Why we sell cosmeceutical skincare

By Dr Mervyn Patterson / 01 Jul 2014

Dr Mervyn Patterson explains why a good skincare line is an essential tool in any clinic’s armamentarium

Skincare is the basic ingredient of any customer’s treatment regime and, as a clinic focused on helping everyone achieve their best results, using a skincare line that suits their needs and delivers the best possible results is essential.

Customer satisfaction increases loyalty

Giving customers a quality experience, with everything we do, should lie at the heart of any clinic’s ethos. Our skincare must feel and smell pleasant to use and give the customer the desired consistency to suit their preferences and skin type.
With a population that ranges from those who prefer the very lightest of feel, through to those where the desired feeling after application is an intensely moisturised sensation, the skincare line has to comprise of a range of different formulations. One can have the most effective product in the world but if it is unpleasant to use then it won’t be very popular.
An example of this is sunscreen; the desire to use high SPF values has to be tempered with the ability to produce elegant, pleasant formulations. We recommend sun protection as part of our anti-ageing strategy and it is a requirement to all our post procedure regimes. Some chronic conditions such as melasma require absolute adherence to a sun protection strategy. Daily application of a high SPF is an essential part of any regime to achieve and maintain improvements. Sunscreens with combinations of physical, chemical and biological components can achieve high levels of UV protection and, at the same time, appear virtually invisible on the skin. Mineral make-up can also be utilised to add UV protection, with at least one line achieving SPF ratings of 50 in a “barely there” look.

Proven results

Our customers come to our clinics because they expect to see results. Many will have spent years researching the approach to their skin, their chosen treatments and skincare regimes. This is to be lauded and not criticised. These are exactly the customers we want to see through our doors; the ones who do their homework and base decisions on considered evidence. Increasingly, the modern savvy woman is rejecting the over- hyped marketing spin and looks to see what evidence exists to help justify her spend and achieve the desired results. Likewise, we as doctors and nurses are being asked to base our decisions on evidence-based science. It is therefore imperative that we have considered the science behind all of our procedures and treatments.
Skincare lines are now increasingly presenting evidence for their claims, but in many instances these are anecdotal and lack scientific robustness. In my opinion, it was a pivotal moment for the skincare industry when a cosmeceutical company went head-to-head against a prescription product — previously considered as the gold standard in topical anti-ageing therapy. In the first study of its kind, a blend of botanical agents was shown to be equivalent in treating all the measured signs of skin ageing, without the high levels of irritation and reactions seen with the tretinoin 0.05%.1

Logical science

If the skin becomes healthy, then it will look its best. This simple, logical statement should underpin everything we do in aesthetics. Repairing the external top 10 to 15 skin cells and restoring optimal barrier function is essential to skin health. A healthy roof helps to protect the underlying skin from a range of “insults” that want to penetrate the deeper layers of our skin. Cleansers, toners and moisturisers must be designed with the correct balance of lipids to ensure the correct mix of the three key lipids between the surface cells. Controlling chronic inflammation in the skin is another critical component of any skincare regime. Unchecked, inflammation leads to unwanted pigmentation, vein formation, abnormal skin cells, destruction of collagen, sagging and wrinkling. Choosing moisturisers with a wide anti-inflammatory effect is now considered an essential aspect of modern skincare. We have chosen a moisturiser containing both barrier repair and anti-inflammatory properties that, in an independent clinical study, was shown to be highly effective in treating the signs of skin ageing.2 Optimal cell nutrition is also a logical step in achieving healthy skin. Human skin cells have a basic requirement for a balanced, physiologically appropriate level of vitamins and trace nutrients to achieve ideal function. Now formulators have achieved a combination of oil and water-soluble ingredients in a single preparation to encompass all the key vitamins — A,B,C,D and E. In an independent clinical study a novel formulation containing these ingredients was shown to be significantly more effective, with less irritation, than another established brand.3 

Safety and tolerability

In order to achieve a satisfied, loyal client we need effective regimes that are pleasant and safe to use in the long term. We do not want complaints about anything we do. It is therefore essential that our skincare line is proven to be safe and well tolerated.
On the contrary, some skincare brands pride themselves on the harsh approach. “Prescription strength” is a term often used — the impression conveyed is that the more aggressive the skincare regime, the better the result will be. This is not a philosophy we support. Reactions and irritation mean more queries to answer and more time spent on the phone reassuring clients. In my experience, problems such as redness, dryness, flaking and peeling dramatically reduce consumer satisfaction, ruin compliance with the regime and make future use of the product less likely. The incidence of cosmetic sensitivity is now becoming an important issue for those of us involved in the skin and aesthetic industry. A questionnaire study looking at self-reported incidence of skin sensitivity was sent to a random 3,300 women and 500 men in Buckinghamshire. The response rates were 62% for women and 52% for men, with the incidence of self-reported skin sensitivity being 51.4% and 38.2%, respectively. 10% of women and 5.8% of men described themselves as having very sensitive skin. 57% of women and 31.4% of men had experienced an adverse reaction to a personal product at some stage in
their lives, with 23% of women and 13.8% of men having had a problem in the last 12 months.4 Nielsen et al patch-tested patients in Denmark in 1990 and 1998 and reported that contact sensitisation to cosmetic related allergens had doubled.5 Set against this backdrop of high and rising incidence of cosmetic skin reactions, it is essential that clinicians recommend skincare products that are safe and tolerable.

Management of chronic skin complaints

Melasma is an example of a chronic skin disease that may need a lifetime of adherence to a skincare regime to control and minimise its appearance. In additionto daily high factor sunscreen, the use of regular de-pigmenting agents that suppress melanin production is essential to optimise control.
Agents such as hydroquinone and high strength retinoids carry a significant risk of irritation. If use is discontinued, because of their tendency to disrupt the skin barrier and increase chronic inflammation, the pigmentation can rebound to levels worse than before starting to use the products.6 In an independent clinical trial, a novel blend of botanical depigmentors was shown to be as effective as a combination of hydroquinone 4%, tretinoin 0.05% and vitamin C at reducing pigmentation, and the botanical regime was significantly less likely to cause irritation and rebound.6

Optimising results of our clinic treatments

We offer a wide array of treatments to help modify or improve the skin. Intense Pulsed Light (IPL), fractional non-ablative laser treatment, microdermabrasion, handheld and machine microneedling, peels and any number of combinations, depending on the clinical indication. The Dermafrac, a combination of microdermabrasion infusion combined with vacuum-controlled microneedling and LED light therapy, is a very popular procedure within our clinic.
The combination of microdermabrasion and peeling has been a longtime favourite. Combinations of IPL and moderate strength peels are now emerging as exciting treatment strategies for resistant acne and photo- damage. Many of these treatments share the same underlying principle: controlled skin injury producing an inflammatory response, which in turn leads to some degree of reabsorption and skin repair. Persistent barrier disruption and inflammation, beyond the acute reaction, are features that are unlikely to be helpful for optimal skin health. For this reason we choose skincare that is proven to rapidly close the external skin barrier post procedure. In a split face study on laser resurfacing, a proprietary blend of lipids and botanical ingredients improved re-epithelialisation and visibly reduced erythema faster than alternative products used in 75% of the patients. All of the study patients preferred the feel and ease of application of the proprietary product. In a second aspect of this study the key complex within this cream was tested for its ability to normalise barrier function after tape stripping or skin peeling. It produced an 89.6% reduction in trans epidermal water loss TEWL, 45 minutes after application compared to 43.1% reduction with application of 100% petrolatum. Two hours after resurfacing, the stratum corneum had completely normalised whereas petrolatum had reduced TEWL by only 55%.7 By considering the evidence available, we have been able to choose a skincare line that works well for our patients needs and supports the treatments that we offer in our clinic. 

Advanced combination treatments

The combination of IPL and mid range peel is a very effective treatment for resistant acne and photo damage. A treatment consists of an IPL, followed directly by a skin peel and combines the positive effect of both treatment modalities. In a clinical study, four combined IPL/peel treatments over a 12-week period with an at-home skincare regime, utilising keratolytics, was shown to be highly effective at clearing acne that had failed to respond to various topical and oral treatments. A follow up one year after treatment confirmed a significant long-term effect.8 There are thousands of skincare lines now available on the market, with more being added each week. Every manufacturer has the answer, be it the doctor or famous plastic surgeon behind the brand, the “made by NASA” claim, the magic ingredient or the patented formulation that sets them apart. Revisiting basic skin physiology and examining the quality of the supporting evidence remains a vital step for a clinic owner in deciding the best skincare range to use. 

Financial disclosures: Medical director at Eden Aesthetics, distributor of Epionce / Agera skincare, Colorescience mineral make up, and Dermagenesis microdermabrasion and Dermafrac micro-needling machines. @drmervpatterson 

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