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Combination Skin: What It Is, and How to Treat It

The Baumann Skin Typing System (BSTS) uses a scientifically validated questionnaire to determine if skin is dry or oily.  In the Baumann Skin Typing System, dry skin is defined as skin that has less water content than normal skin and makes a decreased amount of sebum as compared to normal skin. Oily skin is defined as skin that makes an adequate or increased amount of sebum. (With this definition, oily skin is preferable.) In the BSTS, you cannot be both an O (Oily type) and a D (dry type) at the same time.  The question always comes up- “What if I am a combination skin type?”  This blog will discuss the science of combination skin and explain why it doesn’t really exist.

What Is Combination Skin?

In the last decade of my research on skin type, I have found that when people say they have “combination skin” they exhibit one of two patterns: 1. Increased sebum production in the mid- face T- zone area or 2. Full facial dryness in the winter and oiliness in the summer with heat and humidity. These two skin patterns must be discussed separately.  

Overactive Sebaceous Glands in the T-Zone

The T-zone, which includes your forehead, nose, and chin has more sebaceous glands and makes more sebum than the rest of the face.  When these glands are overactive due to stress, hormones or genetics, increased facial oil is produced. Although this oil is produced in the central face, the act of rubbing the skin may spread the sebum to other parts of the face. People with overactive T zone sebaceous gland feel shiny in the day and do not like the feel of heavy moisturizers on their skin- especially in the central face.  They prefer lighter lotion and milk type moisturizers applied only to the sides of the face.  These must be non-comedogenic because this skin type tends to get blackheads and whiteheads easily. The important thing to understand is that this skin type is making fatty acids, ceramides and cholesterol in their sebum already.  Therefore, they do not need the lipid laden barrier repair moisturizers that dry skin requires.  They only need a light humectant moisturizer with a very small amount of occlusive ingredients.

This skin type is diagnosed as an “O” type in the BSTS because the sebaceous glands are making an increased amount of oil.  A light moisturizer should be applied to the sides of the face only. In the daytime, a sunscreen is applied to the entire face.  This sunscreen preparation will contain all the moisturizing ingredients needed for the mid-face.  Over use of moisturizer in the midface will lead to shininess, blackheads, and possibly acne.

Skin That is Dry in the Winter and Oily in the Summer

Many people who state that they have combination skin really mean that their skin changes from dry in the winter to oily in the summer. Rather than calling this a combination skin type, it is more correct to say that the skin is an “O type” in the summer and a “D type” in the winter.  What this means is that the skin carrier is impaired. In low humidity environments such as the desert or in the cold winter, the skin is unable to hold onto water and it evaporates off leaving the skin dehydrated. This skin type does not make enough sebum to compensate and prevent this from happening.  For this reason they are a D type in winter.  However, in summer (or a humid climate) when there is more water in the air, less water evaporates from the skin’s surface. The adequate or increased levels of sebum production make the skin feel more hydrated and may feel oily over the T zone.  I have many patients who live in Miami in the winter and Aspen in the summer.  They are a dry type in Aspen and an Oily type in Miami.  It really has to do with the amount of ambient humidity in the environment.  This type may notice dryness after a long airplane trip because of the lack of humidity in the airplane. Treating this skin type is simple.  One option is to add a humidifier to your house, however that will not solve the problem when you are outside.  It is best to follow an oily skin prescription regimen in the humid months and a dry skin prescription regimen in the drier months.  Your dermatologist will be able to guide you.

Combination Skin and Acne Medications

If you have combination skin and acne, you will find that it is more difficult to tolerate your acne medications during the cold months.  Acne medications include benzoyl peroxide, retinoids and salicylic acid- all of which tend to dry the skin. Changing your cleanser and moisturizer to those recommended for dry types will allow you to tolerate your acne medications in the winter. It is best to get recommendations from your dermatologist but if that is not possible, look at Skin Type Solutions under the dry sensitive skin (DS) types to find a cleanser and moisturizer that will work for you. Zerafite is an example of a brand that would be appropriate.

Combination Skin and Anti-Aging Skincare

infla-man_croppedMany anti-aging products contain retinoids which are a bit unique from other products because they are able to penetrate into the skin extremely well.  In the dry months, the dehydration of the skin leads to an increased risk of inflammation and irritation. If the skin barrier is compromised, much more retinoids can enter the skin and provoke inflammation. Following the skincare recommendations for a DS (dry, sensitive) skin type found at SkinTypeSolutions.com and switching to a creamy non-foaming cleanser and a barrier repair moisturizer during the winter months can allow you to tolerate your antiaging regimen in the winter.

Dry environments increase the risk of waking up INFLA-MANleading to inflammation.

 

The Bottom Line

There is no such thing as combination skin.  Instead, think of yourself as changing your skin type between an O and a D based upon ambient humidity. Other factors such as hormone fluctuations, pregnancy, stress, exercise, change in sleep patterns and diet can also affect your skin barrier and sebum production causing you to change your skin type.  The best thing to do is to see your dermatologist and retake the questionnaire that determines your skin type. Then you should adjust your skincare regimen accordingly.  The skincare regimen should help balance your skin.  If it stops working, then retake the questionnaire.  Once you learn the pattern of your skin and what types it changes to, you will not need to retake the questionnaire to adjust your regimen.  You will be able to follow the recommendations at SkinTypeSolutions.com and adjust accordingly.  Plan to have an O regimen and a D regimen that you alternate between.

Combination skin might seem like a skincare challenge at first, but the truth is, it’s really all about identifying the triggers that change your skin type between oily and dry. If you don’t yet know your Baumann Skin Type, find a professional in your area who can provide a thorough assessment.

 

Dr. Leslie Baumann, M.D. and her team at Baumann Cosmetic Dermatology believe in proof, not promises. World-recognized for both cosmetic and general dermatology, our treatment strategies rely exclusively on evidence-based, scientifically verified products and procedures that promote skin health and a natural appearance. We combine effective medical procedures with individualized instruction on proper skincare, nutrition, supplementation and lifestyle in order to maximize the health of the skin and body as a whole while minimizing the effects of aging. For more, visit Dr. Baumann’s blog for daily updates Monday through Friday, or inquire about an appointment through Derm.net.

September 16, 2016 Skincare

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