Makeup and Retin A, respectively, are good examples of these categories. Makeup enhances the appearance of the skin surface; Retin A improves the beauty of the skin by altering the structure of the skin through increased collagen accumulation. Retin A was the first drug for reversing visible age-related changes of the skin that became a mega-drug. It also gave us the first real glimpse into the magnitude of the demand for home-use anti-aging treatments that were not simply "beauty" treatments. However, Retin A required a prescription, which in turn required a visit to the doctor. People were used to buying their beauty products at various retail venues. Industry accommodated this desire with products such as retinol.Retinol rapidly gained popularity as an active ingredient that could circumvent Food and Drug Administration regulatory drug status and provide some of the benefits of Retin A without requiring a prescription or doctor visit. Thus a "new" category of skincare products emerged. Dr. Albert Kligman and others coined the name "cosmeceutical" to describe these products because they could be sold as cosmetics, but they had actions and benefits similar to pharmaceuticals. Cosmeceuticals rapidly increased in popularity. The rest is now history. Cosmeceutical skincare products are now appearing in staggering numbers. While the regulatory issues have allowed the rapid and cost-effective introduction of new products compared to the traditional FDA clinical clearance pathway, they have also allowed the development of a "Wild West" scenario in which claims may not be supported by science. In fact, not only does marketing frequently outpace the science, but good, controlled, double-blind, independent clinical studies subjected to peer review and statistical validation are, unfortunately, very few and far between. This poses a great challenge for us as clinicians. Adding to this dilemma is the potential ethical conflict for physicians who dispense these products from their offices for profit. When we write a prescription for our patients, we should be focused on the benefit for them versus the risk of adverse events — and our "profit" should be the satisfaction of seeing our patients improve. We also typically have a tremendous body of data from scientific studies, which allows us to make wise decisions. In stark contrast, when we choose a cosmeceutical therapy, in many cases such data is scanty or completely absent. Furthermore, there is often no assurance that two formulations using the same active ingredient at identical concentrations are bioequivalent for clinical benefits. Where do we turn to obtain expert advice and scientifically based answers to our questions so that we can give our patients the very best care and treatment plans? Do we turn to our professional society-sponsored CME courses? To textbooks? To the company, for scientific and safety studies they sponsored? Often we cannot. Our resources may be limited to what is provided by the company marketing information and the Internet! Many of our patients are more knowledgeable than their physicians. It is a difficult situation, which is becoming more challenging for physicians with each day that passes. What we see in this issue of Cosmetic Surgery Times are some outstanding examples of the benefits of well-designed and formulated active ingredients in cosmeceutical products. We are going to see some remarkable advances and rapid introductions of new cosmeceutical technology in the next few years. Let's encourage the use by our patients of science-based products. Professionally, let's send the message to the industry that their investment in good research will be rewarded. Finally, let's communicate to our professional societies that we need CME courses that effectively help us to sort through the "maze" of cosmeceutical products and teach us how to give our patients the best possible advice and care. |
