Healthy Beauty

Cosmeceuticals claim to protect and lighten the skin, reduce wrinkling, eliminate cellulite, and even reverse the aging process; essentially, a cosmeceutical is any product that biologically alters the skin. “Ninety percent of all cosmetics sold in the world today are probably cosmeceuticals,” Kligman said in that same 2005 interview. “The terminology regarding the distinction between cosmetics and drugs is a marketing game in the U.S. If you reverse aging, you are a drug. If you smooth skin, you are a cosmetic. Categorization depends more on the language on the bottle than the product in the bottle.”

Some cosmeceuticals have also been embraced by dermatologists as treatments for diseases of the skin. The clever promotion of these products by a growing number of dermatologists, many of whom earn hefty fees consulting for cosmeceutical companies or produce and market their own products, raises disturbing questions about professional conflicts of interest which may tempt dermatologists to inflate cosmeceutical product claims.

With so many claims for the effectiveness of cosmeceuticals relying on anecdotes, these products have understandably been characterized as a “voodoo science.”^2,3 Evidence used to claim effectiveness for most of the products sold as cosmeceuticals has not been supported by rigorous clinical trials or other science-based data. Only a double-blind clinical trial^c that lasts from four to six months, the gold standard of laboratory testing, can prove the worth of these products, and few such trials have been performed.

The Mayo Clinic issued a warning in June 2007 that cosmeceutical products contain “powerful active ingredients that can affect biological processes,” and emphasized how these ingredients have not been subjected to rigorous safety testing. Anti-wrinkle creams, lotions, and related skin treatments use complex and potent chemicals with drug-like properties that stimulate skin cell production but in doing so also alter the biological processes that regulate the structure of the skin. These biological changes pose unknown and untested potential dangers to human health. In addition, the overwhelming majority of cosmeceuticals draw no distinction between the supposedly active ingredients in their products and other ingredients, further confusing consumers interested in the identity of ingredients in the products they purchase.

We are bombarded with claims for the greater effectiveness of high-priced cosmeceutical products with fancy packages and exotic-sounding ingredients. These claims, unsurprisingly, are misleading. The first loud whistle blown on this trend came in late 2006, when a Consumer Reports magazine story concluded that there is no correlation at all between the price and the effectiveness of anti-wrinkle creams. (“The best advice is prevent those wrinkles in the first place,” the magazine stated. “Stay out of the sun and don’t smoke.”¹⁸)

In a January 4, 2007, New York Times report, “The Cosmetics Restriction Diet” by Natasha Singer, highly qualified academic dermatologists were quoted making statements such as “the cheapest products work just as well as the more expensive ones,” and this one about the origins of product ingredients, which should really get your attention: “all these skin-care products come out of the same vat in New Jersey.” The article goes on to point out how moisturizers “don’t do much except for creating a smooth surface so that make-up can go on without drag.” If you want to be a smart buyer, then you should “cut down on the $100 skin care product and cut your skin care budget.” Still another expert is quoted as saying that “it is difficult to determine how well creams work, whether they cost $10, $100, or $1,000.”

Why are manufacturers so reluctant to conduct adequate safety testing on their products? As Dr. Mary P. Lupo of the Tulane University School of Medicine, in an article for a 2005 issue of Dermatologic Surgery, observed, “[M]anufacturers make a calculated decision not to make claims that will result in scrutiny by the U.S. Food and Drug Administration of the product as a drug. Clinical testing could also draw the attention of the FDA, so some manufacturers opt instead to allow the consumer arena to become the test market.”⁴

Without either manufacturers or the FDA evaluating the safety and toxicity of the ingredients in these products, consumers who buy cosmeceuticals quite literally become guinea pigs in a vast uncontrolled experiment where the only benchmark to measure safety will be how many people suffer health consequences from using the products—a standard for measuring cause and effect that is so flawed as to be useless, since cosmeceutical users simultaneously absorb chemicals from many other personal-care products and cosmetics. This means there is no definitive way to differentiate which products may be responsible for any observed health problems.

And there are likely to be health problems. What has been reliably demonstrated in tests on cosmeceutical ingredients is that many of these products contain dangerous, often undisclosed ingredients that remain hidden behind slick marketing campaigns.

In a March 2007 article in O, The Oprah Magazine, writer Jenny Bailly warned of “pain, scabs and bruises” that could result from non-surgical anti-aging procedures and cosmeceutical products, but misrepresented hydroxy acids as just “lift[ing] away dead cells on the surface of skin, revealing fresher smoother skin underneath.”⁵ It’s a common misperception. But even the industry’s Cosmetics Ingredient Review Compendium admits that AHAs are not only skin irritants, but also “can act to remove a portion of the skin surface” known as the stratum corneum, which absorbs long-wave ultraviolet radiation from sunlight and tanning beds.⁶ The Compendium also admits that a statistically significant increase in the number of sunburn cells was seen in guinea pig skin treated with AHAs, and that “pre-treatment with AHAs could increase skin damage produced by ultraviolet radiation.” Apart from increasing the risk of sunburn, products containing AHAs are thus likely to increase the risk of skin cancer, particularly malignant melanoma.

Despite these concerns, the Compendium claims that AHA ingredients can be safely used at concentrations up to 10 percent in personal-care products and at concentrations as high as 30 percent in salon products. One problem that complicates this advice is that the industry still fails to disclose the concentration of these ingredients in most products. Worse still, AHAs are used in an estimated 5 percent of all products without appearing on the label at all.

The FDA issued a consumer warning in 1992 that the use of “skin peel” products like those containing hydroxy acids, advertised to remove wrinkles, blemishes, blotches, and acne scars, “could destroy the upper layer of the skin, causing severe burns, swelling and pain”⁷—an unprecedented action by the FDA. But in spite of these warnings, or more likely because these warnings have been poorly publicized, the public’s use of these products has increased dramatically, thanks to reckless but seductive industry claims about how they supposedly enhance the youthful appearance of skin.

Products containing hydroxy acids should never be used, regardless of those products’ claims. But there is one category of product in which the use of hydroxy acids is downright ludicrous: sunscreens. Following over a decade’s review of AHAs, studies sponsored by the FDA finally warned that AHA ingredients in sunscreens increase susceptibility of the skin to damage following exposure to sunlight—the very thing sunscreens are supposed to protect against—and thus increase the risk of skin cancer.⁸ These studies also identified a doubling of UV skin damage among people using products containing AHAs. While typically failing to take any regulatory action, in this case the FDA proposed the following contradictory recommendation: that sunscreen users should be warned to “limit sun exposure while using these products and for a week afterward.”⁹

The other eleven:

1. Retinoids. Vitamin A or carotenoids, and their synthetic retinoid derivatives (including retinol and tretinoin), are the most common cosmeceuticals on the market. As antioxidants, they protect cells from free radical damage. Local application of the synthetic tretinoin (vitamin A acid) is used to bleach pigmented spots and smooth wrinkling caused by excessive or prolonged sunlight exposure. Despite their popularity, retinoids have shown only limited effectiveness. They are not, however, dangerous.

2. Antioxidants. Antioxidants are natural substances that protect our bodies against damage from free radicals. Skin is continually exposed to damage not only within, from free radicals, but without, from heat, cold, air pollutants, and, most importantly, UVA long-wave radiation. Antioxidant cosmeceuticals claim to reduce or reverse this damage. Antioxidant cosmeceutical ingredients include vitamins such as B-5 (and its synthetic derivative panthenol), C, E, and nicotinamide; lycopene; polyphenols such as coffeeberry in coffee plant fruit and resveratrol in grapes; genistein, the isoflavone in soy milk and fermented soy; EGCG (epigallocatechin-3-gallate); pycnogenol, an extract of French marine pine bark; grape seed extract; and DMAE, found in coldwater fish, particularly salmon. While they may be useful, there has been no clinical evidence as to their effectiveness in cosmeceuticals. There are no dangers associated with their use.

3. Botanicals. Botanicals are extracts taken from natural plants. Well over sixty natural botanicals are currently marketed in chemically pure or concentrated forms, in an increasingly wide range of products. They include grape seed, horse chestnut, German chamomile, curcumin, comfrey, allantoin, aloe vera, and virgin olive oil. They also include green and black tea, soy, pomegranate, and date, some of which have been found to be effective in clinical trials.² As with antioxidants, there has been no clinical evidence as to their effectiveness in cosmeceuticals. Also as with antioxidants, there are no dangers associated with their use.

4. Mica. Mica is the name for a group of fine crystallized minerals that create a light glow in facial cosmetics by increasing the reflection of light. They can be colored or colorless. Mica is harmless, except when inhaled as a fine dust, when it can cause acute or chronic lung irritation.

5. Tyrosinase Inhibitors. Tyrosinase inhibitors are a diverse group of natural whitening agents that inactivate tyrosinase, the enzyme responsible for skin darkening due to its role in the formation of the natural pigment melanin.¹⁰^,¹¹ They include vitamin C, kojic acid, arbutin, azaleic acid, licorice, mulberry, and burner root extract. The most recent of these is melanostat, a patented synthetic peptide. (See also number 8 below, for other uses of peptides in cosmeceuticals.) There is no scientific evidence that these are effective. While they may or may not be useful, their use at least appears to pose no serious health threat.

6. Anti-Cellulite Creams. Anti-cellulite creams supposedly treat cellulite, the normal skin puckering or dimpling adult women develop, to varying degrees, as part of the normal hormonal process of aging. However, there is no evidence whatsoever that any creams can reduce or have any beneficial effect on cellulite—though they do at least appear to have no negative effect.¹² Advertisements claiming these effects, such as Unilever’s New Dove Firming Lotion, or Esteé Lauder’s much more expensive Body Performance Anti-Cellulite Visible Contouring Serum, are problematic at best.¹³

7. Bisabolol. Bisabolol, like hydroxy acids (though less commonly used), is a dangerous skin peeler and penetration enhancer that facilitates the absorption of other ingredients into the skin.

8. Peptides. Peptides are chains of amino acids often used in anti-wrinkle products. Peptides cannot penetrate the skin barrier alone; they are often paired with a penetration enhancer to drive the peptide deep into the skin. The evidence for their effectiveness is very limited, and due to their pairing with penetration enhancers, their presence can pose a serious threat.

One expensive anti-wrinkle cosmeceutical, StriVectin-SD, aggressively marketed as an “Anti-Aging Breakthrough” and “Better than Botox,” is based on a chain of amino acids known as Pal-KTTKS (sold under the trade name Matrixyl). In the product, Pal-KTTKS is chemically linked to the penetration enhancer palmitic acid. StriVectin-SD is claimed to increase skin’s strength by stimulating enzymes to produce more collagen, thus reducing wrinkling. However, the effectiveness of the product is based on short-term clinical trials with a relatively small number of women,¹⁰ without any subsequent follow-up. More seriously, StriVectin contains toxic ingredients, particularly five hormone-disruptive parabens, and also PEG, which is usually contaminated by potent carcinogens.

Argireline, or acetyl hexapeptide, is a cheaper anti-aging cosmeceutical marketed by the New Jersey-based Janson Beckett company.¹⁴ This product is a peptide chemically

Nanoparticles Creep Into Cosmeceuticals as Penetration Enhancers

Many cosmeceuticals work—or are claimed to work—because they also include nanoparticles that let their ingredients penetrate into the skin.

Take the Men’s Skin Care line developed by dermatologist Dr. Nicholas Perricone, who is perhaps best known as the author of three New York Times bestselling books, including The Perricone Prescription. Here is how Perricone’s Web site describes his products: “Dr. Perricone has developed a patented technology exclusive to this line, called Fullerene. Fullerenes are highly stable, microscopic hollow spheres that carry the active ingredients into the skin. They bring the intriguing and trans-formative world of nanotechnology to the fine art and science of high performance skin care.” Fullerenes, with an average size of 1/10,000 of a millimeter, have been introduced into a growing number of anti-aging products, particularly skin creams touted as reducing wrinkles and firming up the skin surface.

An equally alarming and similarly unproven yet overhyped anti-aging trend is the use of nanoparticles ingredients in foods that, when eaten, allegedly prevent wrinkles by promoting skin cell regrowth.

As with sunscreens and sunblocks, the addition of these ultraminute nanoparticles to anti-aging skin products—and foods!—races ahead of safety concerns to create a potential public health hazard.

linked to a different penetration enhancer, acetic acid residue, and is claimed to fight signs of aging in skin by reducing muscle movements that cause wrinkling.

9. Restylane. Restylane, or Perlane, is an anti-wrinkling agent manufactured by Q-Med, a Swedish biotechnology company. ¹⁵ It is based on the natural biodegradable ingredient hyaluronic acid, the effectiveness of which is well documented. ¹⁶ In fact, restylane has been shown to be more effective than collagen in double-blind clinical trials six months after injection by dermatologists in the naso-labial folds, wrinkles that run from the bridge of the nose to the corners of the mouth. It’s also cheaper than collagen. Injections that combined restylane and the prescription drug Botox (botulinum toxin) were also reported to be more effective than injections of either product alone.

10. Mexoryl SX. Mexoryl SX, which we discussed last chapter as a highly effective new sunscreen and sunblock, is also claimed to have “proven anti-aging benefits.” But this claim is based on a clinical test of only “32 women ... in just two weeks.” Mexoryl SX is a proprietary ingredient in L’Oreal’s Revitalift UV cream (a product that, notably, also contains hormone-disruptive parabens and the dangerous sunscreen ingredient avobenzone).

11. Pro-Xylane. A more recent L’Oreal product, Skin Genesis, containing the innovative natural ingredient Pro-Xylane, has been claimed to be an effective long-term anti-aging product.¹⁷ However, there is no available scientific evidence on either its effectiveness or its safety.

Numerous clinical studies have demonstrated the multiple therapeutic benefits of natural green tea due to its anti-carcinogenic, antioxidant, and anti-inflammatory properties. In a 2005 trial of green tea extracts published in the journal Dermatologic Surgery, it was revealed that topical and oral formulations of green tea polyphenols can prevent or modify skin damage caused by UV radiation exposure. Forty women with moderate photoaging of the skin were randomly assigned to either a placebo group, where they drank a harmless but inactive potion, or a group that followed a regimen of 10 percent green tea cream and 300 mg twice-daily green tea oral supplements. The clinical trial lasted for eight weeks.

“Participants in this trial confirmed the well-established ability of green tea derivatives to prevent skin damage following UV radiation exposure.”¹⁹

In an unrelated clinical trial done in 2002, study participants topically applied date palm oil to their eyelids twice daily for five weeks. Researchers found that “a statistically significant reduction in wrinkle surface (27.6%) and wrinkle depth was achieved.”²⁰

A physician associated with Oregon Health Sciences University surveyed the medical literature in 2005 for the safe and active use of botanicals in cosmeceuticals and came to this conclusion: “The most significant human cosmeceutical data have been generated with formulations containing green and black tea, soy, pomegranate, date, and a grape seed-based mixture.”²

One of the Estée Lauder companies, Origins, launched a new line of anti-aging cosmetics products in late 2006 that it called “a totally integrative approach to skin care ... to help your skin be as healthy as possible, [and] optimize its defenses against age accelerators.”³ The line of products is marketed under the brand name of Dr. Andrew Weil for Origins, and the use of that name alone seemed designed to emphasize the naturalness of these products; Dr. Weil is a bestselling author who extols the virtues of natural health and healing. Origins further bills itself as using “natural resources from many different cultures and alternative healing traditions,” in product formulations that “ensure our products are authentic and as natural as can be.”

What I found among the ingredients when I studied the product labels surprised and disturbed me. These products being touted as “natural” contained a long list of toxic synthetic ingredients. For instance, Origins’ Plantidote Mega-Mushroom line, which consisted of a face serum and face cream, included the harmful ingredients limonene, parabens, butylene glycol, and bisabolol.

Here is a listing of the most harmful ingredients (and why they’re harmful) from a survey I did of the complete Origins product line:

• Limonene, a skin irritant also rated as a carcinogen in 1990 by the National Toxicology Program.

• Ethoxylated detergents, which unless purified (and labeled to that effect) are contaminated with high concentrations of the potent carcinogens ethylene oxide and dioxane.

• Parabens, which even at very low concentrations can produce toxic hormonal effects, particularly in male embryos and infants.

• Butylene glycol, a skin irritant related to the antifreeze ethylene glycol.

• Bisabolol, a penetration enhancer that drives other harmful chemicals deeper into the skin.

Not only are the claimed anti-aging effects of these Origins products not based on any clinical trials, but when I communicated the list of dangerous ingredients to the CEO of Origins, she responded that she was uninformed about the “scientific technicalities” of what the company’s products contained. A senior scientist for Estée Lauder even attempted to challenge evidence on the carcinogenicity of limonene on the irrelevant grounds that a European Council Directive relating to limonene’s allergenic effects had made no reference to its carcinogenicity.

The company maintained that its ingredients “are all acceptable in cosmetic formulations throughout the industry”—which is, of course, part of the problem!

Much as with any other muscles in the body, our facial muscles need to be exercised in order to stay toned. Facial yoga has been heralded as a face-muscle training technique that can provide people with a natural facelift, one without the side effects and hazards of chemicals and surgery.

New York yoga teacher Annelise Hagen’s book, The Yoga Face: Eliminate Wrinkles with the Ultimate Natural Facelift, utilized these facial exercises, which include smiling slightly while pursing your lips (the Smiling Fish), transferring air from cheek to cheek while puffing out your face (the Satchmo), and blowing kisses while trying to keep your forehead smooth (the Marilyn).

A Time magazine article in late 2007 brought the techniques to a national audience and quoted practitioners as claiming that it had taken years off their faces. They said the most obvious differences after a month of doing the exercises could be seen around the eyes and on the forehead. “It’s like natural Botox,” declared Leta Koontz, who holds Fresh Face Yoga workshops at a studio in Pittsburgh, Pennsylvania.²¹

While no clinical studies have been done to support facial yoga’s effectiveness, at least you know there’s no danger from toxic or unknown ingredients!

Table 13: Toxic Ingredients in Products for Youth Seekers

INGREDIENT	TOXIC EFFECT(S)
Bisabolol	Penetration enhancer
Hydroxy Acids	Penetration enhancers and skin irritants
Limonene	Carcinogen
Nanoparticles (“micro-fine,” “ultra fine”)	Penetration enhancers
Parabens	Hormone disrupters

Safe Products and Ingredients For Youth Seekers

ANTI-WRINKLE PRODUCTS

Numerous medical studies have found several natural botanicals to be safe and effective, particularly date palm oil for eyelid wrinkles and topical green tea cream for sun damage to skin.

The anti-wrinkling agent restylane, or Perlane, used in products made by Sweden’s Q-Med, incorporates a natural biodegradable ingredient called hyaluronic acid that has been shown to be both safe and effective.

Botox injections have been in use long enough to be considered relatively safe, but must be injected by a qualified dermatologist.

Skin Peelers

Twelve Categories of Cosmeceutical Ingredients