ORLANDO – The increasingly popular role of cosmeceuticals in treating acne has created some confusion among both dermatologists and their patients as to what’s really effective and worth recommending.
This was the focus of a presentation at the Orlando Dermatology Aesthetic and Clinical Conference by Dr. Hilary E. Baldwin, who reviewed the cosmeceuticals most likely to make a clinical impact on patients with acne.
Dr. Hilary E. Baldwin
While there are no definitive data that prove that cosmeceuticals are the most effective means of managing acne, “sometimes cosmeceuticals may actually be helpful as adjunctive therapy,” said Dr. Baldwin, vice chair of dermatology at the State University of New York at Brooklyn. “Compared to prescription medications, I think these are just a drop in the bucket, but they’re a drop in the right direction.”
The main benefit of using cosmeceuticals for acne is to improve the barrier function of the skin. With increasing evidence that acne either causes or is caused by barrier defects, cosmeceuticals can be used, at the very least, as “extraordinarily well-made moisturizers,” according to Dr. Baldwin. In addition, because moisturizers are anti-inflammatory, they can improve the tolerability of other topical treatments dermatologists recommend to their patients, both prescription and over-the-counter.
For reducing Propionibacterium acnes, consider tea tree oil and lily leaf oil, both of which have a small but promising amount of clinical data behind them. For tea tree oil, Dr. Baldwin referred to a randomized study of 124 patients, which compared 5% tea tree oil gel with 5% benzoyl peroxide for treatment of mild to moderate acne (Med J Aust. 1990 Oct 15;153[8]:455-8). The study found that although the onset of action was slower for tea tree oil, overall it had a significant effect in improving acne in the patients, by reducing the number of inflamed and non-inflamed lesions.
“Both of them worked, but benzoyl peroxide was statistically better,” Dr. Baldwin said. “There were fewer side effects in the tea tree oil group, with less people complaining about skin discomfort.”
There are less data regarding lily leaf extract, however, with only one study she said was worth mentioning: a 4-week trial comparing lily leaf extract and 5% benzoyl peroxide that was “so complicated, and had so many arms, that they ended up having only 4-5 patients in each arm, so I don’t think they can conclude anything,” she remarked.
For management of acne-related inflammation, there is good evidence to suggest botanicals are an effective treatment. A double-blind, randomized, 12-week study coauthored by Dr. Baldwin found that in a cohort of 80 patients, benzoyl peroxide and salicylic acid were more effective when combined with botanical extracts than when used on their own (Semin Cutan Med Surg. 2015 Sep;34[5S]:S82-S85).
Furthermore, explained Dr. Baldwin, “evidence suggests that patients were also using [the botanical extract treatment] more because there was a preference for that,” indicating the increasing desire for more natural, cosmeceutical approaches to treating skin ailments by the general public.
“[Cosmeceuticals] appeal to this increasingly mature and demanding acne patient population,” she said. “[Patients] have a preference for a natural approach to skin disease, they believe that strengthening the host is more important than killing a pathogen, they think [cosmeceuticals] have less of a potential for side effects, and it also gives [patients] a sense of control, which attenuates some of the psychological sequelae of acne.
Dr. Baldwin also recommended oatmeal-based cosmeceuticals for their potential benefit in barrier repair, licorice-based cosmeceuticals for their ability to reduce both postinflammatory hyperpigmentation and post inflammatory erythema, and niacinamide. Niacinamide has been shown to reduce postinflammatory hyperpigmentation when used with other treatment options.
Dr. Baldwin emphasized, however, that cosmeceuticals should always be considered as a supplement to other, ongoing treatments, not the main treatment for acne.
She did not report any relevant financial disclosures.