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Patients expect dermatologists to have answers for which cosmeceuticals can help their condition. Experts run through pros and cons of several common ingredients.
Acne is an unwelcome visitor for teenage girls. But for older women, acne can be a double whammy: It’s often both unwanted and unexpected.
“The psychological impact on the adult female is much different than the teenager,” says Hilary E. Baldwin, M.D., medical director of the Acne Treatment and Research Center in Morristown, N.J. To make matters worse, she says, adult women can be more difficult to treat because their faces are less tolerant of irritating treatments, and they’re more prone to inflammation than blackheads.
“The estimate is that half of women in their 20s and a quarter in 40s have acne,” Dr. Baldwin says. “Once you have it past the age of 25, it’s highly likely you’ll have it until 45.”
Adult women are longtime veterans of cosmetics, and they often turn to cosmeceuticals in search of acne and rosacea relief. But there’s a big problem: “We don’t have a lot of evidence that they can work,” says Julie C. Harper, M.D., of the Dermatology and Skin Care Center of Birmingham in Alabama. “That doesn’t mean they don’t work. We just need big studies.”
Drs. Baldwin and Harper spoke about cosmeceuticals and their effects on acne and rosacea at the Orlando Dermatology Aesthetic & Clinical Conference in January.
One purpose of cosmeceuticals, like cosmetics, is to improve a person’s appearance. Like drugs, cosmeceuticals also have some biological function. But few studies are performed on cosmeceuticals, Dr. Baldwin says, and the research that does exist tends to be weak, perhaps enlisting only six to eight subjects without blinding or placebos.
“There’s no hope on the horizon that the situation will get better,” she says. “The companies that manufacture them don’t want them to be drugs. They want to promise to reduce the signs of fine lines and wrinkles, not actual fine lines and wrinkles.”
In terms of acne, Dr. Baldwin says, cosmeceuticals hold the potential - at least hypothetically - to augment acne treatment through several mechanisms:
However, “the only thing that we know for sure,” she says, “is that patients may be able to more easily use acne medications if you repair the barrier of the skin and make it hardier.”
Moisturizers and sunscreens are helpful and worth recommending, Dr. Baldwin says. According to her, moisturizers and cosmeceuticals may help acne by improving skin barriers, reducing inflammation, providing sun protection and reducing hyper-pigmentation.
“Women like to use cosmeceuticals because they like to feel as if they’re doing something,” she says. “They want to be pro-active about this. They’re going to use these things anyway, so they might as well be things that are helpful, not harmful.”
Dr. Baldwin reminds dermatologists that they should regularly bring up the use of these helpful products.
“No acne visit is complete without a discussion of skincare in general, and make sure you describe how you want them to wash their face and dry it, and how you want them to use sunscreen and moisturize.”
Other cosmeceuticals can potentially have positive effects, like green tea/black tea, witch hazel and retinol, which may reduce greasiness, and tea tree oil, which decreases P. acnes. AHA, BHA and LHA, meanwhile, have exfoliating properties, while numerous botanicals may reduce inflammation.
On the negative side, cocoa butter, castor oil and some mineral oils can actually make acne worse, Dr. Baldwin says. Alpha hydroxy acids can be a problem too because they can make acne treatments more irritating to the skin.
In terms of rosacea, Dr. Harper says, cosmeceuticals could potentially provide benefits through sun protection, barrier repair and anti-inflammatory, anti-oxidant and anti-angiogenesis properties.
In particular, Vitamin B3 - niacinamide - has shown promise in strengthening the skin barrier and may be an option for patients who can’t afford prescription medications for rosacea.
“I’ve used it more topically than orally for rosacea,” Dr. Harper says, although both may improve the condition.
There’s another potential benefit. “Oral niacinamide has been shown to decrease the development of non-melanoma skin cancer,” Dr. Harper says.
According to Dr. Harper, dermatologists should also be aware that patients sometimes don’t realize they have rosacea and inadvertently make things worse.
“They see bumps they think they have acne. They’ll pick up a product with benzoyl peroxide or salicylic acid that can be irritating,” she says.
In the big picture, cosmeceuticals - for better and for worse - will continue to entice patients. “They’ll want to know what to use,” Dr. Baldwin says, “and expect us to have knowledge.”
Disclosures: Drs. Baldwin and Harper report no relevant disclosures.