Cosmeceutical recommendations should come with caution

Editor's note: For a list of cosmeceuticals that deliver what they promise, check here.

Las Vegas - Although the science behind many cosmeceutical products is growing, dermatologists should use caution in recommending many of these products and ingredients, according to experts who spoke at Cosmetic Surgery Forum 2010 in Las Vegas in December.

The contents of some cosmeceuticals can cause unintended side effects in certain patients, depending on their skincare needs.

For example, according to Vivian Bucay, M.D., transforming growth factor beta-3 promotes collagen synthesis, but vascular endothelial growth factor (VEGF) promotes angiogenesis.

“Is angiogenesis always desirable? Growth factors may trigger expression of pre-existing, subclinical precancerous lesions,” she says.

Dr. Bucay, clinical assistant professor, department of physician assistant studies, University of Texas Health Science Center, San Antonio, says she believes this is what happened to her and four patients she put on a popular cosmeceutical containing VEGF.

In her case, Dr. Bucay says that while taking high-dose interferon as an adjuvant therapy for melanoma, she developed two actinic keratoses on her face (where she had applied the cosmeceutical product for two years prior to her melanoma diagnosis), but not on other sun-exposed areas.

"We know that patients with melanoma have VEGF levels at least 10 times higher than average (Brychtova S, Bezdekova M, Brychta T, Tichy M. Neoplasma. 2008;55(4):273-279. Mehnert JM, McCarthy MM, Jilaveanu L, et al. Hum Pathol. 2010;41(3):375-384. Epub 2009 Dec 11),” she says. “I believe that the VEGF in the (cosmeceutical) contributed to the development of the AKs, and they became noticeable while on interferon because it stimulated my immune system to attack them.

“The lesson is that we must think carefully when choosing cosmeceuticals for each individual.” The AKs resolved while she was on interferon, Dr. Bucay says.

Lack of results
Other cosmeceuticals simply don’t work, some experts say.

Kenneth Beer, M.D., director of Palm Beach Aesthetic Center, West Palm Beach, Fla., says StriVectin’s original formulation (StriVectin-SD) “was a nice moisturizer, but it was not superior to botulinum toxins (Beer KR. Dermatol Surg. 2006;32(2):184-197). The original product is still available, but StriVectin’s manufacturer has added several other products, some of which contain the skin lightener niacin.”

Likewise, Jeannette Graf, M.D., in private practice, Great Neck, N.Y., says some manufacturers add gold to skincare products intended to firm and tighten, “although there’s no evidence of any skincare benefit.”

Rather, in 2001, the American Contact Dermatitis Society named gold its allergen of the year.

“We tend to see reactions to gold in areas where there’s contact with eye makeup, foundation, mineral makeup or sunscreens,” she says. “The thought is that these products might contain metal compounds such as titanium dioxide and zinc oxide. If the gold is abraded by these metals, it can lead to release of sensitizing gold products.”

Conversely, Dr. Graf says, “Skin lightening products containing mercury have become increasingly popular in recent years, particularly in sub-Saharan Africa. Although mercury will lighten the skin, is a toxic heavy metal. For me, the most important aspect of any skincare product is, first do no harm.”

Hairy subject?
Regarding up-and-coming cosmeceutical categories, Jeanine Downie, M.D., who practices in Montclair, N.J., says, “There’s an overemphasis on hair in our society - growing hair, keeping hair, making your hair look the best it can. So to me, many shampoos and conditioners are on their way to being almost cosmeceuticals because they're putting in so many different ingredients.”

For example, she says, Phytoprogenium (Lierac Paris) shampoo contains oats and adds shine without preservatives. “It doesn’t dry, and can be used by men and women with all hair types.”

Moreover, she says Lierac Paris is planning to introduce a line of products for sale in physicians’ offices.

“In terms of their Phyto products, which have been out for years, because they’re so popular, the company has actually been able to make them better over time. It’s almost to the point where they have a cosmetic yet pharmaceutical-grade usage,” Dr. Downie says.

Disclosures: Dr. Downie is a consultant for Allergan, Galderma and Medicis. Dr. Bucay is a consultant for Medicis, Allergan, Novartis, Johnson & Johnson, Aveeno, Eleme Medical, Ferndale/Biopelle, Galderma, Azure/HydroPeptide, Bioform/Merz Aesthetics and Syneron. Dr. Graf is a consultant for Allergan, Medicis, Johnson & Johnson, OrthoNeutrogena, Mercer/BioForm, Aveeno and ROC, but she reports no relevant financial interests in any products discussed in this article. Dr. Beer is an investigator, consultant and/or speaker for Johnson & Johnson, Allergan, Medicis, Sanofi-Aventis, Graceway, Lumenis, Eleme, Stiefel and Galderma. He is a shareholder of Cosmetic Boot Camp LLC and Theraplex.