Summary and Key Features
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Expensive cosmeceutical moisturizers do not necessarily improve the skin barrier more than cheaper variants. The most expensive ingredients in most cosmeceuticals are the packaging and the fragrance.
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Moisturizers increase the water content of the skin by occluding moisture loss and as such can only decrease wrinkles of dehydration.
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Glycolic acid peels do not need to be painful to produce exfoliation.
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Cosmetic retinol does not have the same antiaging skin benefits as prescription tretinoin.
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Sunless tanning products do not provide meaningful ultraviolet protection.
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Most cosmeceuticals remain on the skin surface and do not penetrate sufficiently to produce dermal effects.
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There is no definition of what constitutes natural, so botanical ingredients may necessarily be considered natural.
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Cosmeceuticals with numerous botanical ingredients may be harder to patch test, so patients with sensitive skin should minimize the use of such products.
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Introduction
Most dermatologic myths relate to cosmeceuticals and their ability to improve the appearance of facial aging. Notice that the word appearance is always used when referring to the effects of cosmeceuticals on wrinkling. This is due to the fact that improving appearance ensures that claims made regarding the cosmeceutical active are perceived as cosmetic in nature and not pharmaceutical. Claims regarding improving appearance deal with how an active alters looks and not function. Yet there are some claims and myths that seem to continue due to their consumer and marketing appeal. These cosmeceutical antiaging myths represent the most common patient questions encountered by the practicing dermatologist.
Expensive Moisturizers Are More Effective
For many consumers, price equates with quality. This may be true for some commercial purchases, but it is not necessarily true for moisturizers. The most expensive parts of any facial moisturizer are the fragrance, the bottle, and the packaging. None of these contributes to the efficacy of the moisturizer, only the aesthetic appeal. A quality moisturizer should contain an occlusive agent, a humectant, and some form of silicone. Ideally, it should also contain a sunscreen to provide the added benefit of sun protection. No moisturizer in any price range will improve the wrinkling on the lower face demonstrated in Fig. 34.1 .
Moisturizers Remove Wrinkles
Moisturizers do not remove wrinkles, they simply minimize their appearance. The role of moisturizers in reducing wrinkles is primarily through increased skin hydration. The moisturizer contains an occlusive agent, such as petrolatum, mineral oil, or dimethicone, which prevents transepidermal water loss (TEWL) from the skin surface and increases the water content of the skin. This increased water content decreases or even eliminates wrinkles that are due to stratum corneum barrier defects. Barrier repair will possibly improve the skin surface appearance and the moisturizer creates an environment to initiate barrier repair. Thus moisturizers do not remove wrinkles ( Fig. 34.2 ), they simply can provide an environment to reverse dehydration due to stratum corneum barrier defects.
There are some moisturizers that are labeled “wrinkle blurs.” This clever terminology might indicate to the consumer that the wrinkles are somehow less visible. These products are based on silicone gel that fills in the depths of the wrinkles accompanied by small light-reflective particles that decrease the appearance of the wrinkle depth. The optical effects of these products are quite remarkable, but they are only a cosmetic, and the benefit lasts until the silicone product is removed from the face.
Cosmeceuticals Can Produce Beneficial Effects on Facial Muscles to Improve Skin Tone
The first cosmeceutical introduced to produce an effect on facial muscles was DMAE, which is dimethylaminoethanol. It is a releaser of acetylcholine, a neurotransmitter required for muscle movement. DMAE was originally introduced as a homeopathic nutritional supplement for individuals with Alzheimer’s disease and children with attention deficit disorder (ADD). The highest natural food source of DMAE is salmon, which explains the recent interest in diets incorporating several servings of the fish weekly.
The idea of using DMAE to improve the appearance of the facial skin is based on the concept that the facial skin must cover a bed of facial muscles. If the underlying muscle layer is contracted and firm, the skin has a better framework over which to lie. This may create an improved facial appearance, which is sometimes characterized by the cosmetic phrase “better skin tone.” The first several times that DMAE is applied a skin-tingling sensation is present; however, this disappears with continued use. It is unclear whether accommodation occurs to topical cosmeceuticals intended to alter muscle function with time.
Another group of cosmeceuticals, composed of engineered peptides, claims to interrupt the neuromuscular junction and relax facial muscles, functioning in a manner opposite to DMAE. The most popular neurotransmitter peptide is Argireline (acetyl-glutamyl-glutamyl-methoxil-glytaminyl, arginyl-arginylamide), which is said to interfere with the release of acetocholine by destabilizing the protein complex. For a neuromuscular peptide to work, it must penetrate to the neuromuscular junction, remain in place to create a sustained effect, and achieve a concentration sufficient to produce a visible difference. This is very challenging. In conclusion, much research and many clinical studies remain to be done on these cosmeceuticals designed to increase or relax facial muscle tone.
Bleaching Creams Can Improve Brown Spots Quickly
Unfortunately, no botanically based bleaching cream can quickly improve the appearance of brown spots. Most products take at least 6 weeks and possibly even 3 months to work. This is because none of the bleaching cream actives is effective at removing melanin pigment from the skin. They all work by interrupting one step in the pathway of melanin synthesis or melanosome transfer. This means that the bleaching creams are shutting down new pigment production while the old pigment is being dispersed by traditional physiologic mechanisms.
Bleaching creams are most effective when used on the face due to enhanced penetration through thin skin. Neck, chest, and forearm hyperpigmentation responds even more slowly to treatment due to the decreased penetration of the active ( Fig. 34.3 ). Since hydroquinone has been removed from the OTC market, many new botanically based bleaching creams have entered the cosmeceutical market. One such formulation contains hydroxyphenoxy propionic acid, ellagic acid, and salicylic acid formulation. The hydroxyphenoxy propionic acid decreases melanin production, the ellagic acid is an antioxidant, and the salicylic acid is a penetration enhancer.
