Cosmeceuticals complement in-office procedures

Key Points

Cambridge, Mass. - Not only can at-home cosmeceuticals complement the results of in-office cosmetic procedures, but they also get patients into the habit of taking an active role in their skincare, an expert says.

Cosmeceuticals' role is twofold, says Ranella J. Hirsch, M.D., president of the American Society for Cosmetic Dermatology and Aesthetic Surgery and a dermatologist in private practice.

"There's a very specific, active role, which is to take something that's working and expand upon it," she says.

"There's a beautiful synergy between cosmeceuticals and in-office cosmetic treatments," Dr. Hirsch tells Dermatology Times.

At the same time, she says prescribing appropriate cosmeceutical regimens empowers patients to become an integral part of their own skincare.

More specifically, "It helps to train the patient that prevention and management are an ongoing, two-way street. The patient really benefits by taking on some responsibility for their skin's condition and well-being - they put greater value in the entire rejuvenation process since they are an active participant,"Dr. Hirsch says.

"At a bare minimum," she says, "there's no patient who can't benefit from preventative efforts; i.e., using a sunscreen and/or a retinoid."

For instance, she says patients who come in for laser treatments to address sun damage "can achieve additive benefits with topical retinoids - particularly prescription-strength retinoids - and antioxidants."

Similarly, she says, "It's a no-brainer that these patients should be using sunscreen as part of their at-home treatment regimen."

For patients undergoing laser treatments for acne and related post-inflammatory erythema and hyperpigmentation, Dr. Hirsch says one can achieve synergy by recommending at-home bleaching agents, topical anti-acne medications and retinoids.

Additional recommendations differ depending on a patient's individual concerns, she says. For patients primarily concerned about brown spots from the sun, for example, Dr. Hirsch typically augments the retinoid recommendation with hydroquinone and sunscreen.

The antioxidant alarm

Dr. Hirsch says antioxidants provide backup protection for sunscreens, offering the analogy of a burglar alarm to explain her rationale.

When leaving for a vacation, she says, "You would never just turn on your burglar alarm and leave your front door open. What you're doing with a sunscreen is locking your front door, making sure nothing gets in.

"But just in case someone makes it past that first barrier, antioxidants provide a backup level of protection."

This is a common mistake for patients to apply sunscreen only after they begin experiencing redness or burning while out in the sun, she says.

Among newer antioxidants, Dr. Hirsch says coffeeberry (Revaleskin, Stiefel) and green tea extracts are very exciting, while the combination of vitamins C and E plus ferulic acid (C E Ferulic, SkinCeuticals) is "a tremendous all-in-one product."

Conversely, she says that if a patient has active acne, in addition to a retinoid, "I'm probably going to put them on a topical or oral antibiotic."

Before prescribing a specific agent or routine, Dr. Hirsch says, "Physicians must find out what a patient's real likelihood of using a product will be."

For example, prescribing a twice-daily regimen to a patient who refuses anything other than a once-daily routine is "a waste of your time and theirs. That said, if someone is going to be very compliant, there's only upside to giving someone a more complete regimen."

Typically, she says, "I start patients with sunscreen in the morning and a retinoid at night. If someone is looking for some additional antioxidant protection, often I'll add that in the morning with their moisturizing product and/or sunscreen."

Above all, she says, "The physician must mix it up depending on the patient's interest level and what their life will tolerate. The reality check is, are they going to use the product? Nothing does anything when left in the bottle."

Disclosure: Dr. Hirsch is a clinical investigator for Allergan, Candela, Cynosure, Palomar and Medlite, and a consultant to L'Oréal.

For more information: http://www.skincaredoctors.com/ http://www.ascdas.org/