Evidence of cosmeceutical efficacy growing

The Food and Drug Act of 1938 defines a drug as being intended for use in the diagnosis, cure, mitigation, treatment or prevention of disease.

"The key is that it's intended to affect the structure or function of the body," says Heidi A. Waldorf, M.D., director of laser and cosmetic dermatology, Mount Sinai School of Medicine, New York.

In either case, Dr. Waldorf tells Dermatology Times, "The definition depends on both the ingredients and the intended use and claims" of a product.

This explains why certain ingredients such as alpha hydroxy acids appear in both prescription and over-the-counter products, she says.

'Cosmeceutical' explained

"Cosmeceutical products can be confusing to people," Dr. Waldorf says.

The term cosmeceutical was coined by Albert Kligman, M.D., to denote a product that contains biologically active ingredients but is sold to improve appearance, Dr. Waldorf explains.

"Their claims border on those of drugs. For example, they suggest anti-aging or anti-inflammatory effects," she adds.

It's becoming increasingly important for dermatologists to help patients sort out such claims, Dr. Waldorf says.

"The real issue is that patients are looking for more noninvasive ways to both maintain and improve their skin," she explains. "And we know that the noninvasive methods we use - including lasers, various peels and tightening procedures - work best when accompanied by an appropriate topical regimen."

However, Dr. Waldorf observes that, presently, patients commonly follow the advice of cosmetic-counter salespersons, TV advertisements, aestheticians and friends rather than seeking a dermatologist's recommendations.

Advise on skincare

As dermatologists, she emphasizes, "We must take back that responsibility to be able to advise our patients regarding their skincare choices and regimens."

Generally, Dr. Waldorf divides a basic regimen into morning and evening components.

"For a typical patient," she says, "morning or daytime skincare is about protection; nighttime is about renewal."

Accordingly, she says common elements of daytime skincare include sunscreens, antioxidants and moisturizers.

"The goal is to renew the lipid barrier, strengthen the skin and help protect it from the environment," Dr. Waldorf explains.

In contrast, she says that for nighttime use, "I generally include exfoliants, collagen stimulators and again moisturizers. One doesn't need a moisturizer with sunscreen at night."

By the same token, Dr. Waldorf notes that some products such as retinoids lose their potency with exposure to ultraviolet light.

In addition to product categories already mentioned, she says categories dermatologists must be aware of include antioxidants (including many vitamins), botanicals, peptides, growth factors, minerals, skin lightening agents and healing accelerators.

With such items, Dr. Waldorf says the most popular ones aren't always those backed by the strongest empiric evidence.

"Much of the evidence (supporting) use of various cosmeceuticals is anecdotal," she notes.

Nevertheless, Dr. Waldorf says that among antiaging products, those currently backed by the greatest amount of scientific evidence include retinoids and hydroxy acids.