Wander among the cosmetic counters at your local department store and you might think that you've been transported to some Swiss sanitarium. White-coated doctors step out from behind exotic botanicals. European nameplates compete with pharmaceutical trademarks. And the prices range from unreasonable ($35 for cleansers) to outright silly (as much as $525 for wrinkle cream).
Skin care today is nothing less than a riddle, bottled in pretty glass and wrapped in perfumed boxes, promising extraordinary results and remarkable powers — "in just 48 hours." Clearly we have lost our way.
Somewhere near the intersection of hope and science, marketing has launched a thousand hyperboles. Advertisements blur the lines between drugs and cosmetics. Manufacturers trot out studies that reveal little about how a substance works. And high-priced products carry the false promise of quality and effectiveness.
Given the onslaught, the shrill announcements, the breathless claims, even the most attentive cosmetic dermatologist must feel like a student who hasn't studied for the final exam.
"There are more companies, more products, more ingredients touting more effects," says Dr. Jacqueline Calkin, a Sacramento dermatologist. "Even as a dermatologist, it's very difficult for us to look at a cream and tell you if it's worth your money. Frankly, I'm confused."
Trying to combat time
LET'S be honest. Consumers want to look like that 20-year-old behind the cosmetics counter with bright smooth skin free of discolorations, large pores, acne and wrinkles.
Up to a point it's not an unreasonable goal, says Dr. Leslie Baumann, who in the course of her career as a Miami-based dermatologist has criticized and championed the vicissitudes of the skin-care industry. Many products on the market today, containing sunscreens and moisturizers, will help maintain a younger look.
However, turning back the clock and erasing wrinkles is more difficult, and here, consumers are often misled and disappointed. Lost in the conversation is the sensible reminder that cosmetics and drugs are not the same thing.
Blame Retin-A for the oversight. Before 1971, consumers relied mostly on night creams to keep skin moist. Then with the approval of this acne medication, a synthetic form of vitamin A, the field suddenly became more complicated and crowded. Clinically proven to diminish fine lines and wrinkles, the prescription drug launched a cosmetics industry that for four decades has blurred the line between cosmetics and drugs and produced few effective products, according to experts.
Today, cosmetic manufacturers like to refer to anti-aging skin-care products as cosmeceuticals, a figment entirely of their own creation. In addition, these manufacturers are under no obligation to show that their products work, only that their ingredients are safe (conversely, drug manufacturers spend millions of dollars over many years on studies to prove effectiveness). This is why carefully worded skin-care advertisements will not claim to "remove wrinkles" but "diminish the appearance of wrinkles."
At one time, the government took it upon itself to weed out the snake oils, but with limited resources, the Federal Trade Commission, which regulates advertising practices, has a difficult time monitoring the promises.
"Anti-aging products are a concern to us," says Janet Evans, an attorney in the division of advertising practices at the commission. "The advertisements are expected to be truthful and nondeceptive. The claims are required to be substantiated."
To be fair, though, there are some over-the-counter cosmetics that seem to be as effective as a drug. For example, dozens of products contain retinol, a milder chemical cousin of Retin-A that helps soften fine wrinkles. But because it hasn't been approved as a drug, the hype is somewhat muted.
"Retinol likely works for wrinkles, but the companies can't say so. They can only imply it," Baumann says. "They often list retinol as an inactive ingredient."
Beware the pseudoscience
THE challenge posed to cosmetic researchers begins with time itself. Long-term exposure to the sun inhibits collagen production, and elastin — the fibers that allows skin to remain taut — loses its ability to recover after being stretched. In addition, the replacement of dead skin cells with new cells slows down.
Reviving exhausted skin cells is key, and only through scientific testing can skin-care chemists learn whether the remedies they concoct work. But not all science is created equal.
Studies on cosmetics, when conducted, are not nearly as rigorous compared with the testing required of drug manufacturers, and some companies test their ingredients only on cells in a lab dish — not on people. That is a real problem for substances that have to pass through the epidermis, the top layer of skin that acts as a barrier, and reach the dermis, the deeper layer of skin that is composed of cells that give skin its elasticity, firmness and strength.
"Clinical studies are really important," says Beth Jewell-Motz, senior research science at P&G Beauty. "If someone is basing a claim on test tube data, I would be pretty skeptical."
Baumann regards the phenomenon in which extravagant claims are based upon a kernel of truth as pseudoscience. She points to the explosion of peptides in skin-care products as an example. Copper peptide is a protein that gives skin support and resilience, and palmitoyl pentapeptide-3, a type of peptide that can be found in the popular Olay Regenerist line, seems to help exfoliate the skin and promote renewal of the skin's outer layer.
But products containing octapeptides, tetrapeptides and other new-fangled peptides are marketed without evidence of effectiveness or even scientific rationale. Perhaps most controversial is the use of a peptide called acetyl hexapeptide-3, also known as argirelene. Manufacturers of argirelene say their topical cream is as effective as Botox, but some experts say that is impossible because peptides can't cross the skin's barrier like Botox, which works by interrupting nerve impulses to the muscles in the face.
So who is telling the truth?
It's difficult to find unbiased sources in the field of skin care. Most research scientists are affiliated with a particular product or company. As for products developed by doctors? Not always trustworthy, Calkin says.
"The truth is that if a doctor has his name on a label, most of the time he didn't actually create it," she says. "It's disingenuous. It conjures up the idea of him stirring up these products and creating it."
The furthest reaches of marketing
EXOTIC ingredients, high prices and fancy names are other trip-ups — and tip-offs — for consumers.
Many companies infuse their skin creams with natural substances that can have health benefits when consumed in foods and drinks. Green and white teas, for example, are antioxidants that reduce inflammation in the body, and there is some evidence that, when applied topically, they can help protect the skin from environmental stresses, like sun and wind.
Be skeptical, however, of exotic ingredients that sound as if Indiana Jones was hired to deliver them. Labels that read "glycoprotein extracted from microorganisms sourced from sea glaciers" or blends offering "the perfect dose of cryoextract of Arctic Raspberry" or anything "unearthed in the farthest reaches of Madagascar" elicit weary sighs from dermatologists.
"Probably just nice moisturizers," Calkin says.
Nor is price a reliable guide in selecting a good skin-care product.
"If you want to spend a lot of money on skin care, fine, but just know that it's the luxury, the texture and the packaging that you are buying," Baumann says. "You are not buying better skin."
La Prairie's new Cellular Radiance Concentrate Pure Gold, for example, is a luxurious moisturizer that contains pure 24-karat gold micro-particles that act as a temporary "brightener," a substance that reflects light and gives skin a luminous glow. It costs $525 for 1 fluid ounce whereas products with less expensive brighteners such as mica can cost as little as $7.
Many dermatologists contend that perfectly good skin-care products can be found at the corner drugstore. When the maker of Neova sold its copper peptide formula to Neutrogena, Baumann notes, the cost dropped from $80 for Neova to $22 for Neutrogena's Visibly Firm copper peptide cream.
In some cases, however, price does matter. Prescription products with retinoids, for example, will cost more than over-the-counter retinols. Likewise, products with acids, such as alpha hydroxy acid, which exfoliate the skin and encourage the growth of new cells, will usually be formulated at higher concentrations and will pack a bigger punch when sold in doctors' lines as compared with over-the-counter products.
The best advice in the long run is to know your skin type and research the products. Otherwise, you just might fall into the cosmeceutical trap.
"Companies think women want to buy hope in a jar," Baumann says. "I think that is insulting to consumers' intelligence. We deserve not to be sold dreams. We deserve to be told what we're putting on our skin."
HOW TO READ THOSE LABELS
SORTING through the confusing landscape of ointments, creams and solutions found at the cosmetics counter doesn't require an advanced degree. Common sense and a little product awareness go a long way. Read the label and the literature. Here's a list of what to look for.
Retinoids and retinols: Retinoids are vitamin A derivatives that are available by prescription only, such as Retin-A and Renova. They're the only substances proven to soften fine lines and wrinkles. They will not remove deep wrinkles or frown lines and can cause redness and irritation. Their chemical cousins, retinols, are over-the-counter substances that are not as powerful but may still help diminish very fine lines and smooth the skin.
Acids: Alpha hydroxy acid (glycolic acid, lactic acid), beta hydroxy acid (salicylic acid) and polyhydroxy acid are effective at helping slough off the skin's oldest layer and encouraging cell renewal to smooth the skin. They can cause peeling and irritation (polyhydroxy acids are less irritating).
Antioxidants: Vitamins C and E are the most useful antioxidants, which are essentially prevention agents that combat free radicals and protect the skin from sun, wind and pollutants. Antioxidants may also stimulate the skin to make more collagen. Other antioxidants that may provide mild benefits include idebenone, coenzyme Q10, caffeine and those antioxidants found in green and white tea and pomegranate.
Anti-inflammatories: These are substances that can lessen irritation and redness in the skin. They are mostly botanicals such as licorice extract, pine bark extract, milk thistle, quercetin, chamomile and aloe vera.
Peptides: These compounds, similar to proteins but smaller, may work to stimulate collagen and thicken the skin. There is some evidence that copper peptides are useful as well as palmitoyl pentapeptide-3. But many other peptides are too large to cross the skin's surface.
Growth factors: These are substances that act as chemical messengers between cells and influence cell division and new cell growth. They have been used in drugs to treat wounds. Growth factors are just beginning to draw some attention in the cosmetics world. The most promising is TGF-beta, which may increase collagen production.