Providers often advise patients to use topical products at home as part of a rejuvenation regimen. The chemicals in these creams fall into several main categories: vitamin A derivatives (retinoic acid, tretinoin, retinol, tazarotene); diluted glycolics (acid peel chemicals); sunscreens; bleach (hydroquinones); copper peptide formulations; moisturizers; and various other "enhancements" (for example, vitamin C, vitamin E). The popularity of noninvasive prescriptive skin treatments has provided a huge boost for over-the-counter skin-care and cosmetics manufacturers. Many of the same chemicals prescribed by cosmetic surgeons and dermatologists are available in a diluted form and incorporated into products found on the shelves of grocery stores, department stores, drugstores, and salons.
Marketing rhetoric for these products typically includes references to more invasive cosmetic interventions. "If you think cosmetic procedures are too drastic, do we have an alternative for you" is the tagline for one Olay product. Another claims to provide microdermabrasion and chemical peel all in one package. Some over-the-counter lines of skin cleansers, moisturizers, and cosmetics are sold only by physicians, ostensibly so that patients will get better information about their use but also because they can be retailed at a much higher price that way.
Consumers are interested in "natural" products, and advertising usually emphasizes bio-ingredients such as collagen and plant extracts. Some of these ingredients have been used for centuries in folk remedies and in some cases do have active biological properties. However, there is little to no scientific evidence from clinical trials that these ingredients are safe or effective or that they even penetrate beyond the skin's surface layer of dead cells.
Over-the-counter products containing both drugs and cosmetics, herbs (previously called botanicals), or "nutrients" are called "cosmeceuticals," "herbaceuticals," and "nutraceuticals," although these words are not recognized by the FDA as categories. The FDA does require that substances containing both cosmetics and drugs meet the standards for both categories.
Skin care is the subject for an entire book of its own, and there may be more useful scientific knowledge about various ingredients in the future (keeping in mind that relevant controlled clinical studies are rarely performed in the cosmetics and skin-care industry). Still, a few comments are in order about nonprescription products:
Skin cleansers and moisturizers. These products should be expected to do just what their labels say: clean the skin and add moisture/slow moisture loss. Use what you like; the ingredients are irrelevant except for sunblock. Having said that, waterbased products provide less moisturizing than do oil-based products.
Sunscreens. Sunblock is essential, and a product containing a sunblock should be worn daily, at least on the face, and reapplied frequently. Some moisturizers contain sunblocking agents but if yours does not, you should apply a sunblock before you apply moisturizer. Look for a sunblock with SPF 30 or higher. Protection against both UVA and UVB is essential, since both wavelengths are damaging. Unfortunately, sunblocks currently available in the United States do not have good UVA protection, even though effective products for that purpose are available in other countries.
The reason is that products containing sunscreens are considered drugs by the FDA and must go through the expensive premarket testing processcess and get FDA approval before they can be sold. One well-regarded and reportedly very effective product, Mexoryl, was submitted by its manufacturer L'Oréal to the FDA for approval in 2001 but is still not available legally in the U.S.
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