International Consensus on Anti-Aging Dermocosmetics and Skin Care for Clinical Practice Using the RAND/UCLA Appropriateness Method
January 2024 | Volume 23 | Issue 1 | 1337 | Copyright © January 2024
Published online December 16, 2023
Zoe D. Draelos MDa, Liu Wei MDb, Mukta Sachdev MDc, Bruna S. F. Bravo MDd, Vasanop Vachiramon MDe, Marie Jourdan MDf, Martina Kerscher MD PhDg, Catherine Delva h, Stephanie Leclerc-Mercier MDi
aDermatology Consulting Services, PLLC, High Point, NC
bDepartment of Dermatology, Air Force General Hospital, Beijing, China
cDepartment of Dermatology, Manipal Hospital, Bangalore, India; MS Clinical Research Pvt Ltd, Bangalore, India
dClinica Bravo and Bravo Research Center, Rio de Janeiro, Brazil
eDivision of Dermatology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
fCentre Laser International de la Peau-Paris (CLIPP), Paris, France
gDivison of Cosmetic Sciences, University of Hamburg, Germany
hInferential, Paris, France
iLaboratoires Vichy International, Levallois-Perret, France
Abstract
Background: The objective was to provide international recommendations on anti-aging dermocosmetics for clinical practice starting with essential ingredients for protection and repair before working up to advanced products for specific concerns.
Methods: Seven international experts reviewed 8 hypothetical case scenarios covering different ages, skin issues (eg, sensitivity, acne, melasma), and exposure to exposome factors for both sexes and all Fitzpatrick skin types (FST). The RAND/UCLA appropriateness method was used to obtain consensus. Seventeen key ingredients were rated on a scale from 1 (totally inappropriate) to 9 (totally appropriate). Statistical analysis, 2 meetings, and email discussions refined the recommendations.
Results: High-factor broad-spectrum sunscreen (ie, protects against ultraviolet [UV] A and B rays), niacinamide, and other topical antioxidants were recommended for all scenarios. Further discussions were required for other ingredients. Tinted sunscreen/iron oxide were recommended for all FST, although compliance may be sub-optimal for darker skin phototypes (IV-VI), if not cosmetically acceptable. Combining a facial foundation with broad-spectrum sunscreen was recommended for darker phototypes to obtain visible light protection closely matching diverse color tones. Retinols were not recommended as a first-line treatment for sensitive skin, especially FST V and VI, due to the risk of irritation. After ablative laser treatment, alpha hydroxy acids should be avoided or used with caution in FST IV to VI due to the risk of post-inflammatory hyperpigmentation.
Conclusion: We describe a simple, practical tool for use in daily dermatology consultations for providing recommendations on anti-aging dermocosmetics to cover diverse and inclusive populations of patients, addressing all skin types and international needs.
J Drugs Dermatol. 2024;23(1):1337-1343. doi:10.36849/JDD.7798
INTRODUCTION
Dermocosmetics are topical cosmetic products that penetrate the stratum corneum to provide medicinal or drug-like benefits.1 Among the multitude of dermocosmetics available, consumers often seek professional guidance during dermatology visits for recommendations on the best options for their specific skin aging concerns, and it can be challenging for dermatologists to recommend the best products taking into account every patient's specificities.2 Furthermore, there may be little scientific evidence on the effectiveness of some dermocosmetics (and the active ingredients) to guide the selection of products.3
The use of appropriate dermocosmetics to decrease visible signs of skin aging should be started early from around 20 years onwards. Multiple active ingredients may be required depending on the patient's specific concerns. The optimal skincare regimen for a given patient will depend on their age, gender, skin type, and skin conditions, as well as their exposure to exposome factors that influence skin aging: encompassing external environmental factors (sun exposure, pollution, temperature, microbiome alterations); lifestyle factors (lack of sleep, stress, poor nutrition, smoking); and internal factors (hormonal variations).4,5
