Cosmeceuticals: The Principles and Practice of Skin Rejuvenation by Nonprescription Topical Therapy

BACKGROUND: Aesthetic practice relies on a harmonious relationship between medicine and commerce. Bridging the gap is a large number of skincare products that make therapeutic claims while avoiding the regulatory framework of pharmaceuticals. In this gray area, clinicians find themselves poorly disposed to counsel patients wisely as the industry is expanding faster than empirical evidence of efficacy and safety can be acquired. To serve our patients and engage with industry, we must understand the theoretical principles and evaluate the clinical evidence in practice. OBJECTIVES: The purpose of this paper is to classify cosmeceuticals by method of action, explain how they work in principle with reference to skin aging, and evaluate the clinical evidence for them. METHODS: A literature and cosmetic clinic website search was conducted to establish a list of the most commonly advertised cosmeceuticals, and a peer-reviewed literature search was then conducted to establish the clinical evidence for them. RESULTS: A huge number of cosmeceuticals are marketed for skin rejuvenation but almost invariably they fall into 1 of 4 categories. These include the induction of tissue repair mechanisms, inflammatory modulation, scavenging of reactive oxygen species, or a combination of the 3. With the exception of retinol derivatives and hydroxy acids, the clinical evidence is limited, despite promising preclinical evidence for several cosmeceuticals. CONCLUSIONS: Cosmeceuticals reside within a highly competitive ecosystem and are often brought to market based on preclinical, not clinical evidence. Success and failure will largely be governed by the establishment of clinical evidence in retrospect.