Cosmeceutical regimen: Deliver the results patients crave, but keep it simple

March 1, 2008

As the cosmeceuticals category explodes, dermatologists need to know how to dispense practical advice while keeping recommended regimens simple, says an expert.

Key Points

New York - With an ever-expanding plethora of cosmeceutical products available, dermatologists must strive to deliver the results patients crave with the simplest regimens possible, an expert says.

"There's a lot of information out there, and it can get overwhelming for patients and physicians," says Heidi A. Waldorf, M.D., director of laser and cosmetic dermatology, Mount Sinai Medical Center.

"As dermatologists, we need to be able to guide our patients through the forest of products - both prescription and over-the-counter (OTC)," she says.

"We must recognize that patients are being bombarded with information about OTC products, with lots of promises from companies. And patients are going to use them," Dr. Waldorf tells Dermatology Times.

She says she usually prescribes a straightforward cosmeceutical antiaging protocol that emphasizes protection during the daylight, renewal at night.

Moreover, she gives each patient a checklist that spells out which products to use, in which order, each day.

More specifically, she says that while prescription retinoids and sunscreens can achieve quantitative results, qualitative results such as skin brightening and reduction of light scatter are the province of OTC cosmeceuticals.

Cosmeceuticals geared toward daytime protection include sunscreens, antioxidants/anti-inflammatories, pigment protectors and moisturizers that maintain the lipid barrier.

To promote overnight renewal of the skin, Dr. Waldorf recommends mixing and matching exfoliants, collagen stimulators, pigment lighteners and moisturizers that revitalize the lipid barrier, in accordance with patients' needs.

Antioxidants

Antioxidants represent the fastest-growing cosmeceutical category, Dr. Waldorf says.

These include vitamins A, C, E and B, along with coenzyme Q10, idebenone, green tea and ferulic acid. Other options include kinetin, silymarin, soy, pycnogenol, curcumin, grape seed extract and pomegranate.

Antioxidants are said to provide antiaging and anti-inflammatory properties, along with anti-carcinogenesis (genistein, for example) and photoprotection (by quenching free radicals, blocking the UV-induced inflammatory pathway and perhaps achieving synergy with sunscreens).

However, Dr. Waldorf says, "Many antioxidant products have issues with formulation, such as stability, concentration and color."

Additional cosmeceutical options range from botanicals to peptides, metals and growth factors.

Peptide-containing products have become very popular, particularly those containing so-called signal peptides meant to temporarily mimic the effect of botulinum toxin.

Sunscreens

Among sunscreens, perhaps the most promising new ingredient is Mexoryl SX (ecamsule, LaRoche-Posay), which provides protection at wavelengths from 290 nm to 490 nm, Dr. Waldorf says.

In U.S. products, Mexoryl is used with avobenzone to improve the latter's photostability and provide more complete UVA protection.

Dr. Waldorf says implementation of the FDA's latest proposals regarding testing and labeling of sunscreens, including the long-awaited rating of UVA protection, will not be put into effect until at least 2009.

Retinoids

The retinoid category includes vitamin A and its metabolites (retinoic acid and retinaldehyde), as well as vitamin A esters (retinyl acetate, palmitate and propionate).

Retinoids can deliver both clinical results, such as reduction in fine and coarse rhytids, and histopathological results, such as increases in collagen, elastin and fibronectin, Dr. Waldorf says.

Although prescription retinoids will provide the most significant improvement, irritancy can limit their use. That's where over-the-counter products are useful, she says.

Alpha hydroxy acids (AHAs) and beta hydroxy acids (BHAs) both act as exfoliants, she notes. However, AHAs also can moisturize, reduce hyperpigmentation and improve dermal and epidermal signs of photoaging.