Jennifer Levine, MD, a New York City-based plastic surgeon, suggests skin care products to every patient she sees.

"I feel it is very important that patients have an at-home regimen to complement and improve their results," she says. "Otherwise, it's like going to the dentist and then not brushing your teeth."

The products Levine discusses often fall under the category of cosmeceuticals — products that claim to have a therapeutic effect on the skin lasting beyond its application. Levine, like other doctors who carry these products, displays the products in her office waiting room. Prices range from $30 to $295, depending on the product.

Although dermatologists and plastic surgeons are the chief specialists who have jumped on the cosmeceutical bandwagon, their popularity is spreading outside these traditional avenues. Even some primary care physicians and gynecologists now offer them to their patients, many of whom express interest about the potential solutions they can offer.

Doctors who sell cosmeceuticals can "lose money or make hundreds of thousands of dollars," depending on the size of their practice, how many patients they see, and how many people/staff in the office sell the products, says Heather D. Rogers, MD, a Seattle-based dermatologist.

"If you are pushy, patients push back or do not return as patients," she says. "The point in carrying products is to make it easy for patients to get the products that can help them."

It's important, Rogers says, for doctors to stick to those products they truly believe in. To that end, Levine often includes products in the price quote she gives patients for procedures.

"We need to educate our patients and have them participate in obtaining their best results," she says. "We often apply one or more of the products at the end of a procedure so that they can see and feel what it does."

While the 1980s term 'cosmeceuticals' is a bit dated in 2022 — it has melded more into general skin care on a wide spectrum of products — the category still exists.

In general, cosmeceuticals are accepted to provide a pharmaceutical therapeutic benefit, but not a biological therapeutic benefit. They may be sold as a cosmetic/skin care, but have performance characteristics suggesting pharmaceutical action. Sunscreen-containing products, which include many OTC face creams, fall under the official category of cosmetic, for instance. In general, cosmeceuticals serve as a subclass of drugs in the eyes of the FDA. "The term 'cosmeceutical' has no meaning under the law," says the agency's website. "The cosmetic industry uses this term to refer to cosmetic products that have medicinal or drug-like benefits."

Going forward, the market looks to remain strong for physician-prescribed cosmeceuticals, with a predicted growth rate of 8.6 % between 2020 and 2025, according to Mordor Intelligence. Much of this falls into the anti-aging product category, as the over-60 crowd explodes.

Cosmeceuticals often contain formulations of antioxidants, growth factors like (TGF)-beta and procollagen, and copper peptide to help with fine lines and wrinkles. They can be found in sunscreens, moisturizers, anti-wrinkle creams and a host of other products, both OTC and prescription. They can be divided into product lines that require a prescription and those that do not. The trouble is that consumers often cannot decipher the difference, and willingly hand over their money for expensive treatments without proven benefits.

Large companies selling these product lines include Merz Pharma, SkinCeuticals International, and Obagi Cosmeceuticals. There are also numerous smaller brands looking to get in on the growing market.

Although many sound very official and promise results beyond over-the-counter (OTC) skin care, unless sold with a prescription, they only have to go through safety testing —not efficacy testing. Their ingredients often include phytonutrients from herbs, oils, extracts, vitamins, and minerals.

"In general," says Rogers, "95% many of these products don't really help skin, and some might even do damage. But there are a small percentage that are well-formulated and do what they promise."

Without FDA regulation, cosmeceuticals tend to exist in a Wild West environment.

"This portion of the industry can make some powerful claims, some of which are true, and some of which are not," says Rogers.

Physicians, therefore, can serve as a backstop for patients desiring cosmeceuticals. They not only educate on which products are efficacious and which are not, but prescribe the more concentrated formulas. Even then, however, there's room for gray area and controversy.

"More and more doctors are getting into the beauty end of medicine," says Rogers. "There are ob/gyns offering Botox, for instance."

It all comes down to demand — patients want products that will improve their cosmetic appearance. That makes entering the market very alluring to physicians of many stripes.

The chief difference between cosmeceuticals available over the counter and those prescribed by doctors is in the concentration of the active ingredients. Back to the original cosmeceutical ingredient — tretinoin — an OTC cream will generally contain about 1%-2% of retinol. Anything below 0.25% isn't effective. In a physician's office, however, the concentration will usually sit around 10%. The same holds true for a bleaching cream, where an OTC product will generally contain about 2%, and by prescription, may contain 8%.

Levine sums it up this way: "Any medical-grade skin care available in doctor's offices falls into skin care that delivers real results," she says.

Levine says that if a doctor is selling a prescription cosmeceutical in their office, it must have some science behind it.

"The products will be based on clinical studies that research real biopsies of skin," she says. "They will look to see what happens to epidermal thickness and collagen, for instance."

Because the market can be so lucrative, there are plenty of physicians — not just dermatologists — who have launched their own cosmeceutical lines. Some are available with a prescription, but plenty are not. Some sell directly from their offices, whereas others have launched lines that go straight to the consumer via e-commerce and through social networks.

In fact, there are even companies whose purpose is to assist physicians in custom designing their own, custom-branded skin care lines — complete with marketing help. Packaged in official-looking containers, these can be an easy sell when coming from a doctor, whether efficacious or not.

Rogers says that some physicians sell their own lines — as well as other lines they carry in their offices — strictly to help patients. But some are lured by dollar signs.

"We are a capitalist society and there's a reason some physicians get into selling cosmeceuticals," she says. "I want to be a voice of reason when it comes to these products."

Often, the payoff for selling cosmeceuticals is an easy, almost passive revenue stream. Much like a retail model, doctors might purchase the products at 50% cost, and then mark them up to 100% making them an attractive addition to income.

"Doctors shouldn't make money harboring on people's fears," says Rogers. "If it's a product you really believe in, then carry it and make the money. Only recommend products that will truly help patients."

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Cite this: Docs Get Retail Savvy to Meet Patients' Desire for the Fountain of Youth - Medscape - Jun 29, 2022.

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