Feedback AAD 2018


Cosmetic and Cosmeceuticals

Cosmeceuticals: Naturally Absurd

Presented by: Zoe Diana Draelos, MD, FAAD
Dermatology Consulting Services, High Point, NC, USA

Micellar water has been gaining traction in the cosmeceutical market lately. It is composed of micelles, which are small beads of cleansing oil molecules suspended in soft water. The micelle has a hydrophobic center with a hydrophilic outer rim allowing the micelle to be dissolved in water. Micellar water is a surfactant that forms micelles in solution. The micelle centers allow for facial sebum to be dissolved while the outer rim allows it to be rinsed off with water. Micellar water is very useful in patients with sensitive skin including patients with eyelid dermatitis, eczema, atopic dermatitis, and mature individuals with dry skin.

Currently, peptide moisturizers are being advertised in cosmetics. They focus on three types of peptides: carrier, signal, and neurotransmitter. Carrier peptides carry an active ingredient to the skin, but are not the actual active ingredient in the moisturizer. Signal peptides provide a signal to the skin initiating a biological event to occur. Neurotransmitter peptides modulate nerve/muscle interaction as a way for moisturization.

Carrier peptides hook an active ingredient to one end of the peptide and facilitate transport to the skin. In wound healing, carrier peptides are used to deliver copper to the wound bed necessary for wound healing and collagen production. However, in a moisturizer, there is a big concern for contamination by metals, especially nickel. Contamination with metals destabilizes the formulation. Because of the presence of a stratum corneum, these formulations are often unable to break the barrier allowing for any moisturization to occur.

Signal peptides are designed to initiate a cascade of events in the skin. The most popular is the palmitoyl pentapeptide palmitoyl-lysine-threonine-threonine-lysine-serine (pal-KTTKS), a synthetic material that was designed as a topical agent to stimulate collagen production (I, III e IV) and thus provide a skin anti-wrinkle benefit. Palmitoyl breaks down the stratum corneum allowing for remaining molecules (KTTKS) to enter the skin. The level of signal peptides used in moisturizers is considerably low at 4 parts per million and resulting advertisements are false and misleading.

Neurotransmitter peptide moisturizers inhibit the release of acetylcholine at the neuromuscular junction (NMJ), which can also be achieved through toxins and modulation of synaptosomal-associated protein 25 (SNAP-25). However, for these neurotransmitter peptides to work effectively, they must reach the NMJ located in the dermis. For this to occur, the neurotransmitter peptide must:

  • Remain at the NMJ for a sufficient amount of time
  • Be replenished
  • Be present in a sufficient concentration
  • Arrive at the NMJ intact.

The combination of these is very unlikely as the body naturally breaks down proteins as a self-defense mechanism.

Over the last few years many cosmetic agencies are refocusing their marketing to advertise what is not in their cosmetics.

For example, many brands have started to manufacture and label paraben-free products, including lotions, lipsticks, shampoos, scrubs, and more. Parabens are the most commonly used preservatives in skin care products. They are termed xenoestrogens because they mimic estrogens. Parabens have since been replaced with Kathon-CG, which is a strong sensitizer and a cause of allergic contact dermatitis with a worse safety profile than parabens. Ironically, there is no evidence of paraben-induced problems and it has a safer profile than Kathon-CG.

Gluten-free is another term that is frequently used especially in the use of lipsticks. Lipsticks have never contained gluten in the past and so the marketing campaign of gluten-free lipstick is a comical claim. Gluten sources include hydrolyzed wheat protein, colloidal oatmeal, beta-glucan, starch, and wheat germ. There are instances where these may be added to moisturizers or skin cleansers as specialty ingredients.

Cruelty-free products are defined as those that do not harm animals or kill animals. However, many of the raw materials used in the development of these products are tested on animals for safety purposes. While the final product may not be tested on animals, there is a strong possibility that raw materials are tested on animals, thus falsifying the claim.

Vegan skin care products eliminate the use of animal ingredients or animal derived ingredients. There is no functional advantage in formulations using vegan products; they simply represent a different avenue.

The term “natural” has no regulatory meaning for cosmetics according to the Federal Drug Administration (FDA), but the United States Department of Agriculture (USDA) does regulate use of the term organic. Organic products are those harvested without synthetic compounds. To be included in the National Organic Program (NOP) USDA, these products must be 95% organic to bear the USDA seal.

False eyelashes and eyelash extensions have been gaining popularity. They come in a variety of shapes, sizes, and colors, and may be made of human hair, mink, or synthetic materials. Lashes are attached to an elastic band with a methacrylate-based glue, which is a strong allergen that may cause eyelid allergic contact dermatitis. Eyelash extensions are also available where individual eyelashes are applied one at a time to natural eyelashes.

There are a number of problems that may surface with the use of false eyelashes and eyelash extensions including:

  • Contact dermatitis to the glue
  • Damage to natural lashes (breakage or accidental removal)
  • Glue issues:
    • Glue eye shut
    • Glue in eye
    • Inappropriate attachment of lash.

It is important to remind patients not to sleep in false eyelashes as they can break natural eyelashes.

Key Messages

  • Micellar water is a dilute cleansing solution appropriate for the removal of cosmetics and facial cleaning in patients with sensitive skin.
  • Peptide moisturizers have difficult penetration into the skin and documentation of their duration of action is questionable.
  • Claims of “x-free” products are gaining traction in the marketplace but may be of little value in the clinical setting.
  • False eyelashes and eyelash extensions may cause adhesive allergic contact dermatitis and may damage natural eyelashes.


Present disclosure: The presenter has reported that there are no conflicts of interest for this presentation.

Written by: Debbie Anderson, PhD

Reviewed by: Victor Desmond Mandel, MD



Acne: What's New

Hillary E. Baldwin, MD, FAAD

Atopic Dermatitis

An Update on Topical Therapy for Atopic Dermatitis

Amy S. Paller, MD, FAAD

Atopic Dermatitis

A Cytokine-Driven Systemic Disease with Implications for Therapeutics

Emma Guttman, MD, PhD, FAAD

Atopic Dermatitis

Atopic Dermatitis: New Developments

Lawrence F. Eichenfield, MD, FAAD

Cosmetic and Cosmeceuticals

Cosmeceuticals: Naturally Absurd

Zoe Diana Draelos, MD, FAAD

Cosmetic and Cosmeceuticals

Hot Topics in Cosmetic Dermatology

Anthony V. Benedetto, DO, FAAD

Cutaneous Oncology, Melanoma

2018 Skin Tumors in Children

Jane M. Grant-Kels, MD, FAAD

Cutaneous Oncology, Melanoma

Melanoma Update 2018

Allan C. Halpern, MD, FAAD

Cutaneous Oncology, Melanoma

Strategies in the Current Management of Melanoma

Daniel Ethan Zelac, MD, FAAD


Hairy Matters: What’s New in Alopecia

Wilma Fowler Bergfeld, MD, FAAD

Infectious Diseases

HIV in 2018

Kieron S. Leslie, MD, MBBS, MRCP, DTM&H

Infectious Diseases

Adventures in Syphilis

Theodore Rosen, MD, FAAD


How do I Choose a Systemic Agent for Psoriasis?

Amy S. Paller, MD, FAAD


Biologics and Psoriasis: the Beat Goes On

Mark Lebwohl, MD, FAAD