Cosmeceutical products plentiful, but research scarce

Las Vegas - Peer-reviewed data on cosmeceuticals is lacking, but some of the most thoroughly researched offerings include coconut oil and lignin peroxidase, according to experts who spoke at Cosmetic Surgery Forum, held here.

Other hot products for the coming year range from facial and body oils to fruit extracts.

“As core aesthetic physicians,” says Manjula Jegasothy, M.D., “we’re the ones that the whole aesthetic industry - from beauty editors in the press to aestheticians in medispas - looks to, to see what we’re recommending. So we need a high degree of scientific scrutiny when we pick a product to dispense in our offices.” She is an associate clinical professor of dermatology, University of Miami Miller School of Medicine.

Carl R. Thornfeldt, M.D., adds, “We must be very careful when reviewing clinical studies for cosmeceuticals. Make sure that they’re controlled trials, ideally comparing against approved prescription products or something that’s known to have activity, such as retinol.”

As of his most recent review of published dermatology journal articles and American Academy of Dermatology poster exhibits of 2010 to 2013, he says, only 16 companies that market cosmeceuticals have presented a total of 50 blinded placebo- or prescription-controlled human clinical trials of herbal-based cosmeceutical products. Dr. Thornfeldt is a dermatologist in private practice in Fruitland, Idaho. He is CEO and founder of Episciences, and he pioneered the herbal-based anti-inflammatory barrier-repairing skincare product Epionce. He also conducted 16 of the above-mentioned blinded clinical trials.

Seeking studies

Because so many cosmeceutical formulations are proprietary, adds Jeannette Graf, M.D., “Labels tell us as little as possible. However, if you have a reputable company that wants dermatologists to use its products, the company will have studies” available for the asking. She is an assistant clinical professor of dermatology, Mount Sinai School of Medicine, New York.

With labels in the over-the-counter market being particularly vague, Dr. Jegasothy says, “I look for three criteria in evaluating cosmeceuticals that I’m going to sell or promote in my office. The first is that the company from which I’m buying has good studies for their product with regards to their competitors.”

Secondly, Dr. Jegasothy looks for value.

“I don’t think a $300 price-point for a cream is fair. We all perform neurotoxin, filler and laser procedures, and while we all agree that clinically-proven skincare is the backbone of a complete anti-aging strategy, it should be as affordable in the long term as minimally invasive procedures, done by a board-certified dermatologist, facial plastic surgeon or plastic surgeon are,” Dr. Jegasothy says.

Finally, and most important in terms of practicality, she considers whether the product is cosmetically elegant and user-friendly. In other words, “Does it smell good? Do my staff and I like it? Does it have multiple uses? Does it require a 10-step regimen? I’m not going to do that. My patients don’t have time for that, either. I like products that have dual-action, with minimal application requirements and strong resale value.”

Top cosmeceuticals

With these caveats in mind, experts offer the following as their top cosmeceutical choices for 2014:

Oils - Facial and body oils are grabbing headlines this year, as BB creams did in 2013, Dr. Graf says. “The refining process of these oils is such that they are so thin and cosmetically elegant that they are suitable for all skin types. Also, because oil attracts oil, they’re very effective cleansers,” especially for acne, although this may appear counterintuitive, she says. “When you use an oily cleanser for patients with acne, you need a very good, deep pore cleansing. These products are light and very fine in consistency,” which allows them to provide such cleansing.

Coconut oil - When taken orally, this saturated fat raises high-density lipoprotein (HDL) and low-density lipoprotein (LDL) levels. But because virgin coconut oil contains medium-chain triglycerides, Dr. Graf says, “It seems not to clog arteries as other saturated fats do.”

In one study, the cardiac mitochondria of rats fed coconut oil for 16 weeks showed the lowest concentration of oxidized proteins and peroxidized lipids versus rats fed olive or fish oil (Lemieux H, Bulteau AL, Friguet B, et al. Mitochondrion. 2011;11(1):97-103).

Coconut oil also packs antioxidant and antibacterial properties, she says. For example, it has demonstrated antimicrobial activity against Candida strains (Ogbolu DO, Oni AA, Daini OA, Oloko AP. J Med Food. 2007;10(2):384-387), and beneficial effects in conditions ranging from obesity to sexually transmitted diseases, Dr. Graf adds.

Furthermore, “Antimicrobial formulations of coconut oil help wound healing. We also see it being used in acne (Nakatsuji T, Kao MC, Fang JY, et al. J Invest Dermatol. 2009;129(10):2480-2488), and atopic dermatitis (Evangelista MT, Abad-Casintahan F, Lopez-Villafuerte L. Int J Dermatol. 2014;53(1):100-108. Epub 2013 Dec 10; Verallo-Rowell VM, Dillague KM, Syah-Tjundawan BS. Dermatitis. 2008 Nov-Dec;19(6):308-315).” As such, she says, coconut oil can help combat many common dermatologic conditions.

Although not all food-grade ingredients are suitable for topical application, Dr. Graf says that presently, “I tell patients to get a bottle of organic virgin coconut oil. It’s solid at room temperature, but once applied to the skin, it melts. It’s a superb moisturizer.”

Manuka honey - All honey possesses antibacterial activity, Dr. Graf says, because it contains methylglyoxal. Derived from the Manuka bush in New Zealand, “Manuka honey has by far the highest level of this antibacterial ingredient.” Manuka honey’s shelf stability also makes it effective if taken orally, she says. As such, “It will be a great ingredient, particularly for treating adult acne in women, because of the moisturizing effects of honey as well. It also has the potential to be a very good ingredient for moisturizers and masks for adults with dry and combination skin.”

Swiss apple stem cell extract - “Though this ingredient is the subject of thousands of publications, we need more data in peer-reviewed journals, Dr. Jegasothy says. “In a 20-patient study, a cosmetic extract of Malus domestica reduced wrinkles in the crows’ feet by 15 percent after four weeks’ use (Schmid D, Schurch C, Blum P, et al. SOFW Journal/Int J for Applied Science. 2008(May):30-35). “Essentially,” she says, “Swiss apple stem cell extract inhibits cell senescence definitively in vitro.”

Exfoliating Heel Cream (Biopelle) - “In Miami,” Dr. Jegasothy says, “we have to show our feet all the time.” Fortunately, “Cosmeceuticals are not just for the face,” she says. Dr. Jegasothy instructs patients to apply this cream (active ingredient: glycolic acid 30 percent) to the soles and sides of the feet every other night - and not to don socks afterward, which can absorb the cream. After several weeks of this regimen, she recommends 30 percent salicylic acid peels every six weeks to two months.

“They don’t really peel the feet,” Dr. Jegasothy says, “but they remove the top layer of stratum corneum. Together, the combination gives patients what I call ‘Miami feet’ - no calluses or white scale on the soles.”

Up the Anti (Biopelle) - This broad-spectrum sunscreen (sun protection factor 30) emerges from the tube as a bluish-purple foam, then turns bronze when rubbed into the skin. “People want a bronzing product,” Dr. Jegasothy says, “and it has great UVA-UVB broad-spectrum coverage. I also like anti-aging eye creams that have tints in them, that serve as concealers as well. Examples include Tensage Radiance Eye Cream (Biopelle).”

CutaVive Professional Skin Rejuvenation Emulsion (Cutagenesis) - Along with anti-aging properties, this product shows promise in wound healing, says Mark G. Rubin, M.D., a dermatologist based in Beverly Hills, Calif. Its key ingredient is perfluorodecalin (PFD), a liquid that can solubilize massive amounts of oxygen. As such, he says, “PFD has been used by the military as a blood substitute on the battlefield.” CutaVive adds pressurized oxygen to the PFD to provide the equivalent of a roomful of oxygen (14 atm) in a can, he says. “Because of the nature of the emulsion, it outgases oxygen over three to six hours. Oxygen products have been around for a long time. But I have yet to find one with an oxygen level higher than ambient oxygen - 160 mm Hg - except for CutaVive, which has three to four times that amount.”

Disclosures: Dr. Rubin is a co-founder of Cutagenesis. Dr. Thornfeldt is a shareholder in Episciences. Dr. Graf is a consultant for Allergan, Merz, RXi Pharma, Neutrogena and Johnson & Johnson, but reports no financial interests relevant to any of the topics discussed. Dr. Jegasothy reports no relevant financial interests.