The skin health and beauty pyramid concept was developed based on extensive scientific literature on ingredients, formulations, and technologies, and a robust understanding of the mechanisms of skin aging.6,7 The pyramid simplifies product recommendations into 3 categories: pyramid base for protection and repair (photoprotection, antioxidants, DNA repair enzymes) against exposome factors, eg, sun exposure, pollution, hormonal changes, lifestyle factors; pyramid middle for renewal by moisturization, exfoliation, and cell turnover (retinoids and alpha hydroxy acids [AHA]); and pyramid top for stimulation (peptides, bioidentical growth factors, stem cells, circadian rhythm modifiers).6,7 Using this tool, dermatologists can start at the initial visit by recommending essential products for protection and repair and then work up in later visits to more advanced products that may be appropriate for specific concerns.
The objective of this study was to expand the pyramid concept to provide a scientifically validated practical tool to develop a rational approach to selecting the best antiaging dermocosmetic ingredients for diverse and inclusive patient populations, covering different ages, both sexes, Fitzpatrick skin types (FST), as well as skin issues (eg, sensitivity, acne, melasma) and exposure to exposome factors.
MATERIALS AND METHODS
Expert Panel Voting
A panel of 7 international dermatologists with experience in cosmeceuticals reviewed 8 hypothetical case scenarios as representative examples of the many diverse populations seen in dermatological consultations.
Method
The RAND/UCLA appropriateness method (RAM) was initially developed so that, even when robust randomized controlled trials are lacking, physicians can make decisions by combining evidence from scientific literature and collective expert opinion on the appropriateness of performing a procedure at the level of patient-specific symptoms, medical history, and test results.8 The RAM is a modified Delphi method but differs by providing panelists the opportunity to discuss their judgments. This method was thus considered to be a good tool for reaching a consensus on the use of dermocosmetic products. The concept of appropriateness refers to the relative weight of the benefits and harms, where a dermocosmetic was considered appropriate and worth using (not considering cost) if the expected health benefit exceeded the expected negative consequences by a sufficiently wide margin.
