Making Cosmeceutical Choices Zoe Diana Draelos, MD Consulting Professor Department of Dermatology Duke University School of Medicine Durham, North Carolina

Consultant Research Funds L’Oreal Procter & Gamble NuSkin Avon Stiefel Dial Corporation J&J (Neutrogena, RoC)

Creating a Successful Cosmeceutical Regimen Evaluate the best science available on products in the marketplace Utilize an ingredient approach Pick ingredients to each deliver a unique benefit realizing that the moisturizer is the most effective active Balance esthetics, cost, and patient needs

How do you select ingredients to meet patient needs with substantiate efficacy? 4

Cosmeceutical Regimen Goals Moisturization Firmness Discoloration Wrinkling Antiaging Prevention

Cosmetic Regimen: Moisturization

Brick and Mortar Model of the Stratum Corneum Lipid Corneocyte (protein) Ordered Epidermal lipids Covalently bound lipid layer on corneocyte surface

Transmission Electron Microscopy Image of Lipid Bilayer In Xerotic Skin Absence of organized lipid bilayers Amorphous matrix Corneocytes

Moisturization Most important cosmeceutical effect on the skin, usually due to vehicle constituents Documented by observing water leaving the skin (TEWL), directly related to barrier function Documented by measuring water in the skin, directly related to hydration

Transepidermal Water Loss

Transepidermal Water Loss Inhibited by occlusive moisturizers (petrolatum, dimethicone, mineral oil, sesame seed oil, borage oil, etc) Environment created for barrier repair to occur, which enhances skin hydration Moisturizers function to decrease evaporation, do not directly hydrate skin

Moisturizer Occlusive Ingredients Petrolatum=99% Mineral oil=approximately 50% Vegetable oils (sesame, borage, jojoba, flaxseed, hemp, soybean, etc.)=approximately 40% Dimethicone (oil in oil-free products)=approximately 50%

Moisturizer Humectant Ingredients Substances that draw water from the viable epidermis and dermis to the stratum corneum Mimic the effect of glycosaminoglycans in the dermis, such as hyaluronic acid Glycerin, propylene glycol, sorbitol, gelatin, urea, sodium lactate, vitamins, protein, Na PCA, butylene glycol

Cosmetic Regimen: Skin Firmness

Skin Firmness and Skin Elasticity Skin elasticity also known as firmness, skin tone, skin resistance, skin rebound, skin tightness The more skin is stretched, the more elastic it becomes It is desirable to have skin that is firm, but rebounds with quick elasticity when stretched

Skin Elasticity

Skin Elasticity

Skin Firmness and Elasticity Skin elasticity is actually a moisturization claim Hydrated skin is firmer than dry skin Can interpret skin elasticity measurements both ways Higher means that skin is firmness, lower means that skin is more flexible

Cosmetic Regimen: Skin Discoloration

Skin Discoloration Skin pigmentation also characterized as skin evenness, skin tone, skin radiance Desirable skin color is an even blend of yellow (collagen), brown (melanin), and red (hemoglobin) Products decrease melanin synthesis, impede melanin transfer, speed melanin exfoliation, degrade melanin

Dermospectrophotometer

Skin Discoloration Hydroquinone most effective, poisons melanocyte (2% probably ineffective) Kojic acid and arbutin, deoxyarbutin next most effective Licorice extract, pulp mulberry, bearberry extract next most effective Sunscreen is the active ingredient in many skin lightening products

Cosmetic Regimen: Wrinkles

Skin Wrinkling Efficacy Silicone or photographic maps can be used to assess periorbital wrinkling that cannot be evaluated via photographs Accuracy of placement and skin condition can affect results Many different attributes of a wrinkle can be characterized

Profilometry: Silicone Replicas

Youthful Silicone Replica

Photoaged Silicone Replica

Skin Wrinkling Quickest way to reduce a wrinkle is through hydration from moisturizers May use small near invisible light reflective particles, cosmetic correction Dimethicone paste, functions like spackle to smooth surface Dimethicone gel primer to prevent cosmetic migration

Antiaging Prevention

GeneChips and Skin Aging Prevention Signals associated with young skin, improved barrier, etc. Young Skin (Sun Exposed & Sun Protected) Identify opportunities for cosmetic intervention Biopsy Versus Old Skin (Sun Exposed & Sun Protected)

Large gene clusters are differentially regulated in young vs Large gene clusters are differentially regulated in young vs. old photodamaged skin. Key: Blue=down-regulated, Red=up-regulated, White=no change. 31

GeneChips to Understand Ingredients Signals associated with improved skin tone, lightening, etc. New products for improved skin tone appearance Ingredients Cultured Skin

Cosmeceutical Choices Summary What is the most important cosmeceutical choice? Moisturizer and moisturizer. What should you put on your skin? Dimethicone, glycerin, petrolatum What should you use for antiaging? Sunscreen with avobenzone, oxybenzone, octocrylene, reflecting spheres, antioxdant botanicals

Cosmeceuticals Summary Is the active the high profile ingredient or the moisturizer vehicle? What is the duration of action of the dose? How can the effect be measured in a medically significant manner? Questions hard to answer in current US regulatory environment

Cosmeceuticals Summary Is the active the high profile ingredient or the moisturizer vehicle? What is the duration of action of the dose? How can the effect be measured in a medically significant manner? Questions hard to answer in current US regulatory environment

Cosmeceuticals Summary Is the active the high profile ingredient or the moisturizer vehicle? What is the duration of action of the dose? How can the effect be measured in a medically significant manner? Questions hard to answer in current US regulatory environment