Cosmeceuticals: Scrutinize ingredients, pick and choose best products

New York - Cosmetic patients today have a multitude of cosmeceuticals from which to choose, and each product claims to raise the bar in its effectiveness in skin rejuvenation. Many of these products do have some degree of effectiveness, and yet others may be the cause of hardship in terms of eliciting an irritant or allergic contact dermatitis in the unfortunate user. According to one expert, physicians need to scrutinize the ingredients of these cosmeceuticals and carefully pick and choose among the vast array of products for the benefit of their patients.

"The plethora of aesthetic topical products on the market today can, at times, be somewhat overwhelming to cosmetic patients who seek to keep their appearance youthful.

"With all the different products available and the golden promises the pharmaceutical companies often claim, it can be challenging to choose the best topical for a given cosmetic indication," says Ellen S. Marmur M.D., assistant clinical professor and chief, division of dermatologic & cosmetic surgery, Mount Sinai Medical Center, New York, New York.

The cosmeceutical market is imbued with most any type of topical product for skin rejuvenation one could imagine, bar the true “fountain of youth.” Business is booming for cosmeceuticals, and cosmetic patients often buy into the claims of a given product - sometimes too many products at once, in order to address the cosmetic imperfections they may have. Unfortunately, these cosmetic products are often laden with an army of chemicals and preservatives, and the good intention of using these topicals may sometimes backfire on the patient in the form of an allergic or irritant contact dermatitis.

Many cosmeceutical companies make scientific-sounding marketing claims about the efficacy of their products. It is the job of the dermatologist to give a scientific, unbiased, well-researched opinion concerning the therapeutic good these products can achieve.

However, according to Dr. Marmur, complete transparency as to how these scientific claims are founded is one of the fundamental problems that make it difficult to pass judgment on many cosmeceuticals. There is very little published, peer-reviewed information and evidence-based medicine concerning cosmeceuticals that would help physicians reach a clear conclusion as to whether these products can help or hurt patients.

"It is important to remind ourselves as well as our patients that cosmeceuticals are technically cosmetics. When consulting my patients, I usually start off our discussion with a disclaimer that we our doing the best we can concerning advice with a very little amount of information from the companies.

"My approach now tends to be one of cautious optimism as well as realistic optimism that hopefully one of these products will be effective and hopefully these companies will allow us access to their in-house research so that we could better assess their efficacy," Dr. Marmur explains.

Scientific understanding

Tape stripping, Franz cell assay and microvascular assessment are all methods by which the penetration into the skin can be evaluated; however, a more comprehensive understanding of skin biology and just how molecules are able to penetrate through the skin barrier is of paramount importance, Dr. Marmur says.

How these topicals penetrate the stratum corneum, how they bypass the chemical properties of the epidermis and ultimately how these ingredients interact with their target in the dermis are crucial concepts in scientifically understanding the penetration of topicals in the skin.

"Many cosmeceutical companies are not as forthcoming as they could be concerning the methods in their studies by which they base their claims of effectiveness of a given product. Ideally, dermatologists should have access to these studies and methodology so that the same scientific and evidence based assessment approaches could be applied," Dr. Marmur says.

"It would be good to apply the strict standards we use for medications to these cosmeceutical products," he says.

Antioxidants, botanicals

Antioxidants and botanicals are just some of the ingredients that these companies claim to be so effective in skin rejuvenation. Topicals containing coffee berry, idebenone and niacinamide are just some ingredients that are commonly used for the treatment of wrinkles and fine lines achieving a skin tightening. Dr. Marmur regularly reviews the cosmeceuticals of her patients - one ingredient at a time and carefully advises them which topical to stay away from and which ones could be cosmetically beneficial.

It is not uncommon that patients religiously apply and mix layer after layer of various cosmeceuticals that contain sometimes up to 50 different chemicals and some of these patients may negatively react to this onslaught of chemicals that can pose as potential allergens.

Establishing goals

"I first try to establish the cosmetic goals of my patients. Then after scrutinizing all of the products they present to me, I advise them to limit the daily regimen of cosmeceuticals to three of the most promising products.

"According to their level of satisfaction with those products, I can then mix and match other products they may want to use. Bottom line, these products should always include a good moisturizer and a good sun screen," Dr. Marmur says.

With all of the high claims written on the packaging of these products, Dr. Marmur says the patients who use these cosmetic products are likely also getting a placebo effect. Patients enjoy these topicals because it helps them feel younger, at least psychologically.

Unfortunately, not all that glitters is gold and sometimes one or more of the ingredients of these products can be the cause of sometimes severe irritant or allergic contact dermatitis.

"We should embrace the era of cosmeceuticals as physicians, but we need to adhere to scientific principles and guidelines in order not to do any harm to our patients," Dr. Marmur says.DT

Disclosures: Dr. Marmur reports no relevant financial interests.