INSIDE DISSECTING COSMECEUTICALS

WRITER: RICHARD T. BOSSHARDT, M.D., FACS

Cosmetics have been around since the first cavewoman used chalk dust to powder her nose before heading out for another day of hunting and gathering. Her mate probably grunted something to the effect that she looked particularly alluring that morning and the future of cosmetics was assured.

The desire to look one’s best has persisted and fueled the multibillion dollar cosmetics industry, but has taken on a new dimension with the addition of a nod to wellness as opposed to just looking good. The concept of wellness — a state of balance between the mind, body, and spirit that maximizes one’s potential — dates back to the emergence of the middle class in the 19th century as a consequence of the Industrial Revolution. At last, people had the time and means to devote to bettering themselves and their circumstances, rather than just struggling to stay alive.

Now, when it comes to the discussion of cosmetics, it really is one for women. Cosmetics are understood to be things that enhance appearance and nothing more. Men, even modernday “metrosexuals,” rarely use pure cosmetics, like facial makeup, eyeliner, eye shadow, lipstick/lip gloss, and mascara. Constant change in life and culture is a given, however, and in 1980, the term “cosmeceutical” was coined by Dr. Albert Klingman, a dermatologist. Dr. Klingman, a somewhat controversial figure, discovered that retinoic acid, more popularly known as retin-A, could be used both medically to treat acne and cosmetically to treat wrinkles. The ripple effect of this discovery was huge.

It did not take long for the cosmetics industry to appreciate the potential of this discovery and, thus, the cosmeceuticals industry was born. Cosmeceuticals are products that combine the appearanceenhancing character of a cosmetic with the therapeutic character of a pharmaceutical product. In 2010, the industry had grown into a $16 billion per year juggernaut.

Most everyone is aware of pharmaceuticals. These are products that have a biologic effect on our bodies. Pharmaceuticals range from nonprescription products, like aspirin, to the most potent new generation antibiotics. They are intended to prevent or treat disease and illness and alter the structure and/or function of cells or tissue in the human body. In contrast, cosmetics are inert. Pharmaceuticals are regulated by the Food and Drug Administration (FDA) and must meet high standards of effectiveness and safety.

Cosmeceuticals straddle the fence between cosmetics and pharmaceuticals, a regulatory “no man’s land” where perception becomes as important as reality. The FDA does not recognize the term “cosmeceutical.” A product is either a cosmetic or a drug… or it is not. Products that claim pharmaceutical properties are treated as drugs and are subject to the same regulations as any other drug.

A common example of a cosmeceutical would be makeup containing a sunblock. Because sunblocking agents are intended to prevent burns, sun damage, and possibly future skin cancer, they are regulated by the FDA as drugs and must meet certain conditions for approval. A product intended to hide freckles and blotchy pigmentation in the skin would be a cosmetic. If it contained something to treat spots and make them fade away, it would be a cosmeceutical and under FDA regulation.

However, not all cosmeceuticals come under FDA scrutiny. Many claim to have benefits that stop short of meeting the definition of a drug. Here is where semantics comes into play. How a cosmeceutical describes its action often determines whether it is regulated or not. Terms like “beautifies,” “moisturizes,” “hydrates,” “protects,” “conceals,” “highlights,” “conditions,” “cleanses,” and “refreshes” all imply a benefit beyond simple cosmetic enhancement without claiming to treat or prevent any skin condition per se. Descriptions such as “prevents signs of aging,” “regenerates damaged skin,” “stimulates skin repair,” “fades pigment spots,” and “penetrates into skin to act…” would all be therapeutic claims.

Cosmeceuticals do not want FDA oversight. It is time consuming and expensive to seek FDA approval for a drug. Companies must prove safety and effectiveness with peer-reviewed, controlled, scientific studies. These are absent for many, if not most, cosmeceuticals.

Agents with medicinal properties used in cosmeceuticals include antiinflammatory products, such as steroids and derivatives of non-steroid drugs like aspirin; antioxidants, such as vitamins C and E; alpha hydroxyl acids, like glycolic and lactic acid; and pigment lighteners, such as hydroquinones. For the consumer, there are several problems with unregulated cosmeceuticals. For one, the potency of the supposedly active agent is usually not listed on the labeling and is often well below the usual level of what is used therapeutically. The effectiveness of the active agent in accomplishing those wonderful results claimed by the manufacturer is hardly ever substantiated with controlled clinical trials. It is truly the wild, wild West out there with purveyors of many of these products being the modern equivalent of old snake oil salesmen. The operating principle, overwhelmingly, is “let the buyer beware.”

On the plus side, there is probably little danger from most cosmeceuticals. The same low potency that makes their effectiveness problematic also tends to insure that serious reactions and complications from their use are rare. An example of an exception might be sun damage, and even skin cancers, arising from overreliance on the sun protection claims of some products.

As a physician, I take the position that so long as there is little danger and you feel that it is beneficial to you — and you are willing to part with your money to use it — then go for it. As a physician, I also have to practice according to evidence-based, ethical medical principles, and I cannot in good conscience recommend, or sell, many of these products to my patients. While I can happily prescribe retin-A to a patient because of its known skin rejuvenating effects, I cannot similarly recommend a cosmeceutical with an unknown concentration of this medication, nor can I say that one brand is better than another. Many physicians today, in an effort to improve their bottom line, offer proprietary and even self-named products for enhancing skin health. Their medical degree gives them a greater perceived authority and legitimacy. Many of these products come from clearing houses that will take generic cosmeceuticals and label them with the physician’s name or their practice name. I believe such marketing is disingenuous.

My prescription for skin health is relatively simple. Live a healthy lifestyle that includes enough exercise, good nutrition, rest, engaging work, and social interactions. Avoid unnecessary direct sun exposure and use a high quality sunblock consistently when outdoors. Also, avoid excess alcohol intake and all tobacco products and stay well hydrated. For your skin, use a simple soap and a buff pad to remove dead surface cells. Use a good moisturizer and high quality makeup. Learn to apply it well. If you do these things, you probably do not need to spend a lot of money on cosmeceuticals.

Thefirst step towards a beautiful, healthy smile!

We here at Lake OMS practice a full scope of oral and maxillofacial surgery that includes expertise in the areas of corrective jaw surgery, wisdom teeth removal, diagnosis and treatment of facial injuries, as well as bone-grafting procedures Drs. Azizi and Figueroa employ the most recent advances in dental implant technology by utilizing CT-guided system for minimally-invasive implant surgery. With this technology, we can evaluate the bone ahead of time and place implants precisely in an ideal functional and esthetic position. We are committed to provide the highest quality treatment so our patients can smile and function with confidence.

Lake Oral & Maxillofacial Surgery

19051 US Highway 441, Suite 100, Mount Dora 352.735.5005 • www.LakeOralSurgery.com