Walk through any chemist or department store – even a supermarket aisle – and you’ll be bombarded with products making claims about your skin. You’re “suffering” from ageing skin. You’re showing six of the seven signs of visible ageing. You’ve got clear symptoms of "DNA damage".
For every problem, there is a solution for a price. DNA repair serum. Anti-ageing creams. Black diamonds from outer space, endorsed by NASA. But do any of these products actually work? How do we separate the science from the pseudoscience?
Miracles don't exist even in the world of wonder-creams. But you can support the health of your skin. Credit: iStock
Worldwide, the cosmetics market is valued at $740 billion and growing. But Dr Adrian Lim, the former Dean of Education of the Australasian College of Dermatologists, says what works and what doesn’t is not straightforward.
The cosmetics sector is largely an “evidence-free zone”, he says, and dependent on studies which are conducted according to totally different standards to studies done on drugs. “If you look back to cosmetic products of the last three decades, 99 per cent of claims are extinct and buried,” he says.
Can we turn back the clock?
One of the biggest misconceptions, experts say, is that the right cream can reverse or reduce ageing or even alter cells and DNA.
“Scientifically speaking, it is impossible to reverse skin ageing,” says Dr Fabrizio Spada, a chemist and R&D manager at Ego Pharmaceuticals, which produces common skincare products such as the QV range, sunscreens and also pharmaceutical products. “Nothing exists that will reverse ageing, and making a claim that your product will do so is false. All a cosmetic can do it can temporarily change the appearance of the look and feel of skin.”
Skin ageing is a complex process influenced by genetic and environmental factors that manifests in many ways: drying out, loss of elasticity and texture, appearance of spots, wrinkles and more. Scientists still don’t really understand how it works, let alone know how to reverse it.
There is no evidence that any skin cream can do anything to reverse the skin’s ageing process, Dr Spada says. The only thing you can do is prevent the damage occurring in the first place.
“The best you can do for your skin is to protect it from more damage, which means using SPF50+ sunscreen, preferably both the chemical and physical kinds,” says Dr Cara McDonald, a consultant dermatologist at St Vincent's Hospital Melbourne and at Complete Skin Specialists.
High quality skin care can also help reduce the appearance of fine lines and wrinkles, but finding it on a supermarket shelf is next to impossible, Dr McDonald says.
Inactive actives
While some skincare products, especially those marketed as “cosmeceuticals” (a contentious term introduced by clinicians) advertise active ingredients, the way they measure whether those active ingredients work is very different to drug companies, experts say.
“There are cosmetic actives and there are pharmaceutical actives,” Dr Spada says. “A pharmaceutical active has a pharmacological effect on the skin – so it works like a drug. It must satisfy certain requirements under the Therapeutic Goods Administration (TGA) and cannot be part of a cosmetic.
“A cosmetic active is an ingredient that may cause superficial changes in the skin, such as the appearance of skin, and has no effect on the rest of the body.” Where it becomes confusing for consumers is when both drug companies and cosmetic companies claim to be using the same active ingredients such as vitamin C.
The ingredient may be the same, but its effectiveness is measured in very different ways: one is based on cosmetic clinical trial results, and the other on strictly regulated, TGA-approved clinical trial results.
Cosmetics manufacturers claim vitamin C stimulates collagen repair and can improve fine lines, reduce inflammation and pigmentation. While some brands may have figured out how to make these active ingredients have some effect on the appearance of skin, the majority (especially the cheaper products) unable to substantiate claims they are making, Dr McDonald says.
Do I need antioxidants?
Antioxidants are also cosmetic ingredients, according to the experts. Antioxidants such vitamins A, C and E, and η-3 fatty acids, "mop up" free radical agents caused by sun and UV damage. That’s important, because if we let them run wild they can damage our cells and DNA.
Studies do show antioxidants can be beneficial for skin when eaten, as well as having a range of valuable health benefits, which suggests we should all stock up on antioxidant-rich tomatoes, spinach and corn. But their effects when applied to the skin are still largely unsubstantiated, and require more research.
Why? Your digestive system is designed to absorb nutrients from the food you eat, Dr McDonald says. Your skin, on the other hand, is designed as a barrier and is very difficult to actually penetrate. “What penetrates skin is totally different to the gut lining, skin is designed to keep everything out,” she says.
That does not mean the products are useless, says Dr McDonald. More expensive products have found ways to get their ingredients to penetrate the skin’s protective layer, where they can go to work.
“Cheaper products will 'name-drop' the ingredients but don’t usually have the right concentration or delivery to back them up. You get what you pay for (in most cases),” she says. In the case of vitamin C, Dr McDonald says that “better quality brands (medical-grade skin care products such SkinCeuticals C E Ferulic) have worked out ways to stabilise it and get it into the skin”.
Many skincare product labels include claims that sound scientific. But are they?
“Another very common active in skin care is niacinamide, and in the right concentration (such as in the Rationale Immunologist serum) it will have excellent anti-inflammatory and antioxidant properties,” she says.
The one active ingredient that all experts agree does seem to work is topical retinoids (sold as Retin-A or Retrieve). Developed as an acne treatment in the 1970s, researchers eventually discovered it also can fade age spots, even out pigmentation, speed the turnover of skin cells and increase the production of collagen, the protein responsible for skin elasticity.
The caveat? Studies show it can take up to 12 month of regular use to see improvements in wrinkles, and the treatment can be poorly tolerated, resulting in skin reactions such as burning, scaling or dermatitis, which are off-putting to many consumers. It also also only available via prescription.
Two standards of evidence
Many skincare product labels include claims that sound scientific. But are they? Experts say their results are based on clinical trials which are very different from the types of clinical trials undertaken by drug companies.
Dr Spada says cosmetics and therapeutics are held to very different standards, and, unlike drug companies, cosmetic manufacturers are under no obligation to provide evidence for their products before they hit the shelves.
They are also not required to disclose the percentage of their ingredients on the packet, meaning consumers are never sure of how much active, higher quality ingredients are actually in each product, he says.
And most of those studies are done in dishes in a lab. Many are so badly designed they are not worth the paper they are written on, says Dr Lim. “It is a big extrapolation to jump from the petri dish to the human face," he says. "There is just no accounting for human hope and vanity. People do buy into this fantasy.”
Are any cosmetic ingredients dangerous?
Consumers are increasingly looking to buy "natural" and "organic" skincare brands, fearing their regular skincare and makeup contain toxic chemicals. Unfortunately, this has just created another layer of myths and information surrounding ingredients.
“When you say the word chemical, people think they’re being poisoned, when in reality, everything is a chemical. Chocolate is a chemical, and so is water,” says Associate Professor Oliver Jones from RMIT’s school of science.
“People assume that something organic must be better for you, but if something is natural, it doesn’t mean that it’s good for you,” he says, but there is no published evidence showing skincare products is causing people harm.
How can we tell if a product works?
Dr McDonald says it is extremely difficult for consumers to know who has the evidence and the products that have been proven to work. In many cases, even dermatologists must first research products before recommending them to clients.
“It’s very hard to know who has the evidence and who is just riding off the names of the active ingredients with no real effects,” she says. “As a start, cost is a fairly good indication. The higher-end skincare brands such as SkinCeuticals C E Feruli and Rationale Immunologis are evidence-based, and some good supermarket or chemist products include La Roche Posay.”
But when it comes down to it, there isn't any very easy way for consumers to navigate it on their own. “The industry is unregulated and there are no standards across the industry, so as professionals, we spend a lot of time trying to work out what we can believe and testing things on ourselves and patients to see whether the results back up the claims,” Dr McDonald says.
The best option is to see a qualified and experienced dermal therapist or dermatologist, but Dr McDonald warns consumers should still do research: many dermatologists may try to push their own products.
“Ultimately, you need to act with caution and beware anyone who says you need the 'whole range' rather than specific products suitable for your skin."