under 30 years living in cities
than in those living in the country. As for the
incidence of acne, it was signicantly increased in
the young city dwellers. This study also showed
that lifestyle, notably dietary habits, differed con-
siderably according to whether the women lived
in town or in the outskirts. However, the authors
could not specify the actual impact of such factors
on facial skin characteristics.
In the current study, the involvement of diet
can be emphasized. The prevalence of women
with a moderate intake of rather spicy or sweet
foods was higher in the oily skin group. Oily
skin does therefore seem to be partly related to
the intake of spicy or sweet foods. This observa-
tion rather agrees with certain cosmetic, or even
medical recommendations advocating a limita-
tion of dietary sugar intake in case of acne (47,
16). Given the involvement of sebum in acne (17),
our ndings concerning oily skins and sweet
diets are not surprising, even if they have never
been described in this way. The present study
incidentally conrms the high oily skin preva-
lence in women having had acne, particularly
severe acne, or in women still presenting with an
evolutive acne at the time of the study.
The impact of spicy diets is a rather new
nding given that, to our knowledge, no links
between spices and sebum level and between
spices and acne have been previously reported
in the literature. On the other hand, there seems
to be a link between skin sensitivity and spicy
diets (18, 19), the prevalence of sensitive skins
being higher in cities where diets are naturally
spicy (20). However, the results of the present
study show that women with an oily skin also
more often have a sensitive skin and exhibit a
moderate-to-strong reactivity to skin-stimulating
factors such as temperature changes, soap, spices
or stress. There might therefore be a link between
oily skins, sensitive skins and spicy diets, which
remains to be explored, particularly in order to
try to determine the triggering factor.
As the investigation included several centres
distributed throughout the vast Chinese conti-
nental territory, we were also able to assess the
impact of latitude. On the whole, the problem of
oily skins, whether assessed clinically or by
sebumetry, seems to be more frequent in the cities
of northern China (Beijing, Shenyang, Harbin)
than of southern China (Chengdu, Suzhou), with
a particularly high rate in Beijing. It seems that
latitude alone cannot account for such differ-
ences. In the literature, a Japanese study demon-
strated no latitude impact (comparison of North
vs. South of Japan) on sebum levels (21); the main
difference between the two locations concerned
UVB irradiation. In our study, the selected cities
had very different climates: Siberian for Harbin,
cold continental for Shenyang and Beijing, sub-
tropical for Chengdu and temperate with a mar-
itime inuence for Suzhou. Therefore, oily skin
prevalence was most probably related to tem-
perature and relative humidity variations.
Lastly, our study demonstrated that, compared
with the other groups, women with an oily skin
more frequently had irregular menses and their
skin was more reactive to menstruation. These
observations concur with the results of older
studies demonstrating an impact of hormonal
status on skin condition, as in acne for instance
(22). They agree with previous observations re-
garding the impact of menstrual cycle on sebum
excretion (23). A relatively high frequency of the
menstrual cycle abnormalities had been pre-
viously demonstrated in women having acne,
notably in Asian women (12).
Conclusion
The relevance of self-evaluation of skin status
was conrmed by clinical examinations carried-
out by a dermatologist as well as by instrumental
47
Oily skin in Chinese women
assessment of excreted sebum amounts. This
correlation results from a statistical classication
taking into account the facial sites and the in-
tensity of the phenomenon described for these
sites. Comparison of the different skin groups
established through self-evaluation conrms the
interest of this approach.
A quarter of the study population was affected
by oily skin. This was associated with known
factors, such as a past history of acne or irregular
menses. It was also associated with certain eating
habits such as a high intake of sweet foods. Other
highly interesting new links were noted, particu-
larly that between oily skin, skin sensitivity and
spicy diets. Additional studies would help
support this hypothesis, particularly in other
ethnic groups and other countries, and would
contribute toward understanding the origin
of these links.
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48
Nouveau-Richard et al.