Dr. Dima can you expand a bit on the difference between "clinical vs. cosmetic" when it comes to your products?
Dear Ruthann:
What an insightful question! It really shows me how Megheads and consumers in general are increasingly “tuned in” to where they choose to spend their hard earned money. It has a fairly complex answer but I will do my best to clarify.
Actually the essence of your question can be traced back to the Food, Drug and Cosmetic Act enacted by Congress in 1938. To summarize, this law was intended to distinguish between products that were meant for “adornment” purposes and those that were meant to prevent or treat disease. In the case of “cosmetics,” it was clear that such products would only be used for beautification and would not alter the structure or function of skin.
Unfortunately, ‘is it a drug or is it a cosmetic’ has become outdated with the increase in studies of the effect of topical ingredients on the skin. We now know that almost anything applied to skin, whether alpha hydroxy or avocado, peptides or petrolatum or even straight up water can effect skin physiology. To help clarify this conundrum, Dr. Albert Kligman came up with the term “cosmeceutical” in 1998 to help elucidate the vastness between the two extremes. But within the cosmeceutical category itself, there is again a large degree of discrepancy. Some cosmeceuticals lean more towards the cosmetics end and some veer more towards the drug end. In my opinion, it is within this category that the most confusion occurs for consumers (and doctors alike).
Clearly, we are beyond seeking “hope in a jar” and are becoming increasingly focused on finding products with biologically active ingredients that have been proven to effect a visible (and lasting) difference in our skin. In general, the more “biologically active” the ingredients, that is, the more they function to prevent and/or repair DNA damage, promote collagen synthesis and improve the appearance of skin, the more costly they are. In the absence of regulatory guidelines, the term clinical (or cosmeceutical/dermaceutical/ medical skincare etc.) is used to distinguish such products from those that cannot make claims of altering skin…or they do but then get sued for false advertising (ex: L’Oreal). Fundamentally, cosmetics camouflage whereas products containing active ingredients such as retinol, vitamin C, hyaluronic acid, peptides, alpha lipoid acid, dimethylaminoethanol, and vitamin E to name a few can, in the right quantity and vehicle actually alter the structure of skin. A simplified example of this would be the use of optical properties to make topical creams and powders that reflect light in a certain way as to create the illusion of more youthful skin. Such products, depending on the manufacturer, probably have stringent quality control in terms of purity and batch size but are and will always be classified as cosmetic products.
So, in order to further distinguish the “cosmetic vs. clinical” conundrum, how efficacious (and stable) biologically active ingredients are on effecting skin changes and how they are formulated to achieve visible end results are two of the most important distinguishing characteristics. The focus should be on scientific, “clinical,” results that are reproducible (a change in skin texture or pigmentation), as well as preventive and long-lasting results. Remember that an ingredient may be potent with indisputable skin health benefits but such ingredients are often comprised of large molecular structures. A lot of research goes into maximizing the penetrability of such ingredients into the skin barrier where cellular change needs to occur without the irritating side effects. Moreover, a little known fact is that the active ingredients can become essentially inactive if formulated in an inappropriate vehicle.
A great example of this is Vitamin A, aka retinoids. Tretinoin is a well known biologically active, evidence-based, FDA regulated ingredient and something that I have to write a prescription for. Although it works, it is not well tolerated and many people find it extremely irritating and caustic. This side effect, however, is actually proof that it is working to promote collagen synthesis and stimulate DNA repair at a cellular level. Unfortunately, not many patients remain compliant with such a skin regimen. Moreover, there is scientific proof that the synergistic combination of first generation retinoids, while not labeled as “active” ingredients, and not FDA regulated, can be extremely effective when combined with other anti-aging, intracellular free-radical scavengers without all the side effects. How is this achieved? Suffice it to say that, in general, manufacturers of clinical grade products put the equivalent R&D into the products as would go into a pharmaceutical, prescription only product and, as you so eloquently stated in your question, “you get what you pay for!”
It’s so very confusing to patients/consumers as companies spend millions on the clever marketing of “cosmeceuticals.” They are sold in department stores by people in white lab coats with a “clinical” almost lab-like atmosphere with medicinal looking bottles and pharmaceutical sounding names. I mean even I get drawn in! At my office, my patients bring me bags of products (literally), some paying upwards of $500 for an ounce of nothing but “hope or the hopes of a facelift in a jar.” Simply put, it’s marketing madness but, as is usually the case, the proof is in the pudding. When you find the right product that works for you, you’ll know it, right Ruthann? So, if you’re spending $8 on an anti-aging cream or $12 on a mineral foundation and you think you’re getting a good deal…think again.
Best,
Dr. Dima
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