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 

In scenario 7, AHA should be avoided at perimenopause when the skin has become more sensitive, especially if working outside.

In scenarios 7 and 8 for perimenopausal and menopausal women, botanical extracts with antioxidant effects may be recommended, but it will depend on the properties of the specific botanical extract. Cassia extract is an appropriate ingredient to combat the effects of the increase in cortisol in the skin at perimenopause.

DISCUSSION

As may be expected for young patients, such as in case scenarios 1 and 2, the pyramid base includes broad-spectrum sunscreen, antioxidants, and DNA repair, but no topical treatment for the top of the pyramid. In older patients, a consensus was rapidly reached that multiple ingredients are appropriate for perimenopausal and menopausal women, from protection and repair of the stratum corneum to epidermal correction and dermal protection advanced skin care. However, a consensus was not reached on whether AHA should be avoided after ablative laser treatment for dark phototypes at risk of PIH.

Photoprotection is fundamental for all scenarios and is the base of the pyramid.  Broad-spectrum photoprotection with high SPF and high UVA PF are essential for all patients and should be adapted to skin phototypes and dermatoses, as previously described.9 Protection against long UVA1 wavelengths is important as they penetrate more deeply and contribute to hyperpigmentation, photoimmunosuppression, photoaging, and photocancers.10 Similarly, high-energy VL protection with tinted sunscreens containing iron oxides and/or pigmentary titanium dioxide is especially important for dark-skinned individuals as they are more sensitive to VL-induced pigmentary disorders.11-13 Sunscreen technology differs by country with fewer sunscreen options in the US.12 Generally, photoprotection is not always well adapted to darker phototypes as there is a large variation in constitutive skin tones between FST IV to VI, making it more difficult to find a good color match for tinted/iron oxide sunscreens to protect against VL. As an alternative for individuals (for example men) who find pigmented products cosmetically unacceptable, newer organic filters may offer some protection in the near visible region,14 but tinted products containing pigments are still required to provide high protection against high energy VL to prevent pigmentary disorders.13 Furthermore, although makeup has been found to offer no photoprotection,15 a broad-spectrum sunscreen camouflage foundation containing a high concentration of iron oxides may offer high-energy VL protection.16 For melasma, sunscreens should be broad-spectrum with high SPF, and provide high protection against UVA and VL. If the skin tone is not exactly matched, tinted pigmented sunscreens (containing iron oxides) in combination with camouflage foundation in a wider variety of colors can help match the skin tone of every patient while also masking pigmentary disorders and improving quality of life.17 

Natural substances have been used in skin care for centuries and antioxidant botanical extracts are increasingly becoming alternatives to conventional, synthetic dermocosmetics.18 Cassia extract is derived from a traditional medicinal plant and has antioxidant, antimicrobial, and anticancer effects.19 Cassia extract has been reported to reduce the impact of cortisol, which increases in the skin at menopause, on collagen and hyaluronic acid synthesis to stimulate extracellular matrix synthesis.19,20 C-xyloside is a cosmetic active ingredient derived from plants that has been shown to stimulate the synthesis of mucopolysaccharides in the dermis and epidermis to improve skin elasticity and tonicity.21 As dermatologists are not always widely familiar with specific lesser-known extracts, there is a need for high-quality randomized controlled trials for dermocosmetics (and the active ingredients they contain) to make evidence-based recommendations. 

Finally, a knowledge gap is the development of future recommendations on dermocosmetics as adjuncts for aesthetic procedures.

LIMITATIONS

The main limitation and bias of this study is the restricted panel size of international experts for the RAND/UCLA method. Other limitations of the method are the lack of ranking, resulting in variable scoring if a dermocosmetic was considered appropriate but not the first choice, or if appropriate but likely to be cosmetically unacceptable to the patient. Despite these limitations, the advantage of this simple approach is that it ensures only appropriate topicals are recommended for each specific patient type.

CONCLUSION

We describe a simple, practical tool for use in daily dermatology consultations that is adapted to specific patient needs, depending on age, sex, and skin phototype, and covers a diverse range of common skin issues. This work provides recommendations on anti-aging dermocosmetics with a worldwide consensus from experts to cover diverse and inclusive populations of patients, addressing all skin types and international needs. Appropriate dermocosmetics combined with complementary aesthetic procedures for each clinical scenario warrants further study to obtain optimal outcomes.

DISCLOSURES

ZD is a researcher and consultant for L'Oreal. LW, MS, BSFB, VV, MJ, and MK have received honoraria from L'Oreal. CD has no potential conflicts of interest to disclose. SLM is an employee of L'Oreal Group.

Funding: The study was funded by Vichy Laboratoires (L'Oreal).

ACKNOWLEDGMENT

The authors acknowledge the writing support of Helen Simpson, PhD, of My Word Medical Writing.

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AUTHOR CORRESPONDENCE

Zoe Diana Draelos MD zdraelos@northstate.net
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