Efficacy of a Non-Comedogenic Hair Care Regimen for the Reduction of Mild-to-Moderate Truncal and Facial Acne: A Single-Arm 8-Week Study

June 2021 | Volume 20 | Issue 6 | Original Article | 690 | Copyright © June 2021


Published online May 26, 2021

Iris K. Rubin MD

SEEN Hair Care, Bethesda, MD

Abstract
Introduction: Hair care products can be comedogenic, and therefore contribute to acne. Hair care products can leave a residue on the skin, even with rinse off products. This residue may explain why hair care products can cause acne.
Methods: 27 subjects aged 16–45 with mild to moderate facial and truncal acne utilized a non-comedogenic hair care regimen for 8 weeks. Dermatologist assessment of acne severity was performed with the PGA (truncal acne) and IGA (facial acne) scale at baseline and 8 weeks.
Results: At 8 weeks 70% of subjects with truncal acne showed improvement in PGA, and 52% of subjects with facial acne showed improvement in IGA by dermatologist grading. Subject self-assessment corresponded with dermatologist grading, with 74% agreeing that their skin looks and feels healthier at 8 weeks.
Conclusion: This non-comedogenic hair care regimen showed efficacy in improving mild to moderate truncal and facial acne, both by dermatologist grading and subject self-assessment. Hair care products should be considered as a possible contributor to acne.

J Drugs Dermatol. 2021;20(6):690-693. doi:10.36849/JDD.5772

INTRODUCTION

Acne is a common inflammatory skin condition, with a prevalence of ~85% in adolescence. Acne is not just a teenage condition, and the prevalence of acne in adult women has been reported to be 50.9% for ages 20–29, 35.2% for ages 30–39, and 26.3% for ages 40–49.1 Acne’s pathogenesis involves follicular hyperkeratinization, increased sebum production, inflammation, and the bacteria C. acnes (formerly P. acnes). Acne cosmetica was described by Kligman and Mills in 1972 as a low grade, persistent acneiform eruptions of primarily small closed comedones caused by comedogenic cosmetics.2 While it is commonly accepted that acne cosmetica can occur from comedogenic skin care products, hair care products are often overlooked as a contributor to acne, unless someone presents with classic pomade acne on the forehead.3 Pomade acne has also been described as occurring in all skin types, and in both men and women, from hair smoothing products.4 Acne cosmetica from hair care products has been described by the American Academy of Dermatology (AAD) as tiny bumps occurring on the hairline, forehead, and back of the neck.5 In practice many clinicians have observed that hair care products may contribute to acne beyond the hairline/forehead, and not necessarily present with just the classic small comedones of acne cosmetica.

The mechanism by which hair care products contribute to acne may be through a residue that they leave on the skin. We recently published a case report demonstrating that hair care products can leave a residue on the scalp, forehead, cheek, and back. Even rinse off products (shampoo, conditioner) left a residue on the skin for up to 2 hours. A leave in styling product left a residue on the skin for up to 4 hours. The study did not examine beyond these time points.6

This study was performed to better understand the impact of hair care products on facial acne and truncal acne, and to assess the efficacy of a non-comedogenic hair care regimen for the improvement of mild to moderate facial and truncal acne.

MATERIALS AND METHODS

Patients
27 patients (15 female, 12 male), ages 16-45 (mean age, 21.5), with mild to moderate facial and truncal acne enrolled in an 8-week study to assess the efficacy of a non-comedogenic hair care regimen on reducing acne. Informed consent was obtained. All patients completed the study. Mild to moderate facial and truncal acne were defined by a score of 2–3 on the investigator global assessment (IGA) for the face, and physician global assessment (PGA) scale for the trunk (Table 1).

Exclusion criteria included use of an OTC acne product within the last 2 weeks, use of a prescription systemic acne treatment within the last 4 weeks, and use of a prescription topical acne treatment within the past 2 weeks.