Vol. 30. No. 3


The term cosmeceutical was coined by Dr Albert Kligman in 1984 to describe topical products that afford both cosmetic and therapeutic benefits.1 These products exist on the spectrum between cosmetics, which solely adorn the skin, and medications, which must undergo testing to prove a functional benefit. Cosmeceuticals promote skin health but are not subject to safety or efficacy regulation by the U.S. Food and Drug Administration (FDA). The FDA does not recognize the designation “cosmeceutical,” and instead considers these products cosmetics. Modern society’s youth fixation and its insatiable appetite for methods of turning back the clock have fueled an explosion in the cosmeceutical industry. Irrespective of one’s opinion regarding cosmeceuticals vis-à-vis prescription medications, it is impossible to ignore them. Like Spanish explorer Juan Ponce de León on his mythical journey to find the fountain of youth (Fig. 1), consumers inundated by mass media advertisements navigate aisles of products purporting to restore skin radiance. In fact, analysts forecast that U.S. cosmeceutical sales will reach US$21 billion by 2012.2 In selecting contributors to this issue of Seminars in Cutaneous Medicine and Surgery, the editors sought out recognized experts in the field to distill the innumerable products and ingredients available to those most clinically relevant. To maximize the practical benefit of these manuscripts, when possible our authors have included pearls regarding cosmeceutical use in their daily practice. To set the stage, Dr Brandt’s group draws upon decades of experience in the cosmeceutical industry to provide a snapshot of its scope and to forecast future trends. Although not cosmeceuticals, home-use laser and light skin devices also represent direct-to-consumer marketed skin health products that are garnering increased public attention. The editors provide an update on these products and review available evidence for their efficacy. In the next manuscript Drs Emer, Waldorf, and Berson review cosmeceuticals for rosacea that can prove useful adjuncts in its management. In the subsequent article, Drs Jacob and Lupo discuss the use of cosmeceuticals to optimize outcomes of laser therapy. Dr Farris follows with a description of promising new antioxidant ingredients. At the forefront of research on the pathophysiology and treatment of cellulite, Dr Hexsel and her group weigh in on the role cosmeceuticals may play in its management. Next, Dr Woolery-Lloyd shares her experience with cosmeceuticals for hyperpigmentation. Finally, Dr Golubovic and colleagues gaze into the future of cosmeceuticals as they describe novel nanotechnology delivery systems. A comprehensive review of all cosmeceuticals is beyond the scope of this issue. Further limiting a scientifically rigorous discussion of these over-the-counter products is the paucity of published data evaluating their efficacy. However, it is the hope of the editors that the knowledge shared in the pages herein will emphasize the relevance of cosmeceuticals to dermatologists as well as highlight salient manners of incorporating them into daily practice. The editors wish to express our sincere gratitude to Dr Kenneth Arndt, whose exemplary intellectual curiosity and compassion guides us.

Cosmeceuticals: Current Trends and Market Analysis

Fredric S. Brandt, MD | Alex Cazzaniga, MBA
The desire to maintain a youthful image combined with an emerging global market with disposable income has driven the development of many new industries. The cosmeceutical industry is based on the development and marketing of products that lie between cosmetics and pharmaceuticals. Today, there are over 400 suppliers and manufacturers of cosmeceutical products, and the industry is estimated to grow by 7.4% by 2012. Although a number of products advertise predictable outcomes, the industry is largely unregulated and any consumers of cosmeceutical products should consult a dermatologist prior to use. This review will provide a snapshot of the current trends of this industry and provide an analysis of this multi-billion dollar market. Semin Cutan Med Surg 30:141-143 © 2011 Elsevier Inc. All rights reserved.

Home-Use Laser and Light Devices for the Skin—An Update

Jeremy B Green, MD
Over the past several years, a number of home-use laser and light skin devices have been introduced for various indications, including photorejuvenation, hair growth, hair removal and acne treatment. Although these devices allow for privacy and a significant cost advantage, they are typically underpowered and afford lower efficacy than their in-office counterparts. A number of these devices have recently received FDA clearance. Although large clinical trials are lacking, dermatologists should familiarize themselves with the various options to help patients assess their clinical value. Semin Cutan Med Surg 30:144-147 © 2011 Elsevier Inc. All rights reserved.

Botanicals and Anti-Inflammatories: Natural Ingredients for Rosacea

Jason Emer, MD | Heidi Waldorf, MD
Rosacea is a chronic inflammatory skin condition characterized by cutaneous hypersensitivity. There are many therapeutic options available for the treatment of rosacea, but none are curative. Since the pathogenesis of rosacea remains elusive, it is not surprising that no single treatment is paramount and that many patients find therapies unsatisfactory or even exacerbating. Treatments are prescribed to work in concert with each other in order to ameliorate the common clinical manifestations, which include: papules and pustules, telangiectasias, erythema, gland hypertrophy, and ocular disease. The most validated topical therapies include metronidazole, azelaic acid, and sodium sulfacetamide-sulfur. Many other topical therapies, such as calcineurin inhibitors, benzoyl peroxide, clindamycin, retinoids, topical corticosteroids, and permethrin have demonstrated varying degrees of success. Due to the inconsistent results of the aforementioned therapies patients are increasingly turning to alternative products containing natural ingredients or botanicals to ease inflammation and remit disease. Additional research is needed to elucidate the benefits of these ingredients in the management of rosacea, but some important considerations regarding the natural ingredients with clinical data will be discussed here. Semin Cutan Med Surg 30:148-155 © 2011 Elsevier Inc. All rights reserved.

Cosmeceuticals Used in Conjunction with Laser Resurfacing

Mary Lupo, MD
The use of laser resurfacing for cutaneous rejuvenation has become an important tool in the modern dermatologist’s armamentarium. To ensure a successful outcome, proper preoperative and postoperative skin care is essential. Incorporating cosmeceuticals into the perioperative skin care regimen can promote a better overall patient experience by hastening postoperative healing, reducing common side effects, and enhancing overall rejuvenation. This article aims to explore the use of various cosmeceuticals in conjunction with laser resurfacing procedures. In particular, the overall mechanisms of action behind each selected therapy will be discussed, followed by a brief discussion of the existing literature on each agent’s use with laser resurfacing. Theoretical considerations and a limited body of evidence suggest a potential benefit for the use of these agents in conjunction with laser resurfacing procedures; however, further placebo-controlled studies are needed to truly confirm these benefits. Semin Cutan Med Surg 30:156-162 © 2011 Elsevier Inc. All rights reserved.

Innovative Cosmeceuticals: Sirtuin Activators and Anti-Glycation Compounds

Patricia K. Farris, MD
Skin aging is a combination of natural aging with superimposed photoaging. Naturally aged skin is thin, fragile and finely wrinkled whereas photoaged skin is rough and thickened with deep coarse wrinkles. In addition photoaging is characterized by mottled pigmentation, solar lentigines, telangectasias and a loss of elasticity. The science behind skin aging has exploded in the past decade. Skin aging has now been defined on both a cellular and molecular level. The study of genomics in aging skin provides us with potential targets as points for intervention. In this regard, the science behind skin aging becomes a platform for the development of new anti-aging strategies and products. In this paper two new and emerging approaches to treat aging skin will be discussed. Sirtuin activating and antiglycation products are already being marketed by cosmetic and pharmaceutical companies. These anti-aging approaches are backed by basic science research and the ingredients used are supported by proof of concept studies although clinical trials are often lacking. It is this bench to beauty counter approach to cosmeceuticals that remains an industry standard today. Semin Cutan Med Surg 30:163-166 © 2011 Elsevier Inc. All rights reserved.