|Cosmetics & your Skin|
|By New York Times
The Cosmetics Restriction Diet
By NATASHA SINGER
FRAN E. COOK-BOLDEN, a dermatologist in Manhattan, is an advocate of skin-care
minimalism. When a patient recently arrived for an appointment toting 20
different products she was using regularly including an eye cream, a vitamin C
cream, a wrinkle serum, a pigmentation cream, a mask, a peel, a scrub and 'some
sort of special oxygen detoxifying cream' Dr. Cook-Bolden said she confiscated
all but three.
"It gave me a headache just to look at all of those
products," Dr. Cook-Bolden said. "Just two products, a gentle cleanser and a
good sunscreen, are enough daily skin care for most people, and you can buy
those at a drugstore or a grocery store."
Dr. Cook-Bolden is part of a
back-to-basics movement among dermatologists. At a time when beauty companies
are introducing an increasing number of products marketed for specific body
parts including necks, creases around the mouth and eyelids, or for apocryphal
maladies like visible pores or cellulite, these doctors are putting their
patients on cosmetics restriction diets.
They are prescribing simplified
skin-care routines requiring at most three steps: soap; sunscreen every day, no
matter the weather or the season; and, if necessary, a product tailored to
specific skin needs, whether a cream for pimples or pigmented spots, or a
vitamin-enriched moisturizer for aging skin. Each product, they say, can be
bought at drugstores for $30 or less.
Among those doctors who have become
experts at uncluttering their patients? vanity tables and medicine cabinets is
Dr. Sarah Boyce Sawyer, an assistant professor of dermatology at the School of
Medicine at the University of Alabama at Birmingham.
?My New Year?s
beauty resolution for patients is: cut down on skin-care products and cut your
skin-care budget,? Dr. Sawyer said. ?Cut down on those $100 potions.?
some doctors, simplifying skin-care routines is a way to make patients follow a
regimen or a means to soothe irritated skin. But some dermatologists are also
suggesting patients use fewer, less expensive products because they believe
there is little scientific research to justify buying an armload of pricey
cosmetics, Dr. Sawyer said.
?We have good medical evidence on
prescription products,? she said. ?But the science is fuzzy with a lot of
Unlike drugs, cosmetics are not required to prove their
Prescription medications like Accutane for acne and
over-the-counter drugs such as sunscreen ingredients must undergo rigorous
clinical testing before they gain approval from the Food and Drug
Administration. But cosmetics are not subject to the agency?s scrutiny before
they go on sale. The F.D.A. defines cosmetics as topical products that do not
alter the structure or function of the skin.
Dr. William P. Coleman III,
the vice president of the American Academy of Dermatology, said consumers should
view moisturizers and wrinkle creams as no more than superficial
?You have to think of cosmetics as decorative and hygienic,
not as things that are going to change your skin,? said Dr. Coleman, who is a
clinical professor of dermatology at Tulane University Health Sciences Center in
New Orleans. ?A $200 cream may have better perfume or packaging, but as far as
it moisturizing your skin better than a $10 cream, it probably won?t.?
According to F.D.A. regulations, beauty manufacturers are responsible
for the safety of their cosmetics and for their own marketing claims. Although
many beauty companies perform studies on their products, they are not required
to conduct clinical trials on the level of medical research or to make their
proprietary research available to the public.
Dr. Mary Ellen Brademas, a
clinical assistant professor of dermatology at New York University Medical
Center, said the paucity of rigorous published science on cosmetics makes it
difficult to determine how well creams work, whether they cost $10, $100 or
?People are spending $450 on a jar of cream just because it is
made out of something exotic like salmon eggs or cocoons,? Dr. Brademas said.
?But the cheapest products work just as well as the more expensive
A study of wrinkle creams published last month by Consumer Reports
concluded that there was no correlation between price and effectiveness. The
study, which tested nine brands of wrinkle creams over 12 weeks, also concluded
that none of the products reduced the depth of wrinkles by more than 10 percent,
an amount ?barely visible to the naked eye.?
The Consumer Reports study
found, for example, that a three-step regimen of Olay Regenerist products
costing $57 was slightly more effective at reducing the appearance of wrinkles
than a $135 tube of StriVectin-SD or a $335 combination of two La Prairie
?I am seduced by fancy packaging as much as the next
person,? Dr. Brademas said. ?But I have a theory that all these skin-care things
come out of the same vat in New Jersey.?
John Bailey, the executive vice
president for science of the Cosmetic, Toiletry and Fragrance Association, an
industry trade group in Washington, said that skin care varies widely in price
because of amounts spent on research and development of ingredients and product
formulas, and the cost of manufacturing and packaging.
But, he said, it
is difficult to measure performance differences among
?Cosmetics don?t have the same quantitative analysis as drugs,
so you don?t have a set gauge you can use to determine perceived and actual
benefits,? said Dr. Bailey, who has a Ph.D. in chemistry. ?Ultimately, consumers
will have to try products out and find what works best for them.?
back-to-basics skin-care regimen is based on practicality rather than marketing
claims. It does not rely on exotic ingredients grown on far-flung islands
hand-picked by natives only under a full moon.
Dr. Diane C. Madfes, a
clinical instructor at Mount Sinai School of Medicine, said that basic skin care
requires washing one?s face to remove dirt, sweat and bacteria, and using
sunscreen to impede sun damage. People who worry about wrinkles, pimples, dry
spots or pores may want to add one or two treatment products, she said.
Dr. Cook-Bolden, who has been a paid consultant for several mass-market
cosmetics brands, suggested a mild liquid cleanser for the face. Instead of
using toners, which may strip skin, or gritty exfoliation beads and
microdermabrasion systems, which may irritate skin, she recommended using a
washcloth to slough off dead skin cells.
?If you have dry, sensitive
skin, you just pat the washcloth on your face gently in a circular motion,? she
said. ?If you don?t have irritated skin, you can put more speed and pressure on
Dermatologists disagree whether a moisturizer is then
needed. Dr. Brademas said it is superfluous.
?Moisturizer is optional
unless you are in the Arctic,? said Dr. Brademas, who favors Vaseline petroleum
jelly for dry hands, feet, knees and elbows. ?I?m not sure moisturizers do very
much except for creating a smooth surface so that makeup can go on without
Dr. Cook-Bolden took a more agnostic position.
?If you need
a moisturizer, moisturize,? she said. ?If you want less moisture, use a lotion.
If you want more, use a cream. And if you have acne-prone skin, use a gel or a
Although the dermatologists interviewed for this article
disagreed about moisturizer, they agreed on one point: the importance of sun
protection, including hats, avoidance of midday sun and the use of an effective
sunscreen. They recommended that consumers look for formulas that include
ingredients ? like zinc oxide, titanium dioxide or Mexoryl SX ? that impede
damage from the sun?s longer wavelength UVA rays, a protective effect that is
not indicated by a product?s SPF rating.
Beyond soap and sunscreen, Dr.
Madfes said that one or two additional products might be added to personalize a
?People who see wrinkles around their eyes are going
to reach for an eye cream,? Dr. Madfes said. ?Someone who looks in the mirror
and sees large pores may want to use a cleanser with salicylic acid, which can
reduce clogged pores.?
She is also a proponent of night creams that
combine retinol, a form of vitamin A that may help speed up the turnover of skin
cells, and antioxidants such as vitamin C, vitamin E or lycopene that may help
thwart environmental damage to the skin. People with skin conditions like severe
acne or people interested in topical anti-wrinkle drugs should consult their
doctors about prescription medications, she said.
On an expedition last
week to a CVS Pharmacy at Columbus Circle with a reporter, Dr. Madfes examined
the product labels on skin-care items from a variety of mass-market brands and
recommended a few basic products, including Cetaphil cleanser and La Roche-Posay
Anthelios SX sunscreen.
?Higher end, more expensive products may look
better in the box and feel better on your face, but they don?t necessarily work
better than less expensive products as long as you look for ingredients that are
known for efficacy,? Dr. Madfes said.
But she did see one benefit to
?The thing is, when someone buys a $200 cream, they are going
to use that cream,? Dr. Madfes said. ?So, in the end, their skin may
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