Trends in Cosmeceuticals and Nutraceuticals: Exosomes and Adaptogens Take Center Stage

Zoe Diana Draelos, MD, FAAD

Zoe Diana Draelos, MD, FAAD, clinical researcher in High Point, North Carolina, and Editor in Chief Emeritus of Dermatology Times, will present in the session “The Science of Cosmeceuticals and Nutraceuticals” at the 2024 American Academy of Dermatology Annual Meeting in San Diego, California today. In an interview, she expanded on the significance of cosmeceutical advancements, emphasizing the role of adaptogens in tackling exposome-related skin damage, the transformative potential of exosomes for redirecting skin functioning, the importance of dermatology clinicians staying informed for enhanced patient care.

Dermatology Times: What recent advancements in cosmeceuticals and nutraceuticals have caught your attention?

Draelos: Topical agents are like the bread and butter of dermatology. The idea that the skin is related to internal health has led to a thorough of nutraceuticals as well. So, in terms of the cosmeceutical realm, probably the newest thing are ingredients that affect the exposome. And the exposome is the sum of allthe reactive oxygen radicals that attack the body. The exposome would be things like smoking, pollution, combustion byproducts from cars. It's also going to be lack of sleep, diet, or exercise.It's also goingto be things such as sunlight that damage the skin. So the exposome is the sum of all the insults that occur. Now, people are looking at developing adaptogens and adaptogens are substances that protect against oxygen radical damage. The idea is that as you develop adaptogens, and that could be something you take by mouth or that could be something you put on your skin, they'redesigned to prevent insults to the exposome. That is not necessarily a new idea. We've always talked about intrinsic and extrinsic aging in dermatology. But what is new about it is the terminology, the development of adaptogenic substances to treat exposome issues. So that's one very interesting concept.

Now exposome should not be confused with exosomes. So, exosomes are a new ingredient. They're encapsulated genetic code or genetic material that is put on the skin to try and redirect skin functioning. So as opposed to growth factors, which are things that we put on the face for rejuvenation of the past, we now have exosomes that instead of being growth factors themselves contain genetic code like RNA messages that theoretically penetrate into the skin and redirect cellular behavior hopefully from a more aging state to more youthful state. So, exosomes are really the hot new topic and exposomes are really the hot new concept.

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Dermatology Times: Can you elaborate on some scientific principles behind the formulation of effective cosmeceuticals?

Draelos: Effective cosmeceuticals basically have to reach into the skin.They should not sit on the skin in order to have an effect. Substances that sit on the skin are considered cosmetics. So, there are a number of moisturizers designed to sit on top of the skin designed to create a water impermeable barrier to evaporation.Then there are cosmeceuticals that may have substances within the moisturizer that are designed to penetrate. It could be, for example, a pigment lightening product with tranexamic acid in it. Well, that tranexamic acid is a tyrosine kinase inhibitor.It has to get to the side of tyrosine kinase activation, which is where the melanocytes reside at the dermal epidermal junction.So,in order for cosmeceutical to work, it has to reach its target. For a cosmetic to work, it just has to sit on the skin or adorn the skin with color, which sets a very, very important distinction.

Dermatology Times: In your experience, how important is it for dermatologists to stay updated on the latest research and developments in cosmeceuticals and nutraceuticals. And how can this enhance patient care?

Draelos: Dermatologists should be the experts on cosmeceuticals and nutraceuticals because they all relate to the skin. The challenges, however, are that it moves so quickly. Where we get maybe 1 to 3 new drugs a year, there are thousands of new cosmeceuticals that enter the marketplace every year, and that can be sort of overwhelming for the dermatologist. One great way to stay updated is to read my column Cosmetic Conundrums in Dermatology Times because that's what I try and do is take some of the most sophisticated, fast braking, knowledge-based information that is in the cosmeceutical and the nutraceutical realm, and then I write about it every month.

It's really key that we stay up.What's most interesting is that things that happen the cosmeceutical realm also trickle over into the medical realm. The reason they trickle over is because in the cosmeceuticalrealm, you can be so much more inventive.You can bring things to market so quickly, but eventually concepts such as exosomes may indeed trickle over into the medical realm. And a lot of CRISPR-cas work that's being done with genetic diseases is very similar to the exosome work that's being done in cosmeceuticals. So, medical ideas sometimes percolate backwards.

Dermatology Times: How do you navigate that balance between recommending topical treatments and incorporating cosmeceuticals into a comprehensive skincare routine for patients, especially considering individual variations, skin types, and conditions?

Draelos: It's very important to customize things for patients.You may have a patient with hidradenitis suppurativa, seborrheic dermatitis, or psoriasis. While they all need medications that you select and tailor to their unique needs—everybody uses skincare, right? Everybody uses a cleanser. Everybody uses a moisturizer. Everybody should use a sunscreen. As a dermatologist, you want to focus on drugs to help the disease but then you need to optimize the condition of the skin. Those 2 efforts really should be consistent with one another. So if you have someone with psoriasis and they have dry, scaly skin, you may choose to give them a topical corticosteroid, but you also need to give them a good emollient moisturizing cream that minimizes the appearance of the skin scale. They also need to use a good cleanser to exfoliate and remove as much of the psoriatic scale as possible.

So if you think about it, there's really a continuum between the pharmaceutical prescriptions and the skincare recommendations in the cosmeceutical realm and ultimately have complementary treatments that result in better skin help. I know a lot of people sort of separate them into 2 categories. “Now there are Rx products I'm going to give these the OTC ingredients I'm going to give,” but if you really think about it, they must work cooperatively together. So, the dermatologist really should always consider skincare and cosmeceuticals in any disease state.

Dermatology Times: Tell us what AAD attendees will get out of the session “The Science of Cosmeceuticals and Nutraceuticals” on Sunday, March 10 at 3:30 PM PST?

Draelos: The science of cosmeceuticals and skincare is really going to be a late-breaking session where we're going to have experts in the field talk about nutraceuticals, talk about moisturizers, talk about cosmeceuticals. I've personally in talking about skin of color. There are a lot of new understandings that have come out about skin of color. For example, skin of color has higher transepidermal water loss, which is more water loss. But it's also interesting that skin of color also has more water in it—Hispanic skin and African American skin more than Caucasian skin. So, some of those differences in water loss and water content in the skin can help contribute to a better understanding of what ashy skin really means.

Also, one of the biggest needs of skin color is pigment brightening. We're not talking about pigment lightening anymore. There are a number of new ingredients that have been introduced to replace Kojic acid and hydrocodone that were recently removed from most cosmeceuticals. As I mentioned earlier, we have tranexamic acid, silymarin, and arbutin. The idea is that combining multiple ingredients together to hit pigment production and various rate limiting steps such as tyrosine kinase inhibition or melanocyte transfer. The idea is if you have a multi-mechanistic cream that's a cosmeceutical for pigment brightening, it's more likely to have an effect because it hits pigment production in many different areas. So, an understanding of skin of color and then thinking about unique needs of skin of color [is what attendees will learn]. I think that's very, very important, especially with our new emphasis in dermatology about being diverse and inclusive.