Power in actives

Dr Manasi Shirolikar elucidates on the transformative power of cosmeceuticals and key active ingredients for exceptional skin health and aesthetics.

The global cosmeceuticals market was valued at approximately US$ 83.60 billion in 2022 and is projected to reach US$ 155.80 billion by 2030. Cosmeceuticals have become a key category within the skincare industry, combining cosmetic benefits with pharmaceuticalgrade ingredients to address specific skin concerns like hydration, anti-ageing, pigmentation, and acne with proven efficacy. These formulations leverage scientifically-backed active ingredients, making them a popular choice for skincare professionals seeking effective solutions. In India, the growing awareness of advanced skincare treatments and the increasing adoption of cosmeceuticals align with global trends, creating a rising demand for these products.

Shriyal Sethumadhavan explores the key active ingredients commonly found in cosmeceuticals and their impact on skincare routines, in conversation with Dr Manasi Shirolikar, Founder of Dr.manasi.skin (an online consulting brand).

Key active ingredients

One of the most common active ingredients is hyaluronic acid (HA). It is a humectant that can hold up to 1,000 times its weight in water, making it excellent for hydrating the skin. It is especially beneficial for those with a broken skin barrier or experiencing trans-epidermal water loss. It is also suitable for skin that cannot tolerate exfoliants or vitamin C.

Next, we have niacinamide, which is beginner-friendly and suitable for sensitive skin. It hydrates, brightens, and regulates sebum production, making it particularly useful for oily and acneprone skin. Retinoids are another popular group, with variants like retinol, retinyl palmitate, and retinaldehyde available over the counter as cosmeceuticals. Retinoids promote skin cell turnover, stimulate collagen production, and help reduce fine lines and wrinkles (though not deep static wrinkles). They also improve skin texture, provide a plump, glowing appearance, and are effective in managing acne.

Vitamin C is a powerful antioxidant but notoriously unstable, often stabilised with ferulic acid and vitamin E. It aids in collagen synthesis, fights free radicals, reduces pigmentation, and helps decrease signs of ageing.

Exfoliants like AHAs (alpha hydroxy acids) and BHAs (beta hydroxy acids) are also widely used. AHAs dissolve the upper layers of skin, improving texture, pigmentation, and mild acne scarring. BHAs, being keratolytic and lipophilic, penetrate deep into follicles to unclog them and prevent acne formation.

Finally, peptides are gaining popularity. They help with brightening and anti-ageing, although research on their full benefits is still ongoing. Peptides are often included in formulations alongside vitamin C or retinoids for added benefits.

Challenges with sensitive skin

The first and most important step is understanding the patient’s medical history. We need to check for any allergic reactions they have had or any known allergies. For example, some patients are allergic to topical vitamin C, while others cannot tolerate benzoyl peroxide. It is also essential to know what products they have tried before and whether those worked for them. Patient history is vital for crafting a balanced skincare routine with cosmeceuticals.

For sensitive skin, it is crucial to avoid products that may impair the skin barrier. Since such skin types are already prone to irritation, taking a thorough patient history is essential to identify any allergies or sensitivities to specific ingredients, which can then be avoided.

Gentler formulations are preferred for sensitive skin. For instance, instead of AHAs like glycolic acid, we might use azelaic acid or opt for milder acids such as lactic or mandelic acid in lower concentrations. Similarly, instead of salicylic acid, we could use gentler alternatives like betaine salicylate. Niacinamide is also a good option as it supports the skin barrier without causing irritation. Patch testing is highly recommended, and moisturizing formulations with cosmeceuticals can help minimise epidermal damage.

For acne-prone skin, the focus is on using non-comedogenic, oil-free, water-based formulations. It is essential to avoid oil-based products that could clog pores and worsen acne. Modern, lightweight cosmetic sunscreens are preferable as older formulations often caused breakouts.

Sebum regulation is another critical factor. Keeping the skin moisturized with products containing hyaluronic acid, for example, helps maintain hydration and prevents excessive oil production, which can lead to clogged pores.

Additionally, patients with acne often struggle more with post-inflammatory hyperpigmentation (PIH) than the acne itself. Incorporating products like exfoliants or azelaic acid to address PIH is essential, as it helps reduce marks that can persist for weeks or months after the acne resolves. This approach is key to addressing both acne and the pigmentation issues that patients prioritise.

Enhancing in-office results

Cosmeceuticals can effectively complement in-office treatments like chemical peels and lasers. Pre-treatment, preparing the skin is crucial. For instance, before using a Q-switched Nd:YAG laser, many dermatologists prefer products like kojic acid, hydroquinone, or tretinoin to reduce pigmentation and promote skin cell turnover. AHAs are also beneficial as they help remove the upper layers of the skin, enabling the laser to target superficial melanin more effectively. Ingredients such as kojic acid, vitamin C, AHAs, tretinoin, and hydroquinone work well for persistent pigmentation.

Post-treatment care focuses on supporting the skin barrier. Products containing ceramides, peptides, and HA are ideal for soothing and repairing the skin. For instance, after a high-strength salicylic acid peel, patients should use gentler products such as niacinamide, which helps strengthen the skin barrier and regulate sebum production, without causing further irritation.

It is essential to avoid harsh actives like retinoids or salicylic acid immediately after a peel or laser treatment. Instead, gentler formulations with HA, peptides, or ceramides are highly effective. A few days post-treatment, incorporating salicylic acid or niacinamide can further enhance results while maintaining skin health. I recommend combining HA, peptides, and ceramides immediately after treatment, followed by niacinamide and salicylic acid later for a comprehensive approach.

“Today’s patients are more informed and proactive – they often want to include cosmeceuticals in their skincare routine.”

Identifying quality products

It is important to scrutinise the claims made by these products. For instance, some products boast “no preservatives”, which is unrealistic for practical use since most consumers cannot finish a product within 5-10 days. Preservatives are essential for stability.

Next, examining the ingredient list is crucial. If a product claims to provide brightening or sun protection but only contains essential oils, it will not deliver the promised results. For example, sunscreens with carrot seed oil, which has an SPF of only 7, may be misleadingly marketed as SPF 50. Reading the ingredient list – mandated on all products – can help assess whether the product aligns with its claims.

Clinical data is another key factor. Reputable companies often back their products with clinical trials and data, sometimes accessible on their websites. Even studies involving a small group of 30 subjects are better than none. Look for clinical photographs, publications, and efficacy studies, not just for the active molecule but for the final product itself.

Many companies, particularly international brands and some emerging Indian ones, provide proper SPF certifications for their sunscreens. Patents also set high-quality cosmeceuticals apart, demonstrating that the company has invested in unique formulations or molecules.

Finally, third-party trials further validate a product’s efficacy and quality. Products supported by independent testing, clinical data, patents, and certifications are more likely to stand out in an unorganised market and prove to be high-quality cosmeceuticals.

Addressing patient expectations

It is essential to establish a clear timeline for patients, as they often come in without knowing what to expect. Simply asking them to wait 12 weeks will not suffice; you need to explain how the treatment works, its mechanism of action, and when they will see results.

For example, a patient with acne often has additional concerns like PIH, scarring, or even fine lines. I start by addressing active acne first, as other treatments are ineffective during inflammation. At the same time, adding ingredients like AHAs or azelaic acid can address pigmentation to keep them reassured. By the fourth or sixth week, they see progress with their acne and are more patient about the timelines for pigmentation or fine lines, which typically take 8-12 weeks.

It’s vital to communicate the plan clearly to ensure compliance. Patients need to understand the timelines – for instance, that retinoids take 8-12 weeks and niacinamide 6-8 weeks to show results. Collaboration is key; unless they adhere to the routine, the treatment will not succeed.

Respecting patient preferences is also important. If they prefer to finish a product they are currently using, I accommodate that rather than forcing immediate changes. For concerns like scarring, I set realistic expectations, explaining that even with advanced treatments, the skin will not return to its pre-scarring state.

Clear communication, realistic timelines, and a collaborative approach are crucial for managing patient expectations effectively.

Role of formulation stability

Formulation stability is critical for the effectiveness of cosmeceutical products. Let’s take L-ascorbic acid, for example. It is highly effective but also extremely unstable. For patients using vitamin C, I recommend L-ascorbic acid, particularly for those without sensitive or acne-prone skin. It works well for mature patients, individuals with melasma, or those with dry skin.

To ensure stability, L-ascorbic acid must be co-formulated with stabilisers like vitamin E and ferulic acid. Additionally, packaging plays a crucial role. The product should be in an opaque bottle to prevent oxidation and, ideally, in an airless pump to minimise exposure to air. Droppers should be avoided as they can further oxidise the product.

When assessing formulation stability, key factors include the packaging, the percentage of active ingredients, and the stabilisers used. Patients should also follow any specific storage instructions provided to maintain the product’s efficacy.

Personalised solutions

With much of my practice being online, I work with patients across India and beyond, which requires tailoring treatments based on their ethnic backgrounds and skin concerns.

For example, a patient from Kashmir, who typically has a lighter skin tone (Fitzpatrick Type II to III), is more prone to postinflammatory erythema (PIE) rather than post-inflammatory hyperpigmentation (PIH). In such cases, you will often see red spots instead of pigmented brown spots. For these patients, I prefer using ingredients like niacinamide or azelaic acid, which address PIE effectively.

On the other hand, patients with deeper skin tones are more likely to experience PIH than PIE. For PIH, ingredients like glycolic acid or kojic acid are more effective. These can help lighten hyperpigmented areas better than niacinamide or azelaic acid, which are more suited for addressing erythema. Additionally, PIH responds well to vitamin C, while certain procedures like IPL (intense pulsed light) work better for PIE than for PIH.

For Caucasian skin (typically Fitzpatrick Type II), PIE is more common than PIH. In such cases, I tailor routines with gentler active ingredients, especially for sensitive skin. Introducing products gradually helps avoid irritation or burns, which this skin type is more prone to. In contrast, Fitzpatrick Types IV and V, often considered more prone to PIH, are actually quite resilient in my experience. I rarely see significant PIH unless there is an aggressive treatment, like a chemical peel, which may occasionally cause temporary hyperpigmentation that resolves on its own.

Ultimately, tailoring cosmeceutical treatments involves understanding the patient’s skin type, specific concerns, and how their skin responds to active ingredients or procedures. This personalised approach ensures better outcomes while minimising the risk of adverse reactions.

Cosmeceuticals in practice

Many doctors are hesitant to use cosmeceuticals because it is not something we are traditionally taught. Our medical textbooks do not have a dedicated section on cosmeceuticals, so it can feel unfamiliar or even unnecessary at first.

However, I encourage practitioners to educate themselves on cosmeceuticals and its benefits. I have had numerous patients consult me after visiting other dermatologists who dismissed the importance of cosmeceuticals, leaving the patients dissatisfied. Today’s patients are more informed and proactive – they often want to include cosmeceuticals in their skincare routine.

As practitioners, it is essential to work in tandem with their preferences. By understanding and embracing cosmeceuticals, and recommending the right ones, you can significantly enhance your practice. Even between treatments, giving your patients a well-structured skincare routine, including a simple cosmeceutical like a niacinamide serum, can make a huge difference.

When patients see positive results and feel heard, they are more likely to trust you, return for follow-ups, and remain loyal. So, integrating cosmeceuticals into your approach can truly elevate your practice and strengthen patient relationships.