Topically-applied natural oils and botanical extracts, constituents of which may still be in use today, formed the cornerstone of skincare thousands of years ago. Today’s skincare technology borrows from the natural, but also delves deep into the modern and manmade, with increased reliance on foundational research transparency.
“We are trending back toward science, seeking the value of an expert over an influencer when looking at skincare,” said dermatologist Rita Linkner, MD, of Spring Street Dermatology in New York, N.Y. “With more information available, further driven by the COVID-19 crisis, patients are expecting more rigorous research, looking for scientifically-proven efficacy and safety over hype and greenwashing.”
Carl Thornfeldt, MD, the founder and CEO of Episciences, Inc., and a practicing dermatologist in Boise, Idaho, agreed. “We are going to see a vast increase in the number of double-blind, randomized, controlled clinical trials for skincare products, which is long overdue. It hasn’t been required, but the public is demanding proven efficacy, with an elevated expectation for safety trials,” he pointed out.
“Over the last few years, we’ve seen a few notable examples of how a solid foundation of research with proven results has raised the bar and driven marketing initiatives,” he continued. “With Epionce we’ve been doing that from the start, and as a result we have ten prescription skincare products with superior efficacy and safety proven in randomized, controlled trials.
We are going to see a growing, purer understanding of which botanical extracts actually work and why,” he added. “A new molecule is discovered in vitro, so they put it in a formulation with multiple ingredients, perform an open label subjective consumer trial which does not determine if the botanical extract actually contributed to any of the clinical results,” he explained.
“Were the molecules in the botanical extract stable through manufacturing and then effective in living human skin? Do the natural ingredients you use or include really have a measurable benefit? Furthermore, poor packaging or manufacture can cause product constituents to degrade to levels too low to cause a discernable effect.”
CBD has been highly touted, for example, but its utility for skincare is questionable, at least for now. “At least once a week I get asked about CBD,” Dr. Linkner shared. “There is really no science showing the value of CBD for aging skin at this time, but companies are doing research and this may change.”
There is worth in botanicals, according to Dr. Thornfeldt. “Epionce was built after
discovering there are two foundational abnormalities that drive 14 skin disorders including aging: compromised barrier function and chronic destructive inflammation,” he reported.
“There are seven pathways of inflammation in the skin, antioxidants only work on two of them. There are five pathways to barrier repair, and recent research has revealed more about barrier dysfunction due to factors from the environment and sunscreen constituents being absorbed by skin,” he elaborated.
“The botanical world is full of powerful actives but also secondary compounds providing stability and improved delivery. We call this the ‘entourage effect.’ By rigorously evaluating herbs we are learning how they affect these pathways to inflammation and barrier maintenance, and how they keep skin microbes in check,” Dr. Thornfeldt continued.
“We are creating all-botanical formulations that beat prescription products head-to-head. With Epionce Purifying Spot Gel we combined seven herbs with over-the-counter anti-acne products and saw better results faster versus prescription clindamycin/benzoyl peroxide, without irritation. With our Renewal Calming Cream we took our Barrier Repair technology and added herbs with anti-itch and anti-inflammatory properties. This was so effective that at day eight treating subjects suffering from moderate eczema experienced greater than a 50% reduction in redness, itching and scaling! By day 22 more than 80% of the subjects were clear. These efficacy numbers are substantially higher than four high-profile prescription topical products, including the most recent one on the market for eczema therapy. The key is targeting the mechanisms of action with multifunctional botanical extracts that are stabilized throughout manufacturing then effectively delivered at therapeutic concentration to specific abnormal cells or strata.”
As new aspects of skin aging are better understood, the emergence of related treatments is a given. Hormonal factors have been discovered to play a powerful part in aging skin.
“Aging women are the largest patient base for skincare, and with an expectation of longer life, women are spending more of their lifetime in that age group,” Dr. Linkner said. “Also, the growth of a holistic approach to healthcare is a contributor as we recognize the importance of factors like lifestyle in healthy skin.”
The adoption of this paradigm is pushing the patient base younger and younger. “I recommend women start medical-grade skincare as early as possible to slow the appearance of aging skin,” Dr. Linkner said.
“When women in their thirties want to take a preventative, strategic, long-term approach to the appearance of aging and healthy skin, it is totally achievable using at-home skincare products, much more so than if they show up at age 50. What we do with in-office procedures can work wonders, especially in conjunction with at- home skincare, but the larger percentage of fuller and longer lasting results comes from lifestyle and use of good, scientifically-tested products if women begin soon enough.”
Jennifer Pearlman, MD, medical director of PearlMD Rejuvenation (Toronto, Ontario, Canada) has been interested in beauty and skincare since childhood. She formulated skincare with her pharmacist during medical school and eventually launched her own proprietary medical grade line, PearlMD Skin Care Rx. “Skincare should be personalized and a key part of the at-home regimen supporting all office-based treatments,” she indicated.
“It is important for physicians to offer safe, effective products that can be personalized to address unique factors such as skin type, sensitivity and underlying concerns,” she said. “Our watchwords are precision, preventative and proactive. You can incorporate effective at-home skincare into your patients’ lives early and when combined with minimally invasive office-based treatments and technologies using light, laser, thermal energy and injectables, you can dramatically change the arc of their facial aging for the better. At-home targeted skin therapy goes hand-in-hand with in-office energy-based treatments and injectables.”
With menopausal and perimenopausal skin in women over the age of 50, there is scientifically-demonstrated and dramatic increase in the rate of skin aging as estrogen levels begin to decrease, Dr. Linkner stated.
“Other than in the reproductive organs we see the most estrogen receptors in the skin. Estrogens are involved in maintaining skin hydration, collagen and elastin, and barrier function. This contributes to the difference in aging skin between men and women. Companies are beginning to address this topically, and theoretically you will see resultant improvement in skin thickness as well as fine lines and wrinkles in estrogen deficient skin (EDS). Work is being done to find carriers that will bring the estrogen to the right layer of skin without systematizing it, because there are definite concerns there.”
Dr. Pearlman is an internationally recognized expert in hormone therapy and has helped to run the largest menopause clinic in Canada for more than a decade. While she provides bioidentical hormone therapy as one pillar of healthy aging, she does not endorse its use on the skin for cosmetic purposes. “The concern with estrogen for skincare is systemic absorption, especially on the face which is so absorbent. Instead, I recommend using targeted skin treatments and providing hormone therapy in the safest and most effective way possible which would not include direct application to the face,” she shared. “There may also be exacerbation of facial redness or pigment, which are definitely not things we want if we are treating skin.”
Early 2019 saw the launch of Emepelle from Biopelle, Inc. (Ferndale, Mich.), which features MEP Technology, a patented ingredient specifically designed to non- hormonally restore the natural function of estrogen deficient skin, as revealed in clinical studies. The serum and night cream regimen also includes other skin- beneficial ingredients.
According to plastic surgeon Gregory Chernoff, MD, medical director of Chernoff Cosmetic Surgery (Santa Rosa, Calif. and Indianapolis, Ind.), Nitric oxide is one of the most important and thoroughly studied molecules in the human body. “It regulates cellular communication, facilitates delivery of oxygen and nutrients to almost every cell in our bodies, and is a potent vasodilator. As we age, we lose the ability to naturally produce it; by age 40 we are producing maybe half of what we were when we were 20. It affects the signs of aging and has use not only for healthier skin, but cardiovascular health as well.”
Non-allergenic Pneuma Nitric Oxide Activating Serum from Pneuma Nitric Oxide, LLC (Austin, Texas) is designed to restore nitric oxide to skin, and includes 20% of the antioxidant vitamin C as well. And, it is safe enough to use in conjunction with other skincare products. “By itself nitric oxide has noticeable benefits, but it excels as an adjunct to your skincare regimen,” Dr. Chernoff said. “With topical use, studies have shown overall improvement in tone and clarity of skin, but also reduction in fine lines, blending of pigmentation and dramatic improvement in acne and associated conditions. We also use it to improve post-procedural healing.”
The role of peptides in skincare is gaining traction as well, according to plastic surgeon James Beckman, MD, an adjunct associate clinical professor of dermatology at the University of Arkansas Medical School (Little Rock, Ark.).
“Peptides, by definition, are just short chains of only ten to twelve amino acids. Some help regulate the manufacture and repair of skin collagen. These much smaller molecules can be absorbed into the skin when topically applied,” he explained. “Synthetic peptides used in skincare include Argireline (acetyl hexapeptide-3) and Matrixyl (palmitoyl-pentapeptide 3), but a very powerful and naturally-sourced peptide is being used exclusively by my skincare line.”
Extracellular vesicles known as exosomes are produced by the body and play a key role in intercellular communication and the cellular microenvironment. Their successful implementation for aesthetic and medical use is a major hot topic, partly due to their potential and also the controversy surrounding their approved use. In Dr. Chernoff’s studies, he reported that topical application has shown improvement in aging skin, acne, wound healing and scar therapy.
Exosome Regenerative Complex from BENEV Company, Inc. (Mission Viejo, Calif.) delivers a plethora of amino acids and peptides, growth factors, hyaluronic acid (HA), coenzymes, vitamins and minerals using exosomes from adipose- derived stem cells to facilitate topical absorption. Trials have demonstrated notably increased production of collagen and fibroblasts when used as directed.
A novel use of HA for skin health from Endor Technologies (Barcelona, Spain) includes a range of products using nanoparticles of gold to facilitate absorption of HA by skin, according to Dr. Chernoff. “This activates CD-44 cell receptors on keratinocytes to upregulate natural HA, elastin and collagen production.”
Nanoparticles of pearl, platinum, gold or even diamond, plus HA, are included in the U.SK Under Skin product line (Brazil). “These all act a little bit differently in terms of absorption and activity,” Dr. Chernoff noted. “They bind with different particles of different sizes. Another Under Skin product getting a lot of buzz at the meetings is for melasma, treatment of which is a multibillion-dollar industry. Their Advanced Retinol Restorer is a sustained-release form of retinol combined with skin calming ingredients as part of a variety of products in a kit, which has shown to be very effective, safe and comfortable to use.”
Growth factors have gained prominence, and as new products have proliferated, some have strong science behind them and real potential,” Dr. Chernoff explained. “We are seeing their use in personalized skincare emerging.”
The first product of its kind, SoME Skincare from Aesthetics Biomedical, Inc. (Phoenix, Ariz.), is a customized at-home topical based on autologous platelet-rich plasma which has been harvested, further concentrated and constituted with natural ingredients and stabilizers. Clinical trials have shown safety and efficacy, as well as a shelf life of 90 days at home.
“Using in-office therapies paired with a foundation of solid home-use products and maintenance treatments every few months is reminiscent of what we see in dental care, and as with dentistry, daily brushing and flossing is a necessary adjunct to regular in-office dental cleaning. Skin health is an important indicator of our overall health and wellbeing. After all, our skin is our largest and most visible organ!”
“Early intervention with skincare keeps you looking younger, longer, sooner and often without expensive procedures.” Dr. Chernoff said. “Anyone who can provide a great result less aggressively and at a relatively low cost will keep a patient for life.”
The best is just over the horizon, according to Dr. Thornfeldt. “By the end of the decade we are going to see more and better products that are multi-factorial, reflecting our growing understanding of the skin and how we can safely repair and take care of it.”