The Skin Health and Beauty Pyramid: A Clinically Based Guide to Selecting Topical Skincare Products

April 2014 | Volume 13 | Issue 4 | Original Article | 414 | Copyright © April 2014

Flor A. Mayoral MD,a Julie R. Kenner MD PhD,b and Zoe Diana Draelos MDc

aMayoral Dermatology, Coral Gables, FL bKailua, HI cHigh Point, NC

The use of cosmeceuticals by patients is now commonplace. Without consultation and direction from an informed clinician, marketing pressures can lead consumers to make poor product choices that can result in wasted money and unsatisfactory outcomes. Skin professionals need a scientifically based, succinct tool to guide their patients toward best topical skincare practices. The Skin Health and Beauty PyramidTM is an educational framework and product guide created from extensive scientific literature and study review on ingredients, formulations and technologies affecting skin biology. This clinical tool can simplify product choices for physicians and clinicians in the process of professionally guiding patients toward the optimal use of topical products to achieve best outcomes for skin health and beauty.

J Drugs Dermatol. 2014;13(4):414-421.


Cosmeceuticals” are topical products that provide enhanced skincare benefit which go beyond traditional cosmetics known primarily for covering, moisturizing and cleansing the skin. Cosmeceuticals do not have the same regulatory requirements as prescription skincare products and generally lack rigorous clinical trials to substantiate efficacy, potency, or consistency. Cosmeceuticals for skin rejuvenation are now the fastest growing segment of the multibillion-dollar skin care market. Increasingly, cosmeceuticals are being used in professional practices as adjuncts to in-office procedures and prescription drugs as well as stand-alone home treatments.
Patients frequently seek advice from skin care professionals. More scientific studies are being performed on nonprescription topical skincare products and this provides clinicians with more evidence by which to recommend skincare products.
The subject matter can be confusing for both the patient as well as the provider. For the patient, the market offers products that claim the same aesthetic benefits from different combinations of ingredients at discount (low) or premium (high) prices. For the provider, many have had limited formal education on the topic. Consequently, it can be difficult to sort through the large number of products available to identify those with scientific data to support their efficacy. Of practical concern, discussing and recommending topical skincare products with patients in the midst of a busy clinic can be time consuming. In addition, physicians who are not yet confident in their knowledge of skincare product alternatives may feel awkward when patients ask for recommendations. As a result, many physicians avoid actively discussing cosmeceuticals with patients. This leaves the patient without informed recommendations from their trusted clinician, and uneducated as to how skincare programs may fit into their overall skin health practices.
Skin care professionals are the trusted experts that need to guide patients toward understanding basic skin biology and choosing optimally effective skin care products based on quality clinical studies that demonstrate safety and efficacy for the desired skincare benefit.
The concept of a tool to provide basic skincare product education for patients and help busy professionals guide their patients toward choosing an effective skin care program was first developed by Kenner in 2010 as the Topical Nutritional PyramidTM.1 Over the years, this clinical tool has undergone extensive review as well as practical implementation. The Skin Health and Beauty PyramidTM was created from an extensive review by thought leaders in the field of aesthetic medicine. This tool is intended for use by the novice as well as the seasoned aesthetic provider to allow patients a fundamental understanding of the ongoing need for photo-protection, as well as the multipronged approach needed to repair cellular damage that is ongoing in a continual process.
The goals of the Skin Health and Beauty PyramidTM for the patient are:
  1. Educate on the deleterious effects of photoaging on skin health.
  2. Provide a hierarchical ordering of key cosmeceutical categories with regard to beneficial impact on the skin, so that appropriate usage choices can be made.
  3. Serve as a reference to help patients supplement or scale back on their skincare regimen as needed, without compromising essential skin care.