Cosmeceutical Experts Agree on Best Antiaging Products

The skin care market may pull in $9 billion per year, but three cosmeceutical experts agreed that the best over-the-counter antiaging products come down to two words: "moisturizer" and "sunscreen."

Speaking in separate presentations at the annual meeting of the American Society of Cosmetic Dermatology and Aesthetic Surgery (ASCDAS), Dr. Zoe D. Draelos, Dr. Ellen S. Marmur, and Dr. Michael H. Gold agreed that there is little science to back up claims made by cosmeceutical companies.

Sherry Boschert/Elsevier Global Medical News

Cosmeceuticals fall somewhere between cosmetics and pharmaceuticals; therefore, they are not regulated, and manufacturers are not required to show evidence of antiaging effectiveness. When evidence does exist, it generally points back to the moisturizer and sunscreen properties.

Dr. Draelos, a dermatologist in High Point, N.C., and a consulting professor of dermatology at Duke University in Durham, N.C., studied the ingredients in over-the-counter skin care products. She found that 80% of products are basically moisturizers that serve as a vehicle to deliver a high-profile ingredient being touted by the manufacturer (Plast. Reconstr. Surg. 2010;125:719-24).

"Hands down, it’s the moisturizer" that’s the most important cosmeceutical choice, she said. "All the products that make antiaging claims are making moisturizer claims," and most antiaging products also have sunscreen ingredients in them.

Dr. Michael Gold said he has been dispensing cosmeceuticals for 22 years and has seen the market explode. "There is now a $700 moisturizer," he said. "There may be no difference" between that and a $10 moisturizer, "but some people will pay the $700 because it’s $700."

Dr. Gold, the founder and medical director of a skin care center based in Nashville, Tenn., urged his colleagues, "If you dispense, do it ethically."

Dermatologists have an important role to play by assessing the marketing claims of cosmeceuticals, not just listening to them. "Even though we don’t have a lot of good research right now, patients want something their doctor feels good about," said Dr. Marmur of Mount Sinai School of Medicine, New York, who is also president of the ASCDAS.

She took that approach in her book, written with Gina Way, "Simple Skin Beauty: Every Woman’s Guide to a Lifetime of Healthy, Gorgeous Skin" (Atria Books, 2009). The book "perhaps put me at odds with some of the industry, but we’re challenging them to produce better science," she said.

Dr. Marmur and her associates are conducting the first independent, randomized, blinded, controlled trial comparing over-the-counter antiaging creams. With more than 130 subjects enrolled, the study will evaluate 28 biomarkers in seven lines of products, with the people who apply the products blinded to the product being used.

Not all antiaging cream manufacturers are included, however, "Some brands refused to participate" perhaps because they were afraid that the study would show that their product is effective but is a pharmaceutical, she said.

Dr. Draelos echoed that observation during a question-and-answer session. "The industry doesn’t want closer scrutiny," she said.

Dr. Draelos also spoke at the 2011 Skin Disease Education Foundation's Women's and Pediatric Dermatology Seminar. She said she recommends that her patients start with a moisturizer containing dimethicone, glycerin, or petrolatum. "The most robust moisturizer known to man has these three ingredients," she said.

For antiaging, she suggested recommending sunscreens containing avobenzone, oxybenzone, octocrylene, reflecting spheres, or antioxidant botanicals.

How does that translate into over-the-counter product recommendations for patients? For hands, Dr. Draelos favors Neutrogena Norwegian Formula Hand Cream. For the face, she recommends Johnson & Johnson’s Aveeno Positively Radiant Daily Moisturizer SPF 30, and for the body, she suggests Galderma’s Cetaphil Cream.

In separate interviews, the three dermatologists agreed that more research is needed on the efficacy of cosmeceuticals, and delved into the nuances of ingredients in antiaging skin-care regimens. They also agreed that dermatologists need to be patients’ advocates and educators first and foremost.

Moisturizers and sunscreen undoubtedly are the main ingredients in most cosmeceutical regimens, but there are good data to support other ingredients, said Dr. Paul F. Lizzul of Tufts Medical Center, Boston. Randomized clinical trials have shown that retinoids, for example, can be beneficial, but patients probably are better served by prescription-strength retinoids to get "a better bang for their buck," compared with over-the-counter products, he said.

For other cosmeceutical ingredients, however, there may be in vitro or in vivo data but no rigorous clinical studies to back them up. "Even as a well-trained academic dermatologist with an extensive scientific and clinical research background, I, at times, am at a loss to understand the claims made by some cosmeceutical manufacturers," he said.

Dr. Lizzul does not believe that most of the questionable "active ingredients" penetrate the stratum corneum to be able to have the claimed effects on the dermis or epidermis. In some cases, if the ingredient magically penetrated to the dermis, it could be harmful, not helpful, he added.

"It is curious to me that at many of our meetings, research presented to support product claims is oftentimes no more than anecdotal evidence. If you critically look at the presentation and the actual data, you would be remiss to believe that product X actually works," he said.

On the other hand, the lack of double-blind studies of a particular product or ingredient does not mean that it isn’t helpful. By reviewing the biochemistry, basic science, and clinical observations of a treatment, dermatologists can steer patients toward a potential treatment, said Dr. Wendy E. Roberts, a dermatologist in Rancho Mirage, Calif.

She compared her approach to cosmeceuticals to the correlations she makes as a dermatopathologist. "Under the microscope it could be many things, but you match it with the clinical information and come up with a diagnosis. We can kind of use that model with cosmeceuticals," she said. "With our expertise, we know that there’s this body of evidence, we know the activity, and we have our living lab, which is our patients [whom we] see every day. Those observations can lead to further observations."

Many reports in the medical literature describe antiaging benefits from ingredients like peptides, vitamin C, alpha and beta hydroxy acids, lactic acid, retinol, niacinamide, and other ingredients, which can be incorporated into moisturizer formulas, Dr. Roberts said.

Although the three pillars of cosmeceutical regimens are cleansers, moisturizers, and sunscreen, limiting the discussion to those vague terms is "so 1990s," she said. "As a cosmetic dermatologist, it is my job to be able to know the science of a product and recommend the cosmeceutical for that skin type. Working in the capital of sun-damaged skin, I see how certain cosmeceuticals alone can improve skin qualities."

Dr. Leslie Baumann of Miami Beach also said that ingredients other than moisturizer and sunscreen are necessary, depending on the patient’s skin type. She has patients complete a questionnaire to help determine skin type, and matches ingredients to that type.

Sensitive skin types, for example, need anti-inflammatory ingredients, she said. Aged skin benefits from retinoids. Lighteners can help skin with unwanted pigment.

Dermatologists have an ethical responsibility to advise patients on the best cosmeceutical options and on more affordable options if they exist. "Sometimes cheaper products will suffice, and sometimes they will not," Dr. Baumann said.

Dr. Draelos has been a consultant and researcher for Avon, Dial, Johnson & Johnson, L’Oréal, Nu Skin, Procter & Gamble, and Stiefel. Dr. Marmur disclosed financial relationships with Allergan, DUSA Pharmaceuticals, Genentech, Medicis, Merz, and Sanofi-Aventis. Dr. Gold has been a consultant or researcher for Allergan, Medicis, Mentor (Johnson & Johnson), Merz, Galderma, and numerous other companies.

Dr. Roberts has had financial relationships with Allergan, Johnson & Johnson, L’Oréal, La Roche–Posay, and Ortho Dermatologics. Dr. Baumann has led or participated in research trials for more than 50 cosmetic and pharmaceutical companies. Dr. Lizzul had no relevant disclosures.

SDEF and this news organization are owned by Elsevier.

The skin care market may pull in $9 billion per year, but three cosmeceutical experts agreed that the best over-the-counter antiaging products come down to two words: "moisturizer" and "sunscreen."

Speaking in separate presentations at the annual meeting of the American Society of Cosmetic Dermatology and Aesthetic Surgery (ASCDAS), Dr. Zoe D. Draelos, Dr. Ellen S. Marmur, and Dr. Michael H. Gold agreed that there is little science to back up claims made by cosmeceutical companies.

Sherry Boschert/Elsevier Global Medical News

Cosmeceuticals fall somewhere between cosmetics and pharmaceuticals; therefore, they are not regulated, and manufacturers are not required to show evidence of antiaging effectiveness. When evidence does exist, it generally points back to the moisturizer and sunscreen properties.

Dr. Draelos, a dermatologist in High Point, N.C., and a consulting professor of dermatology at Duke University in Durham, N.C., studied the ingredients in over-the-counter skin care products. She found that 80% of products are basically moisturizers that serve as a vehicle to deliver a high-profile ingredient being touted by the manufacturer (Plast. Reconstr. Surg. 2010;125:719-24).

"Hands down, it’s the moisturizer" that’s the most important cosmeceutical choice, she said. "All the products that make antiaging claims are making moisturizer claims," and most antiaging products also have sunscreen ingredients in them.

Dr. Michael Gold said he has been dispensing cosmeceuticals for 22 years and has seen the market explode. "There is now a $700 moisturizer," he said. "There may be no difference" between that and a $10 moisturizer, "but some people will pay the $700 because it’s $700."

Dr. Gold, the founder and medical director of a skin care center based in Nashville, Tenn., urged his colleagues, "If you dispense, do it ethically."

Dermatologists have an important role to play by assessing the marketing claims of cosmeceuticals, not just listening to them. "Even though we don’t have a lot of good research right now, patients want something their doctor feels good about," said Dr. Marmur of Mount Sinai School of Medicine, New York, who is also president of the ASCDAS.

She took that approach in her book, written with Gina Way, "Simple Skin Beauty: Every Woman’s Guide to a Lifetime of Healthy, Gorgeous Skin" (Atria Books, 2009). The book "perhaps put me at odds with some of the industry, but we’re challenging them to produce better science," she said.

Dr. Marmur and her associates are conducting the first independent, randomized, blinded, controlled trial comparing over-the-counter antiaging creams. With more than 130 subjects enrolled, the study will evaluate 28 biomarkers in seven lines of products, with the people who apply the products blinded to the product being used.

Not all antiaging cream manufacturers are included, however, "Some brands refused to participate" perhaps because they were afraid that the study would show that their product is effective but is a pharmaceutical, she said.

Dr. Draelos echoed that observation during a question-and-answer session. "The industry doesn’t want closer scrutiny," she said.

Dr. Draelos also spoke at the 2011 Skin Disease Education Foundation's Women's and Pediatric Dermatology Seminar. She said she recommends that her patients start with a moisturizer containing dimethicone, glycerin, or petrolatum. "The most robust moisturizer known to man has these three ingredients," she said.

For antiaging, she suggested recommending sunscreens containing avobenzone, oxybenzone, octocrylene, reflecting spheres, or antioxidant botanicals.

How does that translate into over-the-counter product recommendations for patients? For hands, Dr. Draelos favors Neutrogena Norwegian Formula Hand Cream. For the face, she recommends Johnson & Johnson’s Aveeno Positively Radiant Daily Moisturizer SPF 30, and for the body, she suggests Galderma’s Cetaphil Cream.

In separate interviews, the three dermatologists agreed that more research is needed on the efficacy of cosmeceuticals, and delved into the nuances of ingredients in antiaging skin-care regimens. They also agreed that dermatologists need to be patients’ advocates and educators first and foremost.

Moisturizers and sunscreen undoubtedly are the main ingredients in most cosmeceutical regimens, but there are good data to support other ingredients, said Dr. Paul F. Lizzul of Tufts Medical Center, Boston. Randomized clinical trials have shown that retinoids, for example, can be beneficial, but patients probably are better served by prescription-strength retinoids to get "a better bang for their buck," compared with over-the-counter products, he said.

For other cosmeceutical ingredients, however, there may be in vitro or in vivo data but no rigorous clinical studies to back them up. "Even as a well-trained academic dermatologist with an extensive scientific and clinical research background, I, at times, am at a loss to understand the claims made by some cosmeceutical manufacturers," he said.

Dr. Lizzul does not believe that most of the questionable "active ingredients" penetrate the stratum corneum to be able to have the claimed effects on the dermis or epidermis. In some cases, if the ingredient magically penetrated to the dermis, it could be harmful, not helpful, he added.

"It is curious to me that at many of our meetings, research presented to support product claims is oftentimes no more than anecdotal evidence. If you critically look at the presentation and the actual data, you would be remiss to believe that product X actually works," he said.

On the other hand, the lack of double-blind studies of a particular product or ingredient does not mean that it isn’t helpful. By reviewing the biochemistry, basic science, and clinical observations of a treatment, dermatologists can steer patients toward a potential treatment, said Dr. Wendy E. Roberts, a dermatologist in Rancho Mirage, Calif.

She compared her approach to cosmeceuticals to the correlations she makes as a dermatopathologist. "Under the microscope it could be many things, but you match it with the clinical information and come up with a diagnosis. We can kind of use that model with cosmeceuticals," she said. "With our expertise, we know that there’s this body of evidence, we know the activity, and we have our living lab, which is our patients [whom we] see every day. Those observations can lead to further observations."

Many reports in the medical literature describe antiaging benefits from ingredients like peptides, vitamin C, alpha and beta hydroxy acids, lactic acid, retinol, niacinamide, and other ingredients, which can be incorporated into moisturizer formulas, Dr. Roberts said.

Although the three pillars of cosmeceutical regimens are cleansers, moisturizers, and sunscreen, limiting the discussion to those vague terms is "so 1990s," she said. "As a cosmetic dermatologist, it is my job to be able to know the science of a product and recommend the cosmeceutical for that skin type. Working in the capital of sun-damaged skin, I see how certain cosmeceuticals alone can improve skin qualities."

Dr. Leslie Baumann of Miami Beach also said that ingredients other than moisturizer and sunscreen are necessary, depending on the patient’s skin type. She has patients complete a questionnaire to help determine skin type, and matches ingredients to that type.

Sensitive skin types, for example, need anti-inflammatory ingredients, she said. Aged skin benefits from retinoids. Lighteners can help skin with unwanted pigment.

Dermatologists have an ethical responsibility to advise patients on the best cosmeceutical options and on more affordable options if they exist. "Sometimes cheaper products will suffice, and sometimes they will not," Dr. Baumann said.

Dr. Draelos has been a consultant and researcher for Avon, Dial, Johnson & Johnson, L’Oréal, Nu Skin, Procter & Gamble, and Stiefel. Dr. Marmur disclosed financial relationships with Allergan, DUSA Pharmaceuticals, Genentech, Medicis, Merz, and Sanofi-Aventis. Dr. Gold has been a consultant or researcher for Allergan, Medicis, Mentor (Johnson & Johnson), Merz, Galderma, and numerous other companies.

Dr. Roberts has had financial relationships with Allergan, Johnson & Johnson, L’Oréal, La Roche–Posay, and Ortho Dermatologics. Dr. Baumann has led or participated in research trials for more than 50 cosmetic and pharmaceutical companies. Dr. Lizzul had no relevant disclosures.

SDEF and this news organization are owned by Elsevier.

The skin care market may pull in $9 billion per year, but three cosmeceutical experts agreed that the best over-the-counter antiaging products come down to two words: "moisturizer" and "sunscreen."

Speaking in separate presentations at the annual meeting of the American Society of Cosmetic Dermatology and Aesthetic Surgery (ASCDAS), Dr. Zoe D. Draelos, Dr. Ellen S. Marmur, and Dr. Michael H. Gold agreed that there is little science to back up claims made by cosmeceutical companies.

Sherry Boschert/Elsevier Global Medical News

Cosmeceuticals fall somewhere between cosmetics and pharmaceuticals; therefore, they are not regulated, and manufacturers are not required to show evidence of antiaging effectiveness. When evidence does exist, it generally points back to the moisturizer and sunscreen properties.

Dr. Draelos, a dermatologist in High Point, N.C., and a consulting professor of dermatology at Duke University in Durham, N.C., studied the ingredients in over-the-counter skin care products. She found that 80% of products are basically moisturizers that serve as a vehicle to deliver a high-profile ingredient being touted by the manufacturer (Plast. Reconstr. Surg. 2010;125:719-24).

"Hands down, it’s the moisturizer" that’s the most important cosmeceutical choice, she said. "All the products that make antiaging claims are making moisturizer claims," and most antiaging products also have sunscreen ingredients in them.

Dr. Michael Gold said he has been dispensing cosmeceuticals for 22 years and has seen the market explode. "There is now a $700 moisturizer," he said. "There may be no difference" between that and a $10 moisturizer, "but some people will pay the $700 because it’s $700."

Dr. Gold, the founder and medical director of a skin care center based in Nashville, Tenn., urged his colleagues, "If you dispense, do it ethically."

Dermatologists have an important role to play by assessing the marketing claims of cosmeceuticals, not just listening to them. "Even though we don’t have a lot of good research right now, patients want something their doctor feels good about," said Dr. Marmur of Mount Sinai School of Medicine, New York, who is also president of the ASCDAS.

She took that approach in her book, written with Gina Way, "Simple Skin Beauty: Every Woman’s Guide to a Lifetime of Healthy, Gorgeous Skin" (Atria Books, 2009). The book "perhaps put me at odds with some of the industry, but we’re challenging them to produce better science," she said.

Dr. Marmur and her associates are conducting the first independent, randomized, blinded, controlled trial comparing over-the-counter antiaging creams. With more than 130 subjects enrolled, the study will evaluate 28 biomarkers in seven lines of products, with the people who apply the products blinded to the product being used.

Not all antiaging cream manufacturers are included, however, "Some brands refused to participate" perhaps because they were afraid that the study would show that their product is effective but is a pharmaceutical, she said.

Dr. Draelos echoed that observation during a question-and-answer session. "The industry doesn’t want closer scrutiny," she said.

Dr. Draelos also spoke at the 2011 Skin Disease Education Foundation's Women's and Pediatric Dermatology Seminar. She said she recommends that her patients start with a moisturizer containing dimethicone, glycerin, or petrolatum. "The most robust moisturizer known to man has these three ingredients," she said.

For antiaging, she suggested recommending sunscreens containing avobenzone, oxybenzone, octocrylene, reflecting spheres, or antioxidant botanicals.

How does that translate into over-the-counter product recommendations for patients? For hands, Dr. Draelos favors Neutrogena Norwegian Formula Hand Cream. For the face, she recommends Johnson & Johnson’s Aveeno Positively Radiant Daily Moisturizer SPF 30, and for the body, she suggests Galderma’s Cetaphil Cream.

In separate interviews, the three dermatologists agreed that more research is needed on the efficacy of cosmeceuticals, and delved into the nuances of ingredients in antiaging skin-care regimens. They also agreed that dermatologists need to be patients’ advocates and educators first and foremost.

Moisturizers and sunscreen undoubtedly are the main ingredients in most cosmeceutical regimens, but there are good data to support other ingredients, said Dr. Paul F. Lizzul of Tufts Medical Center, Boston. Randomized clinical trials have shown that retinoids, for example, can be beneficial, but patients probably are better served by prescription-strength retinoids to get "a better bang for their buck," compared with over-the-counter products, he said.

For other cosmeceutical ingredients, however, there may be in vitro or in vivo data but no rigorous clinical studies to back them up. "Even as a well-trained academic dermatologist with an extensive scientific and clinical research background, I, at times, am at a loss to understand the claims made by some cosmeceutical manufacturers," he said.

Dr. Lizzul does not believe that most of the questionable "active ingredients" penetrate the stratum corneum to be able to have the claimed effects on the dermis or epidermis. In some cases, if the ingredient magically penetrated to the dermis, it could be harmful, not helpful, he added.

"It is curious to me that at many of our meetings, research presented to support product claims is oftentimes no more than anecdotal evidence. If you critically look at the presentation and the actual data, you would be remiss to believe that product X actually works," he said.

On the other hand, the lack of double-blind studies of a particular product or ingredient does not mean that it isn’t helpful. By reviewing the biochemistry, basic science, and clinical observations of a treatment, dermatologists can steer patients toward a potential treatment, said Dr. Wendy E. Roberts, a dermatologist in Rancho Mirage, Calif.

She compared her approach to cosmeceuticals to the correlations she makes as a dermatopathologist. "Under the microscope it could be many things, but you match it with the clinical information and come up with a diagnosis. We can kind of use that model with cosmeceuticals," she said. "With our expertise, we know that there’s this body of evidence, we know the activity, and we have our living lab, which is our patients [whom we] see every day. Those observations can lead to further observations."

Many reports in the medical literature describe antiaging benefits from ingredients like peptides, vitamin C, alpha and beta hydroxy acids, lactic acid, retinol, niacinamide, and other ingredients, which can be incorporated into moisturizer formulas, Dr. Roberts said.

Although the three pillars of cosmeceutical regimens are cleansers, moisturizers, and sunscreen, limiting the discussion to those vague terms is "so 1990s," she said. "As a cosmetic dermatologist, it is my job to be able to know the science of a product and recommend the cosmeceutical for that skin type. Working in the capital of sun-damaged skin, I see how certain cosmeceuticals alone can improve skin qualities."

Dr. Leslie Baumann of Miami Beach also said that ingredients other than moisturizer and sunscreen are necessary, depending on the patient’s skin type. She has patients complete a questionnaire to help determine skin type, and matches ingredients to that type.

Sensitive skin types, for example, need anti-inflammatory ingredients, she said. Aged skin benefits from retinoids. Lighteners can help skin with unwanted pigment.

Dermatologists have an ethical responsibility to advise patients on the best cosmeceutical options and on more affordable options if they exist. "Sometimes cheaper products will suffice, and sometimes they will not," Dr. Baumann said.

Dr. Draelos has been a consultant and researcher for Avon, Dial, Johnson & Johnson, L’Oréal, Nu Skin, Procter & Gamble, and Stiefel. Dr. Marmur disclosed financial relationships with Allergan, DUSA Pharmaceuticals, Genentech, Medicis, Merz, and Sanofi-Aventis. Dr. Gold has been a consultant or researcher for Allergan, Medicis, Mentor (Johnson & Johnson), Merz, Galderma, and numerous other companies.

Dr. Roberts has had financial relationships with Allergan, Johnson & Johnson, L’Oréal, La Roche–Posay, and Ortho Dermatologics. Dr. Baumann has led or participated in research trials for more than 50 cosmetic and pharmaceutical companies. Dr. Lizzul had no relevant disclosures.

SDEF and this news organization are owned by Elsevier.