Monday, March 12, 2007

Want some fun with nomenclature? Some wordplay to pass the time? Try reading the list of ingredients on an everyday skin-care product such as a cleanser or moisturizer, and chances are you will give up before you hit No. 3.

Skin care, of course, embraces many problems and products, with the latter overseen by the U.S. Food and Drug Administration only when the skin’s physical structure is likely to be changed dramatically in some way by application. Most cleansers and moisturizers are over-the-counter offerings that do not require FDA pre-market approval, but by law ingredients must be named and listed in descending order of quantity.

However, that doesn’t tell a customer which ones are the most effective — to learn when quality trumps quantity. And such formulations — the various manufacturers’ mixtures and methods — generally are patented. Only a research chemist knows for sure what works best and why.

Different formulas promise different results, but specialists regard the differences skeptically in spite of fancy chemical labeling. (“Non-comedogenic,” for instance, simply means the product won’t clog pores.) The top third of ingredients on the list usually make up 90 percent to 95 percent of the product, with water and glycerin among them in both cleansers and moisturizers. (Glycerin, a humectant, absorbs water or helps another substance retain moisture.)

“This entire field has gotten to be ridiculous from both consumer and physician point of view; every time, they come out with brand names we never heard of. The whole field of antioxidants, for example,” says Dr. Eliot Battle Jr., Howard University assistant professor of dermatology and director of a local cosmetic medical spa named Cultura. “In terms of cleansing, what matters first of all is the type of skin. If the skin is prone to break out with acne, then go for antibacterial cleansers such as those from Neutrogena and Aveeno.

“Patients constantly come in to say, ‘Doctor, we are confused.’ I say, ‘Stay away from department stores. Go to a low-dollar range when it comes to cleansers and moisturizers. You don’t need a physician-strength product. Cetaphil works very well. Most quality brand names are good. Johnson & Johnson, Procter & Gamble have very good moisturizers. Hyaluronic acid is effective to draw in moisture. Even Noxzema, which I hate because it clogs pores, but it adds moisture,” he says.

“A dryness to our skin probably is its greatest insult and dangerous in terms of aging and of chance of infection,” he adds.

Dr. Battle says he has no commercial connection with any of the above brands, which he calls “neutral products that can be used on many people.” The words found on most labels are “synthesized products,” as opposed to purely natural, he points out.

Cosmeceuticals on the other hand (a combination of a cosmetic and pharmaceutical) — not a term recognized by the FDA — are advertised as containing active ingredients such as vitamins and antioxidants that are said to have “drug-like effects.” Here again, formulation matters.

Vitamin A or C, Dr. Battle notes, have useful alpha hydroxic acids “that are best tailored to your individual type.” Vitamin A, he says, “makes skin thicker and by reducing the size of pores means better texture. Vitamin C stabilizes bonds of collagen [connective tissue between skin cells] and is also an antioxidant used in repairing sun-damaged skin.”

“It’s a misconception that you have to pay department store prices to get things technologically well designed,” agrees Dr. Alexa Boer Kimball, a dermatologist affiliated with Harvard Medical School.

Another misconception, she says, is “the assumption you should use the same product in January as you do in July. In the East Coast, dry heat in the winter is incredibly drying, which doesn’t happen in July. Frankly, I use something different every day. I look at my skin and decide. Of course, I’m a professional and it goes with the territory.” A person may need to apply moisturizer three times a day in winter to keep dryness at bay, she advises.

While reluctant to recommend brand names, she mentions the Olay line and Johnson & Johnson’s Aveeno as having well-formulated products. She would rather stick to what she calls “general principles” that regard ointments such as aquathor (“a nicer version of Vaseline”) to be more moisturizing than creams; creams as more moisturizing lotions; and lotions as doing more good than gel. The ingredient dimethicone, a silicone, “is outstanding for moisture repair,” she says.

Research dermatologist Zoe Draelos, of Wake Forest University, touts glycerin as “a workhorse” ingredient, and ceramides “good for people with really dry skin.” The latter ingredient she explains as “a normal component made by the body’s intercellular lipids” that proved very expensive when introduced 10 years ago. It since has been synthesized — “not made from human or animal” elements — and is found in certain mass-market products such as CeraVe’s hydrating cleanser.

“Nothing is simple,” says chemist Donald Bissett, a research fellow with Procter & Gamble in Cincinnati, when asked to explain words on a label of CeraVe’s hydrating cleanser, which is not a P&G product. The list started off with purified water, followed by glycerin, behentrimonium methosulfate and cetearyl alcohol, ceramide 3, ceramide 6-11, ceramide 1, hyaluronic acid, cholesterol, polyoxyl 40 stearate, stearyl alcohol, polysorbate 20, potassium phosphate and dipotassium phosphate.

“Water often is number one because it is a good solvent for a lot of other stuff,” he says. “Glycerin is a moisturizer that binds a lot of water to it and tends to get used at high levels, from 1 to 7 percent.” He cautions that the problem is at too high a concentration if it develops a “feel” issue — stickiness. Hyaluronic acid is another moisturizer he calls “a very large polymer present in the skin naturally, but its levels decline with age.” Likewise, cholesterol is “another lipid in the skin barrier that, along with ceramides, is necessary for healthy skin. The body can make cholesterol in an attempt to repair damage, but I don’t think eating a Big Mac is any help.”

Mr. Bissett drew a blank about the last names on the list that a CeraVe representative was only too happy to explain at length. The behentrimonium methosulfate and cetearyl alcohol, she said, was “a multivesicular delivery system and emollient.” The rest of the polysyllabic words amount to either cleansing, “buffering,” or smoothing agents. The last two on the list, the phosphates, help control skin texture so that it doesn’t become too alkaloid and become too dry and rough, she said.

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