Patients are increasingly turning to “natural” and “clean” cosmeceuticals to address their skin care concerns outside of the doctor’s office. The Dermatologist discussed these products with Dr Carl Thornfeldt and scratched the surface on their role within dermatology.
Next time you find yourself inside your local grocery, drug, or even department store, take a moment to peruse the aisles for personal care products. More often than not, you will find claims to support cellulite reduction, antiaging benefits, and scar fading, among others. These products—cosmeceuticals— are either too good to be true or a potential supplement to a dermatologist-backed skin care regimen.
The term cosmeceutical was coined in 1984 by Albert Kligman, MD, PhD, to acknowledge the products that fall in the middle of the cosmetic to pharmaceutical spectrum.1 These products are designed to do more to the skin than simply cover it but do not have the same clinical effects as a prescription drug.2 Surprisingly, the term is only recognized by industry. The FDA notes that cosmeceutical is not a recognized category under the Federal Food, Drug, and Cosmetic (FD&C) Act, which defines products, as based on their intended use, as a cosmetic, a drug, or a combination of both categories (eg, shampoo, antidandruff treatment, antidandruff shampoo, respectively).3
Patients continue to add cosmeceuticals to their daily skin care routine. The average woman uses 15 cosmetic products and applies 150 to 170 chemicals to the skin daily.4 The cosmeceutical market is estimated to reach $85 billion by 2024.5
Marketing’s Impact on Patients
Without a legal definition for the term, manufacturers of cosmeceuticals can carefully place their product within a gray area to avoid certain regulations. Oftentimes, firms violate the FD&C Act by marketing their cosmetic with a drug-based claim or vice-versa.6 The muddled marketing also confuses patients, who then struggle to find appropriate products for their skin and cosmetic desires. There is a plethora of brands available that claim almost miraculous results, and ease of access helps consumers avoid setting an appointment up with their dermatologist.
“Patients are seeing so much lay press about the dramatic efficacy of topical products that do not require a prescription,” said Carl R. Thornfeldt, MD, FAAD, owner of CT Derm PC in Fruitland, ID, and founder of Episciences, Inc, in Boise, ID. “So, they don’t feel there is a need to see the dermatologist for cosmeceuticals.”
The growing use of cosmeceuticals could be easily attributed to the lack of insurance coverage for cosmetic treatments and the rapidly increasing costs of prescription therapies. Patients may also seek alternatives to prescriptions because of a heightened awareness of potential side effects. For example, isotretinoin
(Accutane) received negative press due to reports that linked use of the drug to depression and suicidal thoughts.7 Without adequate knowledge and/or fear of adverse events, patients may have shied away from an effective treatment for severe acne vulgaris to seek alternative topical therapies instead. Notably, a recent study found no significant difference in depression between patients with acne who received isotretinoin vs those who used other forms of therapy,8 but the drug’s notorious reputation remains.
Regardless, marketing may be the largest factor in the growth of cosmeceuticals. Beautifully branded packaging lauded by influencers and celebrities on social media sparks curiosity for the average consumer. Buzzwords such as organic, clean, and natural, in the eyes of the FDA, are just that–buzzwords. There is no legal standard for these terms, thus companies are free to apply the words to “greenwash” their products to appeal to the conscientious consumers. Recently, “wellness” company Goop and the Environmental Working Group both decried chemical sunscreens in favor of mineral sunscreens for their natural ingredients, but these organizations fail to note the lack of evidence to definitively support toxicity or adverse events from systemic absorption of chemical sunscreen ingredients.9
“The concept that ‘if it’s natural, it’s safe’ is a fallacy,” said Dr Thornfeldt. “Four of the six most potent weapons of mass destruction are ‘natural,’ and they are definitely not safe!”