Cosmeceuticals added to skincare regimens may delay invasive treatments

Key Points

New Orleans - Somewhere between soap and water, fillers and facial peels, are skincare regimens that can help to maintain healthy, youthful skin. Most cosmeceuticals aren't required to have approval from the Food and Drug Administration, so they often lack complete studies to support their effectiveness. But they can still play a role in giving skin a younger, fresher appearance.

Mary Lupo, M.D., clinical professor at Tulane University, New Orleans, says dermatologists can help patients to make the most of what they have by identifying the skin's primary and secondary needs and recommending the types of cosmeceuticals that address those needs.

"Most people have more than one problem, and the regimen women follow is very much dependent on what needs to be corrected. I call it identifying our needs and your goals, and what it will take to correct those needs and achieve those goals," she says.

"The hallmark of daytime skincare needs to be protection from ultraviolet damage. The No. 1 way to do that is with sunscreen; the No. 2 priority is antioxidants," Dr. Lupo says.

In the evening, the metabolic rate decreases, so there is less free-radical production. It decreases with rest and sleep and there is no exposure to ultraviolet light. Dr. Lupo describes evening as the time for correction and stimulation.

"Primarily, the retinoids should be the workhorse at night. Retinoids help improve aging skin, stimulate collagen and improve cellular turnover. They help by decreasing the transfer of pigment into the melanosome and increase blood to the skin. They are the cosmeceutical product that has the most science and data behind it," she says.

Dr. Lupo says the appropriate retinoid needs to be chosen based on skin type, tolerance and geographic location.

"What can be used in New Orleans is very different than what is appropriate in Denver. The dermatologist has to work the patient to determine the appropriate retinoid," she says.

Physicians should consider whether the patient exhibits signs of skin inflammation; flakiness; evidence that the lipid barrier is depleted, deteriorated or compromised; or itchy, burning skin. Dr. Lupo says retinoids must be used cautiously with some patients. Sometimes an emollient can be used first to titrate a patient's tolerance to the retinoid.

Collagen

In addition to a retinoid, Dr. Lupo suggests patients use a collagen-stimulating product at night. In general, peptides (such as Lumixyl) or growth factors (Neocutis) are effective.

"These proteins are usually very hydrating to the skin, so they do help protect the barrier of the skin while you're using the retinoid, and they in and of themselves have data suggesting they stimulate collagen production. To me, that's the ultimate combination."

Dr. Lupo offers potential recommendations for people with various challenging skin types. For severe dyschromia, the emphasis may not be on retinoids alone, but on combination products with bleaching agents containing retinoids. That includes treatments such as Tri-Luma (fluocinolone acetonide 0.01 percent, hydroquinone 4 percent, tretinoin 0.05 percent, Galderma), Neocutis Blanche (hydroquinone USP 4 percent, Neocutis) or Lumixyl (a non-hydroquinone lightening agent).

For red, flushing skin, an anti-inflammatory twice a day may be a better alternative, such as Replenix (Topix) or Revaléskin (Stiefel). Emollient antioxidants are particularly good for people with inflamed and dehydrated skin.

Dehydrated and sensitive skin may respond better to essential oils or emollients with ceramides. Patients may want to use an over-the-counter product such as CeraVe (Coria Labs), which contains ceramides to replenish the skin barrier.

Dr. Lupo also recommends exfoliation. "With exfoliation, you facilitate better penetration of the actives into the skin. How often and how deeply the skin is exfoliated again depends on the skin type and condition."

Disclosures: Dr. Lupo serves on advisory boards for Galderma, Ortho Neutrogena and Allergan.