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

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

3. 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

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

5. Cosmeceutical Regimen Goals
Moisturization
Firmness
Discoloration
Wrinkling
Antiaging Prevention

6. Cosmetic Regimen: Moisturization

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

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

9. 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

10. Transepidermal Water Loss

11. 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

12. 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%

13. 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

14. Cosmetic Regimen: Skin Firmness

15. 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

16. Skin Elasticity

17. Skin Elasticity

18. 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

19. Cosmetic Regimen: Skin Discoloration

20. 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

21. Dermospectrophotometer

22. 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

23. Cosmetic Regimen: Wrinkles

24. 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

25. Profilometry: Silicone Replicas

26. Youthful Silicone Replica

27. Photoaged Silicone Replica

28. 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

29. Antiaging Prevention

30. 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)

31. 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

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

33. 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

34. 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

35. 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

36. 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