The skin is the body’s first line of defense for environmental exposure. Much of the “premature” aging (in contrast to intrinsic or chronologic aging) occurs as a direct or indirect result of the skin’s interaction with its environment. While photoaging is properly recognized as one of the principal causes of aging in lighter skin types, many other factors are also significant. For example, tobacco smoke produces a host of problems and in some darker skinned ethnic populations may be the primary cause of wrinkles rather than ultraviolet (UV) light. Ozone, air pollution, industrial, occupational, or recreational exposures bring contact with a diverse array of potential toxins. Personal skin care habits and excessive or improper use of products can also cause problems. Disease and drugs and therapies for diseases may produce many challenges to the skin as well.
Traditionally the sun protection factor (SPF) has been the primary focus of protection from the environment for UV light. Various moisturizer products have some function for barrier protection (5-7). However, there is a growing realization that the issues are more complex than this. As a result, discussion is growing about SPF to include a broader range of UV exposure including UVA-1 wavelengths. You will be reading more about immune protection factor (IPF) and also environmental protection factor (EPF) in the years ahead as our understanding of the full spectrum of environmental insults to the skin is explored.
The common pathways of much of the environmental damage to the skin are twofold: free radical generation and DNA damage. The concept of repetitive small “injuries” to the skin resulting in cumulative long term chronic alteration of the optimal structure and function of the skin resulting in “scars” is a good one. In this scenario wrinkles might be considered “solar scars” … or “tobacco scars” … or “environmental injury scars.” The latter is more comprehensive, but the former are useful teaching tools for educating our patients. The growing evidence that environmental damage reduces the efficiency of mitochondrial ATP production provides a unique area of future research. The ability to “re-energize” skin cells as one ages using cosmeceuticals is another very exciting area for the future (8,9).
If one considers environmental damage then the first goal of therapy is avoidance… followed by protection. then minimizing or neutralizing free radical damage. and finally repair or restorative treatments. As clinicians we try to focus on all of these factors and develop practical, useful, and affordable treatment plans that adapt to our patient’s
lifestyle so that compliance is maximized. One of the great challenges with the proliferation of cosmeceuticals is finding good scientific and clinical data like we are accustomed to having for our pharmaceutical drug therapies. Such information is often absent or studies are poorly designed and physicians are often left sorting through marketing claims instead of scientific data.
This scenario has led to the increasingly popular practice of dispensing cosmeceuticals within the physician’s office. This provides the physician with the ability to control and select products that are scientifically based, but it also opens the door for misuse of the privilege and trust that our patients place in us. The American Academy of Dermatology has a formal policy and guidelines for this practice which is useful to review (Fig. 1) (10).
Properly used, office dispensing can be a very valuable tool for the optimal use of cosmeceuticals (11). Dispensing “private label” products to “control” patient purchase habits or using products which have no scientific or clinical basis established is a good example of practices which do not enhance the physician’s professional stature nor benefit the consumer. Since nearly half of dermatologists currently dispense products, the need for better educational resources for physicians is growing and the availability of textbooks such as this are one part of the effort to put cosmeceutical skin care on a solid scientific and academic basis.
The sales growth of cosmeceuticals is dramatically increasing relative to skin care products in general with special interest for the anti-aging category of products. This trend is likely to continue. The consumers have a need for reliable information, not just marketing claims. Physicians are the traditional source of such information; however, many are poorly informed and their patients are increasingly seeking this expertise and advice elsewhere at non-traditional and often non-medical sources. With the proliferation of products and marketing claims that are ahead of or unsupported by clinical data, it is truly an information wilderness for many products.