Three of the top experts on cosmeceuticals agreed that the best over-the-counter, anti-aging products come down to two simple words: "moisturizer" and "sunscreen."
There is oh, so much more out there being sold in the $9 billion/year skin care market, much of which are anti-aging products. But the skin regimen that provides the biggest bang for the buck: moisturizer and sunscreen. Spend $100 on a product, and chances are its moisturizer and sunscreen anyway.
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.
Cosmeceuticals fall somewhere between cosmetics and pharmaceuticals; therefore, they are not regulated, and manufacturers are not required to show evidence of anti-aging effectiveness. When evidence does exist, it generally points back to – you guessed it – moisturizer and sunscreen.
Dr. Draelos a dermatologist in High Point, N.C., and a consulting professor of dermatology at Duke University, studied the ingredients in over-the-counter skin care products. She found that 80% of products are moisturizers that serve as a vehicle to deliver whichever high-profile ingredient is being touted by the manufacturer (Plast. Reconst. 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 anti-aging claims are making moisturizer claims," and most anti-aging products also have sunscreen ingredients in them.
Dr. Michael H. Gold
When Dr. Gold first spoke at a medical conference many years ago about selling cosmeceutical products in his practice, most dermatologists frowned on the idea. He 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, who is based in Nashville, urged his colleagues, "If you dispense, do it ethically."
Dermatologists have an important role to play by not just listening to marketing claims of cosmeceuticals, but assessing 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, and president of the ASCDAS.
Dr. Ellen S. Marmur
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 randomized, controlled trial comparing over-the-counter anti-aging creams. With more than 130 subjects enrolled, the study will evaluate 28 biomarkers in seven lines of products, with the patients who apply the products blinded to the product being used.
Not all anti-aging 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 idea during the question-and-answer session: "The industry doesn't want closer scrutiny," she said.
Dr. Zoe D. Draelos
I also heard Dr. Draelos speak recently at the Skin Disease and Education Foundation's Women's and Pediatric Dermatology Seminar. Her recommendations for cosmeceuticals include starting with a moisturizer containing dimethicone, glycerin, and/or petrolatum. "The most robust moisturizer known to man has these three ingredients," she said. For anti-aging, she suggests a sunscreen containing avobenzone, oxybenzone, octocrylene, reflecting spheres, or antioxidant botanicals.
How does that translate into over-the-counter products? 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, Galderma's Cetaphil cream.
Dr. Draelos has been a consultant and researcher for Johnson & Johnson, L'Oreal, Procter & Gamble, Nu Skin, Avon, Stiefel, and Dial Corp. 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.
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