How to select best cosmeceuticals for anti-aging

For the over-40 female, topical regimens are a topical issue. Many women want to avoid the wrinkles, dryness, sagging and textural changes that are a noticeable indicator of aging skin. Seeking anti-aging solutions, they often turn to their dermatologists and cosmetic surgeons for advice about cosmeceuticals, which claim both cosmetic and therapeutic benefit.

Unfortunately, today's physicians often lack enough time to review all of the claims in this exploding field. "Market sales in the U.S. for cosmeceuticals and anti-aging products are projected to be more than $16 billion by next year," says Jason K. Rivers, M.D., F.R.C.P.C., a dermatologist with Pacific Dermaesthetics and clinical professor of dermatology at the University of British Columbia, both in Vancouver.

Complicating matters further, cosmeceuticals are not typically supported by double-blind controlled trials. Since they are not regulated by the

"So you have varying degrees of evidence-based medicine. Some companies have spent the money to do controlled trials but to varying degrees of rigor," says Suzanne Bruce, M.D., president of Suzanne Bruce and Associates and the Center for Skin Research, Houston.

PROOF IN THE PUDDING One group of topicals that has been well-studied is retinoids. To date, retinoids are backed by the most evidence as halting collagen loss and increasing new collagen formation.¹ Additional cosmeceutical ingredients touting anti-aging claims include alpha hydroxy acids (AHAs), antioxidants, botanicals, depigmenting agents, exfoliants, growth factors, topical peptides, sunscreens and hormones. As the market continues to grow, the evidence lags — but it is starting to catch up.

For products with no evidence, Dr. Bruce relies on her own documentation and patient satisfaction. "If a patient goes on the regimen and comes back in a few months and says, 'I love the way my skin looks,' that's pretty good evidence it's working," she says. As time passes, more of this evidence is published.

Other physicians take matters into their own hands. "People are always asking, 'What do I put on my skin?'" Dr. Rivers says. The question led him to explore ingredients and eventually develop his own line.

"I think one of the more important things is the fact that there is now more scientific evidence to support the use of [cosmeceuticals], so we have some better idea how to proceed through the maze of products," he adds.

TOPICAL LIMITATIONS When followed properly, the right topical regimen can create improvements in the skin. More often, though, topicals are recommended as complements to advanced procedures. "Most physicians I know are incorporating topicals into their recommendations, because it's a huge plus that can enhance results," Dr. Bruce says.

Rivers likes to use house construction as a metaphor for cosmeceutical use. "If you have a hammer and a nail, you can only do so much. You can't put in granite or do finishing carpentry. To get the 'wow' effect, you really need to have combination therapy," he says.

Topicals alone will not eradicate excessively sagging skin, sunken cheeks or deep wrinkles, but they may improve the skin surface, texture, fine wrinkles and/or color. They are also preventive tools — sunscreens have been shown to be effective in absorbing ultraviolet radiation and, therefore, mitigating resulting DNA damage.