All about actives: dermatologists dish on what works and what doesn't in their practices and in skin care formulations. In order to create an effective skin care formula, cosmetic chemists must start with the most efficacious active ingredients.

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WHETHER designed to treat the signs of aging or acne, the best-selling skin care products on the market rely on effective active ingredients. And while wrinkles seem to be getting all the headlines these days, according to leading dermatologists, acne continues to be the biggest skin malady that drives consumers to seek a doctor's help. Other areas of concern include hyperpigmentation and dilated pores.

Once that prescription is up, however, where can consumers find effective products? That's where skin care products play an important role in a growing market-even in a recession.

A study conducted by Sustainable Youth in conjunction with Kelton Research finds that despite the economic downturn, 33% of American women say they are willing to give up 10% of their savings in order to look a decade younger for the rest of their lives, and the sentiment rises among younger ladies. According to the maker of anti-aging products, 44% of women ages 25-44 would give up 10% of their savings to look a decade younger forever, compared to 26% of those 45 and older. The survey also found that 41% of women with a household income of $40,000 or more would give up 10% of their savings if it meant they'd look 10 years younger, compared to less than 26% who earn less.

It's no wonder then, that consumers are making appointments with dermatologists at a younger age than ever. According to New York City-based dermatologist Andrew Alexis, there is a growing increase in skin aging concerns among his patients.

"My patients aren't waiting for the signs of aging or that first wrinkle," he told HAPPI. "Patients in their 20s and 30s are coming in and they want to know about preventive strategies."

And what advice does Dr. Alexis give them?

"I tell them to wear sun protection, use retinoids and maintain a healthy lifestyle such as avoiding smoking," he said.

With more consumers interested in fending off Father Time, demand for anti-aging products is on the rise. According to Euromonitor International, anti-aging skin care products account for nearly 25% of the global skin care market, which topped $75 billion at retail in 2008 (see chart, p. 69).

More Than Skin Deep

Although acne may be the most common reason patients visit dermatologists, Howard Murad in-sists that topicals aren't enough to cure all skin maladies.

"You can't focus on one thing only. Sunscreen on your face won't cure all ills," noted Dr. Murad. "Your skin is 80% dermis. What you put in it is important. You need internal skin care."

That's where Dr. Murad's Water Principle concept comes into play. He blames water loss at the cellular level as the root cause of most skin problems. With age, cell walls become porous and lose water. Dr. Murad insists that cell walls must be repaired in order to maintain the correct water level.

"We are born with 75% water and die at 0%," he observed. "With each decade there is a decrease in intercellular water level."

To help consumers increase their water level, Dr. Murad recently introduced Sleep Reform supplement and serum. Like all Murad products, the Sleep Reform formula is rooted in The Science of Cellular Water, Murad's proprietary system for optimizing cell hydration and skin health.

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"Seventy-five million people are chronic problem sleepers," explained Dr. Murard. "If you don't get enough sleep, the skin gets dehydrated and can't function properly."

The supplement contains ingredients that improve the ease with which one falls asleep and help reduce nighttime disturbances, allowing the user to wake up refreshed, well rested and ready for the day, according to the company.

Sleep Reform contains Murad's Repair Enhancing Matrix (REM) which reportedly increases the depth and duration of restorative sleep. It also helps accelerate and optimize the skin's repair cycle while providing antioxidant protection to shield cells from further damage. Murad's REM complex is made up of three potent actives: Gamma-aminobutyric acid (GABA) for encouraging muscle relaxation, Methylsulfonyl- methane (MSM), a sulfur donor for enhancing penetration and reducing inflammation, and vitamin C.

The product also contains melatonin, which helps the body, including the skin, sleep undisturbed to maximize the natural repair/regenerative cycle; while glucosamine and B vitamins promote overall health, boost collagen production and ease joint pain. Finally, pomegranate extract provides maximum scavenging of the free radicals that have built up throughout the day's stresses and environmental exposure.

"The cosmetics industry needs to look at sleep," insisted Dr. Murad. "Unfortunately, most people think skin is unrelated to the rest of the body. They put on topical but the skin is connected to the organs. You have to look at it."

Folks may be lacking sleep, but nobody likes to be told "you look tired." According to Dr. Alexis, his practice has seen a surge in requests to treat dark circles under the eyes--a problem that is often difficult to correct.

If the dark circles are due to thin eyelid skin and bluish appearance of underlying blood vessels, Dr. Alexis often recommends topical treatments such as Active C Eyes by La Roche-Posay. But if the dark circles are caused by hyperpigmentation, hydroquinone-based topicals are his first choice. Puffy eyelids are also a problem for his patients, so Dr. Alexis often recommends Hydraphase Eyes by La RochePosay.

Other skin problems that are on the rise in Dr. Alexis' practice include dilated pores and "rough skin." For both problems, he offers topical retinoids; chemical peels, especially salicylic acid peels); fractional lasers; e.g., Fraxel; and other lasers; e.g., Cutera Genesis, which he described as a non-ablative laser rejuvenation procedure.

An A-Rating for Retinoids

Tired eyes aside, acne is the most common skin disease in the U.S., affecting 40-50 million Americans. According to results of a Harris Interactive poll, commissioned by Retin-A Micro, 45.8% of dermatologists' acne patients are adults and 66% of dermatologists say they currently see more adult acne patients than they did a year ago.

Although dermatologists agree that skin care products have gotten better, many insist that retinoids remain the most effective topical anti-aging active available to consumers. Dr. Alexis agreed. To treat acne, he often prescribes a retinoid-benzoyl peroxide combination.

According to Zoe Diana Draelos, a dermatologist in High Point, NC, retinoids are so effective because skin cells have retinoid receptors on their surface. As a result, the retinoid is able to induce a direct skin effect.

As for cosmetic ingredients that can come close to the efficacy levels of retinoids, Dr. Draelos singled out Retinol, as well as retinaldehyde and retinyl propionate as the ones that come closest.

She also warned that products promoting DNA repair (see Anti-Aging & Cosmeceutical Corner on p. 38 in this issue), often fall far short on their promises.

"DNA repair claims are really too strong. Most of them are shrouded in appearance claims," insisted Dr. Draelos. "Reaching cellular DNA with a topical product could be extremely dangerous, especially if the topical is a carcinogen or linked to a carcinogen in the product. Do you really want the preservative mingling with your DNA?"

And Dr. Draelos had strong thoughts on peptides, too, calling them "minimally effective" as they are currently used in skin care products.

"Antimicrobial peptides have demonstrated efficacy in animal models, but most have still failed in human trials," explained Dr. Draelos. "There is a great difference between showing peptide efficacy in a gene chip array and achieving visible benefits in humans within a finite period of time."

Instead, she insisted that the new antioxidants ferrulic acid and phloretin show promise.

"They are the next generation of ingredients beyond AHAs and PHAs," Dr. Draelos told HAPPy. "I also think old ingredients, such as glycerin, are being rediscovered for their ability to modulate aquaporins and mechanistically moisturize the skin."

Treating Skin Discoloration 

Dischromia is the biggest reason why patients come to Dr. Alexis. "Hyperpigmentation remains a big concern for people of color (his primary patient base)," he explained.

For this condition, Dr. Alexis prescribes hydroquinone-based formulas, which he called the gold standard in treating dischromia. Specifically, he uses Tri-Luma Cream from Galderma. In addition to hydroquinone, the formula contains corticosteroid fluocinolone acetonide.

However, Dr. Alexis maintained that no one should be using hydroquinone continuously for more than six months and that's where cosmetics companies and their suppliers have developed a variety of alternative materials.

Some of the active ingredients found in cosmeceuticals that Dr. Alexis finds useful include:

* Arbutin;

* Kojic acid;

* Mulberry extract;

* Licorice extract;

* Vitamins C and E;

* Magnesium-L-Ascorbyl-2-Phosphate (MAP);

* N-Acetyl glucosamine;

* Niacinamide;

* Soybean Trypsin Inhibitor;

* Retinol; and

* Coffeeberry.

The unique needs of people of color isn't limited to skin care. While Dr. Alexis insists he's no expert when it comes to hair care, he urged the industry to find alternatives to current hair relaxer formulas that not only break the hair shaft but also irritate the scalp.

"We see a continued increase in hair loss and breakage issues among African-American women," explained Dr. Alexis.

A lot of this is due to popular hair care practices, such as the use of chemical relaxers, styling hair with heat and stressing hair via braid and weave hairstyles.

"I'd like to see agents that can be used to straighten and style hair that cause minimal damage to the hair shaft and minimal irritation to the scalp. That would be a big improvement for women who suffer from hair breakage."

Years ago, the cosmetics industry and dermatologists often had an adversarial relationship. In recent years, more derms have come to realize that cosmeceutical formulations can play an important role in maintaining skin health after that initial trip to the dermatologist's office.

6th Annual Cosmeceuticals Conference

WANT TO LEARN more about issues that are impacting the global cosmeceutical industry? Then be sure to attend the 6th Annual Cosmeceuticals Conference, which will be held June 29-30 at the Marriott New York East Side hotel, New York, NY.

The conference, chaired by HAPPI columnist Navin Geria, vice president, R&D, SpaDermaceutical Products Group, includes keynote presentations by Howard D. Sobel M.D., director of NY Skin and Spa Cosmetic Surgery Center and Neil Sadick, M.D., Sadick Research Group.

Presentation topics will include:

* FDA standards;

* Dual-DNA repair;

* Breakthrough technology development through strategic partnerships;

* Oral nutrients for skin care;

* Organic certification programs and how to comply with them;

* Cosmetic concerns in skin of color; and

* Global regulatory changes that are impacting the cosmetic industry.

More info: [phone]; Website: www.insightinfo.com; Email: [e-mail]

Looking for a supplier of active ingredients? A list of them starts on p. 74.

Tom Branna

Editorial Director

A Surge in Demand for Anti-Aging Products

* Sales of anti-aging products are growing faster than the overall
market, according to data from Euromonitor International. Here's a
look at the global market for skin care products. Retail sales are
in millions of U.S. dollars.

Category                    2003       2008   Change

Skin care               47,267.6   75,751.1    60.2%
Facial care             37,820.2   60,090.9    58.8%
Nourishers/anti-agers    9,105.4   17,662.3    93.9%
Body care                8,083.4   13,573.4    67.9%
Hand care                1,364.1    2,086.8    52.9%

Source: Euromonitor International