As consumer interest in the roles of nutrition and cosmeceuticals in skincare continues to increase, it behooves dermatologists to be knowledgeable on these topics. An understanding of the mechanism of action and theoretical benefits of cosmeceutical ingredients is fundamental for designing effective skincare protocols and providing appropriate explanations on the rationale for their use, experts say.
"Cosmeceuticals are important in routine skincare, can be a valuable adjunct in the management of a variety of dermatologic conditions, and are useful to optimize the benefits and minimize the risks of many dermatologic procedures," says Dr. Lupo, clinical professor of dermatology, Tulane Medical School, New Orleans. "However, careful thought must be given into product recommendations, taking into account the patient's specific diagnosis and/or treatment."
Dr. Lupo says almost all patients, regardless of their diagnosis or procedural intervention, should be advised on the use of a broad-spectrum UVA/UVB sunscreen in the morning and a prescription-strength retinoid at night. The specific formulation of the retinoid is chosen according to the individual's skin type.
For patients with rosacea, the focus of the cosmeceutical regimen is on agents that offer anti-inflammatory activity. Ingredients to look for include green tea, caffeine, feverfew, coffee berry, licochalcone, chamomile, niacinamide, glabridin, oatmeal and aloe vera. In addition to intense pulsed light and laser treatments for reducing erythema, salicylic acid peels may also be helpful in the management of rosacea because salicylic acid has anti-inflammatory properties. Therefore, it helps to improve redness and pustules, and it also reduces the appearance of enlarged pores that are a feature in many rosacea patients.
Agents with skin bleaching/lightening activity, including hydroquinone, kojic acid and arbutin, are used in the management of melasma. In addition, patients affected with this pigmentary disorder can benefit from cosmeceutical ingredients providing antioxidant activity, including ferulic acid, vitamin C, soy/genistein, glabridin and niacinamide.
"A retinoid is also particularly helpful for inducing exfoliation in melasma patients," Dr. Lupo says.
Procedural intervention for melasma patients takes a conservative approach that is based on less aggressive treatments performed on a more frequent basis. Options include a series of microdermabrasion procedures or lunchtime peels with glycolic acid or trichloroacetic acid, and Dr. Lupo notes she has begun to perform fractional nonablative laser treatments with good results.
"Recurrence is a key issue in the management of melasma, and patients need to understand the chronic, relapsing nature of their disease. Once the hyperpigmentation is improved, a maintenance program must include strict sun avoidance and continued use of a sunscreen, antioxidants, retinoids and bleaching agents to prevent recurrence," Dr. Lupo says.
For managing general photoaging issues, dermatologists should recommend cosmeceuticals that can help to stimulate new collagen production, improve dyschromia and provide barrier repair. Products containing signaling peptides and growth factors are recommended.
"For patients who undergo laser rejuvenation with a fractional CO2 or nonablative fractional laser, products containing reparative peptides and growth factors are particularly helpful during the post-treatment healing phase," Dr. Lupo says.
The success of any cosmeceutical regimen depends on patient compliance; counseling to outline both the "what" and the "why" of the regimen may be just as important as the products chosen.
"Patients who understand the reasons for using particular products and who can appreciate that their cosmeceutical regimen has been specifically tailored to their needs are more likely to be compliant with product use. Those who leave their visit without any explanations may feel instead that they were treated as an easy target for the sale of expensive products," Dr. Lupo says.
Product acceptance also depends on patients sensing that the dermatologist understands and believes in the benefits of the products recommended. Therefore, while the responsibility for a comprehensive discussion of the cosmeceutical regimen and how it should be implemented into a daily skincare program may be delegated to a knowledgeable nurse or aesthetician on staff, the dermatologist should still take the time to offer a succinct explanation of the reason why each product is chosen.
When it comes to dietary interventions for good health, the only strategy ever proven to modify longevity is a calorie-restricted diet, says Zoe D. Draelos, M.D., consulting professor, department of dermatology, Duke University School of Medicine, Durham, N.C.
As documented in a recently reported, 20-year longitudinal primate study undertaken at the University of Wisconsin, the introduction of a 30 percent caloric-restricted diet in middle age delayed the onset of a number of age-related pathologies and significantly reduced mortality rates, she notes.
"This research suggests that many of the diseases that we associate with aging may develop because the typical diet is not optimal to prolong life," Dr. Draelos says.
The impracticality of adhering to a caloric-restricted diet as a means for mitigating the adverse consequences of aging has stimulated research to identify agents that can mimic the positive biochemical effects of calorie restriction. In this area, there has been interest in the value of anthocyanins. Found in brightly colored plants and fruits, these flavonoid pigments have been shown to have antioxidant and anti-inflammatory activities, and based on those properties, anthocyanins (blueberry extract) are also becoming popular in skincare products.
"This is a growing area of research, but further study is needed to document benefits," Dr. Draelos says.