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The effectiveness of alkaline water on oily and acne-prone skin: a case report

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Background: Skin lesions and excess sebum on the surface of epidermis occur mainly among people suffering from acne vulgaris. Scientists are constantly searching for cosmetic procedures that, can not only complement dermatological treatment and decrease sebum production, but also increase patients’ quality of lives. Aim of the study: To evaluate the effectiveness of alkaline water in the treatment oily skin and acne vulgaris in a 21-year-old woman. Case report: A 21- year-old female reported problems with too high a sebum level and skin eruptions like blackheads, whiteheads, and pustules. The sebum level was measured and the global acne severity scale (GAGS) score was used to check the amount of skin eruptions before and after a series of treatments with alkaline water. Conclusions: After a series of cosmetological treatments with alkaline water, there was a significant reduction of sebum secretion and skin eruptions.
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e-ISSN 2544-1620 Medical Science Pulse 2021 (15) 1
B
Acne vulgaris is an inammatory disease charac-
terized by skin eruptions such as comedones, nod-
ules, pustules, papules, blackheads and whiteheads.
ese lesions most commonly appear on the face, es-
pecially in the T-zone (forehead, nose, chin), but are
also observed on the mandible and upper back area.
e development of acne vulgaris may be due to fol-
licular hyperkeratinisation, colonization of Cutibacte-
rium acnes, or too high a level of testosterone. A poor
diet rich in simple sugars, dairy products, and spicy
food may also contribute to deterioration of the skin
condition in these patients [1]. Severe forms of acne
cause scarring, and, consequently, can diminish the
quality of life. Scars or facial deformities aect up to
20% of teenagers [2,3,4]. Skin lesions formed after
acne treatments may negatively inuence daily life
activities and, eventually, lead to depression, suicidal
thoughts and suicide attempts [5,6].
Various cosmetic treatments are eective at re-
ducing skin lesions and sebum secretion. ese in-
clude cosmetic acids such as azelaic (AzA), salicylic
and pyruvic acids. Szymańska et al., showed that
peels containing 30% AzA reduced acne skin erup-
tions and secretion of sebum. Similarly, Jaary et al.
found that pyruvic acid (50%) and salicylic acid (30%)
improved mild and moderate acne without side ef-
fects [7,8]. Cosmetic acids can also be used to re-
duce skin discoloration, which often occurs in people
struggling with acne. In the treatment of skin hyper-
pigmentation, dierent levels of exfoliation are used,
depending on the nature of the discoloration. e
most frequently used acids in this case are glycolic,
Case reports
THE EFFECTIVENESS OF ALKALINE WATER
ON OILY AND ACNEPRONE SKIN:
A CASE REPORT
Published online: 31 March 2021 DOI: 10.5604/01.3001.0014.8295
A – study design, B – data collection, C – statistical analysis, Dinterpretation of data, E – manuscript preparation, F – literature review, G – sourcing of funding
K C1 A,D-F
ORCID: 0000-0002-6435-0179•
M R1 E
ORCID: 0000-0001-6467-7633•
I D1 E
ORCID: 0000-0002-5800-7817•
1 Department of Health Sciences , Institute of Health Sciences,
University of Opole, Opole, Poland
ABSTRACT
Background: Skin lesions and excess sebum on the surface of epidermis occur mainly among people suer-
ing from acne vulgaris. Scientists are constantly searching for cosmetic procedures that, can not only comple-
ment dermatological treatment and decrease sebum production, but also increase patients’ quality of lives.
Aim of the study: To evaluate the eectiveness of alkaline water in the treatment oily skin and acne vulgaris
in a 21-year-old woman.
Case report: A 21- year-old female reported problems with too high a sebum level and skin eruptions like
blackheads, whiteheads, and pustules. e sebum level was measured and the global acne severity scale
(GAGS) score was used to check the amount of skin eruptions before and after a series of treatments with
alkaline water.
Conclusions: After a series of cosmetological treatments with alkaline water, there was a signicant reduc-
tion of sebum secretion and skin eruptions.
KEYWORDS: alkaline water, oily skin, cosmetology, women, sebumeter
Medical Science Pulse 2021 (15) 1
e eectiveness of alkaline water on oily and acne-prone skin: a case report
trichloroacetic, and salicylic acids. However, it should
be noted that these cosmetic acids often cause side
eects after application, including redness, burning,
irritation of the skin, and peeling, which often causes
discomfort [9].
Preparations containing plant extracts also are
extremely helpful in treating acne or excess sebum
production. In the case of problematic skin, plant
extracts such as green tea or lotus can be used. Mah-
mood et al. examined the eectiveness of the above-
mentioned plant extracts for treating oily skin in
men. In one study, green tea and lotus extracts were
used externally, resulting in a signicant reduction
in sebum levels. In another study conducted by the
same authors, a 3% green tea gel was used externally
for 8 weeks, which also reduced sebum on the skin
surface [10,11].
Cosmetology is an interdisciplinary science which
is constantly developing. Scientists are continually
looking for new methods to treat acne-prone skin
types. Recently, hydrogen cleansing has been intro-
duced. is treatment is based on pushing active hy-
drogen particles into the skin at a high pressure. Hy-
drogen cleansing is a non-invasive procedure with no
reported side eects such as skin reddening, burning,
or breaking. e electrolysis apparatus used for this
treatment produces alkaline water (pH=9).
It should be noted that a cosmetic treatment is
selected for each patient individually, and contrain-
dications for potential treatments are extremely im-
portant to consider. Not every person suering from
acne will be able to undergo a treatment with the use
of cosmetic acids, plant extracts or ultrasound, for
example. erefore, a preliminary interview to deter-
mine the indications and contraindications for a pro-
cedure are necessary for the selection of a safe and
eective individual treatment method.
A   
e purpose of this study was to assess the e-
cacy of alkaline water in reducing acne skin eruptions
and decreasing sebum levels.
M  
Study design, setting and duration
Hydrogen purication with alkaline water was
used as a cosmetic treatment in the current study.
e procedure consisted of 6 treatments with the al-
kaline water (pH=9) occurring every 7 days. Make-
up was removed with a micellar uid before each
treatment. e treatment was performed with the
use of alkaline water generated by the apparatus.
To obtain high pressured alkaline water a special tip
was used. e water used during the procedure was
sucked into a special container and the vacuum set
at 12%. Each treatment lasted 10 minutes and was
nished with the application of tonic and a mois-
turising cream. is study was conducted between
January 2020 and February 2020 at Opole Univer-
sity in Poland.
Participant
e participant was a 21-year-old female who re-
ported some problems with excessive sebum secre-
tion and skin eruptions such as blackheads, whitehe-
ads and pustules. e condition was present in the
patient for the past 6 years.
Inclusion criteria
e patient met the inclusion criteria for the
study including an age of 19–23, no dermatological
treatment within last 12 months, mild-to-moderate
acne as measured by the global acne severity scale
(GAGS), and no current hormonal contraception.
Exclusion criteria
Exclusionary criteria for this study were pregnan-
cy, breastfeeding, active inammation of the skin,
bacterial, viral, allergic, and fungal skin diseases, dis-
turbed skin condition, active rosacea, eczema, psoria-
sis, numerous telangiectasias, numerous melanocytic
nevi, skin cancers, oral contraceptive pill use, oral
antibiotic use within the previous three months, or
isotretinoin use within the previous year.
Ethical Considerations
e study was approved by Human Research Eth-
ics Committee of the Opole Medical School (KB/54/
NOZ/2019), according to the principles of the Dec-
laration of Helsinki. e participant was informed
about the principles and purpose of the study, signed
a voluntary written consent form, and was informed
that she could withdraw from the study at any time
without giving a reason.
Data sources/ Measurements
e participant was diagnosed with mild acne vul-
garis (GAGS score=17). e GAGS scale divides the
body into areas (forehead, cheeks, nose, chin, chest
and back) and assigns a factor to each area on the ba-
sis of size. e location and factors are: Forehead – 2;
Right cheek 2; Left cheek – 2; Nose – 1; Chin – 1;
Chest and upper back – 3. Each type of lesion is also
given a value depending on severity: no lesions=0,
www.medicalsciencepulse.com
 K C, M R, I D
comedones=1, papules=2, pustules=3, and nodules=4.
e score for each area (Local score) is calculated us-
ing the following formula: Local score=Factor × Grade
(0–4). e global score is the sum of local scores, and
acne severity is graded using this metric. A score of
1–18 is considered mild, 19–30 moderate, 31–38 se-
vere, and >39 very severe [12,13].
Sebum measurement was performed using a Der-
ma Unit SCC 3 sebumeter. Measurements were taken
before the series of cosmetic treatments and 14 days
following the last treatment. e patient was asked
to remove make-up and not to apply any cosmetics
the evening before the examinations, which were
carried out in the morning hours. e temperature
in the examination room was 22 degrees Celsius and
the humidity was 40–50%. e patient was allowed
to acclimate to the conditions for 20 minutes prior to
each examination and the level of sebum was checked
between the eyebrows and on the chin.
e patient was informed that during the treat-
ment, and for the two weeks following, other cosmet-
ic procedures, dermatological treatments, applying
new cosmetics, going to a swimming pool or solari-
um, or supplementation with any substances reduc-
ing sebum were forbidden. She was recommended
to use only micellar uids and moisturising creams
in homecare. Cosmetics with mattifying or sebum-
regulating eects were also strongly contraindicated.
R
After the series of cosmetological treatments
using alkaline water, it was found that there were
reduced skin eruptions (Table 1) and sebum levels
(Table 2). ese measurements indicated an improve-
ment in the condition of the skin. Treatments reduced
the GAGS score from 17 to 10 and the level of sebum
decreased between the eyebrows (251 to152 µg/cm2)
and on the chin (183 to 130 µg/cm2).
Table 1. GAGS score before and after treatment
GAGS score
before the treatment
GAGS score 14 days
after the last treatment
17 10
Table 2. Sebum level before and after treatment
Area
of measurement
Sebum level
before
the treatment
(µg/cm2)
Sebum level
14 days after
the last treatment
(µg/cm2)
Between the eye-
brows 251 152
On the chin 183 130
D
Key results
Alkaline water is a useful treatment for people
struggling with skin eruptions (acne vulgaris) and
with those who have high levels of skin oiling.
Interpretation
e series of cosmetic treatments with alkaline
water in a 21-year-old female appeared to be very ef-
fective at reducing her skin eruptions. Alkaline water
has a high pH, which reduces sebum on the surface of
epidermis. It may also have an anti-inammatory ef-
fect [14]. Face washes such as soaps also have a high
pH, but when used daily may over dry the skin and
cause irritation [15]. e treatment in the current
study was performed weekly; therefore, the skin pa-
rameters improved rather than worsened. Alkaline
water is well-known in the world of science. Gadek
et al. showed that drinking 2 litres of alkaline water
daily decreased glucose HbA1c levels in people with
type 2 diabetes [16]. is substance has also been
used to treat cancer, and to decrease cholesterol and
creatinine [17,18]. As the application of alkaline wa-
ter to treat acne is relatively new, few studies exist in
the literature. However, Chilicka et al. examined the
use of hydrogen purication in people with acne, and
observed positive results in terms of the reduction
of skin eruptions [19]. Given these ndings, and our
own results, we hope that the study of alkaline water
treatments will become more popular among other
researchers.
As mentioned above, it is not only apparatus
treatments that are eective at reducing skin erup-
tions and excessive sebum levels. Plant extracts such
as green tea have produced positive results in many
studies. For example, Lu et al. found that the treat-
ment of acne patients with green tea capsules admin-
istered orally signicantly decreased skin eruptions
[20]. Moreover, Jung et al., in their study, obtained
a reduction of open comedones and pustules after us-
ing green tea [21].
Sebum is an oily material that is produced in the
sebaceous glands. It is a mixture of triglycerides, wax
esters, squalene, and cholesterol esters. High sebum
levels can be present on face (forehead, nose, chin),
shoulders, and back. Sebum has a protective func-
tion, but too much can increase the likelihood of de-
veloping acne. While acne treatments can decrease
sebum, it is important to note that, given its impor-
tant biological functions, cosmetological procedures
that reduce sebum levels by too much may result in
unwanted side eects [22].
Medical Science Pulse 2021 (15) 1
e eectiveness of alkaline water on oily and acne-prone skin: a case report
According to Fąk et al., microdermabrasion in
a group of healthy people was eective in reducing
sebum. In particular, a statistically signicant dier-
ence in stratum corneum hydration was found on the
cheeks 30 minutes after treatment and in the T-zone
immediately after the procedure. Sebum reduction
was observed immediately after the procedure irre-
spective of skin type and face area [23]. Kołodziejczak
et al. also showed that a series of mixed treatments,
including microdermabrasion and cavitation peeling,
improved the condition of seborrheic skin. Following
these treatments a statistically signicant improve-
ment in skin sebum levels was observed in all facial
areas examined [24].
e advantage of cosmetic treatment lies mainly
in its complete lack of side eects such as irritation of
the skin or burning of the epidermal surface. On the
contrary, cosmetic acids, despite their positive eects
on the acne and oily skins, produce side eects that
may cause some discomfort [1,5].
Study limitations and recommendations
While the current results are promising, it would
be useful to verify the eectiveness of this treatment
in a larger sample of patients, including the opposite
sex. In addition, it would be informative to include a
placebo control group using only normal mineral wa-
ter in future studies.
C
Cosmetic treatment with alkaline water appears
to be safe and eective in patients suering from
acne vulgaris and excess sebum secretion. is treat-
ment signicantly reduced both skin eruptions and
sebum levels. It is worth noting, however, that a cos-
metic procedure cannot replace a dermatological
treatment. us, treatment with alkaline water may
be useful as a complementary therapy in cooperation
with a dermatologist.
R
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www.medicalsciencepulse.com
 K C, M R, I D
Word count: 1936 •Tables:2 •Figures:1 •References:24
Sources of funding:
e study was funded by rst author.
Conicts of interests:
e authors report that there were no conicts of interest.
Cite this article as:
Chilicka K, Rusztowicz M, Dzieńdziora I.
e eectiveness of alkaline water on oily and acne-prone skin: a case report.
Med Sci Pulse 2021; 15(1): 50-4. DOI: 10.5604/01.3001.0014.8295.
Correspondence address:
Karolina Chilicka, PhD
Institute of Health Sciences, University of Opole
ul. Katowicka 68, 45-060 Opole, Poland
E-mail: karolina.chilicka@poczta.onet.pl
Received: 05.02.2021
Reviewed: 15.02.2021
Accepted: 21.02.2021
ble-blind, and placebo-controlled clinical trial. Complement
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apeutic eect on acne by suppression of TLR2 and IL-8 ex-
pression via down-regulating the ERK1/2 pathway. Arch Der-
matol Res 2012;304(8):655-63.
22. Crowther JM. Method for quantication of oils and se-
bum levels on skin using the Sebumeter. Int J Cosmet Sci
2016;38:210-16.
23. Fąk M, Rotsztejn H, Erkiert-Polguj A. e early eect of
microdermabrasion on hydration and sebum level. Skin Res
Technol 2018;24(4):650-5.
24. Kołodziejczak A, Wieczorek A, Rotsztejn H. e assessment
of the eects of the combination of microdermabrasion and
cavitation peeling in the therapy of seborrhoeic skin with
visible symptoms of acne punctata. J Cosmet Laser er
2019;21(5):286-90.
... The observed pH range is indicative of alkalinity strength, the hot spring water may not bring a corrosive effect on skin as this is possible only below a pH of 6.5, and the scaling effect is also minimal as this takes place above 8.5 pH value [6]. However, the high alkalinity values indicate more bicarbonate and soluble carbonate levels, and such alkaline water (pH 9) has been reported to reduce sebum on the surface of the epidermis, lower the skin eruption, and impart an antiinflammatory effect [36,37]. The swimming pool water alkalinity tolerance level is < 500 ppm [30], but the Kharapani hot spring water alkalinity (700-706 ppm) is higher than the recommended level. ...
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... The local score calculated for each area has the formula: Local score = factor × Grade (0-4). The global score is composed of the sum of the local results: 1-18 = mild acne, 19-30 = moderate acne, 31-38 = severe acne, above 39 = acne with very severe course [16]. All volunteers underwent a series of four treatments applied every 2 weeks. ...
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The synergy of cosmetic acids, with their keratolytic and antibacterial properties, with the mechanical exfoliation of the epidermis brings faster and better treatment results. The aim of the study was to compare the effects of using only pyruvic acid and the synergy of microdermabrasion and chemical exfoliation. In total, 14 women diagnosed with acne took part in the study. Two areas were marked on the participants’ faces: the right side (microdermabrasion treatment and a preparation containing pyruvic acid 40%) and the left side (preparation containing pyruvic acid 40%) without mechanical exfoliation. A series of four treatments was performed at 2-week intervals. Skin parameters such as stratum corneum hydration and sebum secretion were measured. Before the treatments, all patients had moderate acne according to GAGS (Min: 19, Max: 22, Md: 20), and after the treatments, it decreased to mild acne according to GAGS (Min: 13, Max: 17, Md: 140). On the right side of the face, there was a statistically significant reduction in sebum secretion in all the examined areas of the face and increase in the hydration of the stratum corneum. On the left side of the face, the differences were also observed in the decrease of sebum value and increase of hydration level; however, they were smaller than on the right side. The use of microdermabrasion in combination with pyruvic acid led to better results in the case of increased hydration and reduction of sebum secretion than using only pyruvic acid treatment. Keywords: acne vulgaris; microdermabrasion; pyruvic acid; moisturizing; sebum
... It should also be remembered that to prevent acne scars it is extremely important to care for the skin of people who suffer from acne. This is evidence-based on numerous scientific studies [58][59][60][61]. Combination treatments are very useful in scars and improve scars much better than a single treatment (Table 1). ...
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Background Acne vulgaris is a chronic inflammatory disease of the pilosebaceous follicles and one of the most common skin diseases. The peeling method has been recently found to be effective for acne treatment. This study aimed to compare the efficacy of pyruvic acid 50% and salicylic acid 30% peeling in the treatment of mild to moderate acne. Materials and Methods In a prospective single-blinded clinical trial, 86 patients with acne were randomly assigned into two groups. In both groups, the routine treatment of acne (topical solution of erythromycin 4%, triclorocarban soap, and sunscreen) were used twice a day for 8 weeks. In addition, salicylic acid 30% for the control group and pyruvic acid 50% for the case group were used. In both groups, acne severity index (ASI) was calculated before and at week 2, 4, 6, and 8 of the treatment. Patient satisfaction was assessed at the end of the treatment. Side effects were recorded using a checklist. Results In both groups, the reduction in the number of comedones, papules, and ASI were statistically significant (P < 0.001) in the course of treatment. However, it was not significant regarding the number of pustules (P = 0.09). None of the number of comedone, papules, pustules, and ASI was statistically different between study groups. Both treatment groups had similar side effects except for scaling in the fifth session, which was significantly lower in salicylic acid – treated patients (P = 0.015). Conclusion Both pyruvic acid 50% and salicylic acid 30% are effective in the improvement of mild to moderate acne with no significant difference in efficacy and side effects.
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Background: Acne is a common, chronic, inflammatory disease of the pilosebaceous unit. It has a significant impact on patient quality of life, especially when lesions occur on cosmetically sensitive areas. Chemical peeling is a well-known option in the treatment of acne vulgaris, but little is known about azelaic acid (AZA) peels. Objectives: To determine the efficacy of 30% AZA peel, in decreasing the amount of secreted sebum, and reducing acne lesions. Methods: The study involved 35 women, with acne lesions on face skin. All the subjects underwent a series of six treatments, performed every 2 weeks. Results: A series of treatments contributed to a statistically significant reduction in the amount of secreted sebum. Similarly, highly significant values determining the overall number of acne lesions and the severity of the disease according to the IGA scale were also changed. The procedure was well tolerated by all participants. Conclusions: Peels with 30% AZA reduced acne lesions and normalized the activity of the sebaceous glands. The reduction of sebum allows us to believe that obtained good results in patients will be stable and long-lasting.
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Objective: The aim of this study was to assess objectively the effects of the combination of corundum microdermabrasion and cavitation peeling in the therapy of seborrheic skin with visible symptoms of acne punctata. Material and methods: The study involved a group of nine women. A series of six treatments with the combination of microdermabrasion and cavitation peeling were performed within facial skin at 10–14 days intervals. Corneometric measurements examining skin hydration level and sebumetric measurements analyzing skin sebum level were made before the series of treatments and after second, fourth and sixth procedure in five facial areas. Clinical assessment of the efficacy of the therapy was performed on the basis of photographic documentation (Fotomedicus). Anonymous questionnaires were used in order to evaluate patients’ satisfaction rate. Results: Statistically significant improvement in skin sebum level was observed in all examined areas (forehead p = 0.002; nose p = 0.001, chin p = 0.01, left cheek p = 0.009, right cheek p = 0.007). In case of skin hydration, significant improvement was found only in the area of chin (p = 0.03). 78% of participants estimated that the improvement was in the range of 55–70%, while 22% of participants of 75–100%. The reduction in the amount and visibility of comedones and pimples were demonstrated on the basis of questionnaire and photographic documentation. Conclusions: Combined microdermabrasion and cavitation peeling treatments improve the condition of seborrheic skin.
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Background Microdermabrasion is a popular form of mechanical peel, used for many aesthetic purposes. Because it removes the superficial epidermal layer, it has an impact on hydrolipid skin coat. Objective The aim of the study was to examine the changes taking place in the hydrolipid coat of the skin after microdermabrasion measured by skin hydration and sebum level. Methods Sixteen healthy women were included in the study, and the aluminium oxide crystal microdermabrasion device was used over the entire face of each patient. Measurements of stratum corneum hydration and sebum level were taken at baseline, just after the treatment, and 30 and 60 minutes later. Results A statistically significant difference in stratum corneum hydration was found on the cheeks 30 minutes after treatment and in the T‐zone immediately after the procedure. Sebum reduction was observed immediately after the procedure irrespective of skin type and face area. In addition, sebum value was found to return to baseline 1 hour after the procedure. Conclusions The observed changes in epidermal barrier function may be responsible for the clinical improvement following microdermabrasion.
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Two of the most important skin care categories with profound dermatologic implications are cleansers and moisturizers. Cleansers are composed of alkaline soaps or the less barrier-damaging synthetic detergents, known as syndets. The lower skin irritation and dryness found with syndets are related to their reduced tendency to cause protein denaturation due to the charge density of protein-bound micelle-like surfactant aggregates. Many cleansing formulations are available for purchase to meet hygiene needs varying by sex, age, ethnicity, occupation, environment, personal preferences, and the presence or absence of skin disease. This discussion covers the science of skin cleansing.
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Objective: The Sebumeter(®) is widely used in both cosmetic and medical research, for measuring changes in sebum levels on skin. It is commonly reported that the units correlated to a mass of sebum on the skin in μg cm(-2) ; however, validation for this has not been published. Also, its use for assessing the presence of other oily materials which are widely utilized in topical skincare products on skin has not been widely discussed. Determining a calibration scale and whether the response of the device is linear with the level of oils present enables quantification of the output of the device, and would validate the device for claims substantiation. Methods: Different doses of a variety of oily materials (paraffin oil, white soft paraffin, capric-caprylic triglyceride, 350cSt silicone fluid and synthetic sebum) were applied to skin, and the Sebumeter(®) used to collect and quantify them. The mass per square centimetre of the oily material delivered to the skin was then compared to the Sebumeter(®) output to develop calibration curves for the different materials. Measurements were carried out on a single volunteer as this work was to verify the concept of quantitative oil assessment using the device. Results: A linear correlation between the mass of the oily material and the Sebumeter(®) output was seen for all the materials tested. However, the absolute response of the device was different for each material, and the output values did not directly give the mass of material on the skin in μg cm(-2) . As part of the calibration, it was also demonstrated that to remove all the oily material from a given area of the skin required multiple 30-s applications of the Sebumeter(®) cartridge. Conclusions: The Sebumeter(®) is a precise analytical instrument capable of quantitative measurement of deposition of oily materials onto skin from topical products (down to the μg cm(-2) level), as well as its traditional use of measuring sebum levels. However, the output values do not directly correlate with the mass of oil present, and generation of a calibration curve is necessary for any ingredient of interest to produce quantitative data for claim support and formulation development.
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Background and aim: Green tea and lotus hold several synergistic antioxidant compounds. This investigation aimed to assess the efficacy of green tea and green tea plus lotus vs. placebo multiple emulsions in healthy adults for controlling casual sebum secretions. Participants and methods: After signing informed consents, twenty-two participants were registered in a single-blinded, placebo-controlled, split-face comparative study. Group 1 participants applied a multiple emulsion formulation with green tea extract while group 2 applied a multiple emulsion with green tea plus lotus extract in a 60 days treatment course. A non-invasive photometric device (Sebumeter™) has been used for the measurement of casual sebum secretions on both sides of the face. Results: Steady and statistically significant reductions in sebum secretions were noted for mono (green tea) and combined treatments (green tea plus lotus) compared to placebo treatment. However, irrespective of the concentration of extracts in active formulations, green tea plus lotus combined treatment produced statistically more sound results (two-tailed p value = 0.0002) than green tea alone (two-tailed p value = 0.0060) in a 60-days treatment course. Conclusions: RESULTS suggest that synergistic compounds in green tea and lotus could be a promising choice for cutaneous disorders where elevated sebum levels are involved in the pathophysiology of these disorders.