Evidence-based routines and pharmaceuticals dominate in medicine. This means that reliable scientific studies are available. In addition, there are recommendations that result from many years of practical experience by experts, but which are not covered by studies. A similar situation can be found in sustainable skin care.
Evidence refers to proven facts that are clear according to the state of the art. In the natural sciences, evidence and studies that meet high quality standards are used for this purpose. The latter is not a given; many studies are flawed – one reason, incidentally, why Nobel Prizes are awarded very late.
However, there are also niches in medicine that lack scientific evidence. Prominent examples are homeopathic preparations. However, this does not necessarily mean that they do not work or only work as placebos.
Guidelines
In medicine, verified studies are recorded in guidelines for the treatment of diseases and medical care. They are published by the Association of Scientific Medical Societies (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V., AWMF).1 A parallel, more modest pharmacy-oriented collection for dermatology and skin care is published, for example, by the Society for Dermopharmacy (Gesellschaft für Dermopharmazie e. V.).2
Independently of this, studies on cosmetic ingredients and treatments are circulated, initiated by universities and manufacturers and published in relevant journals. The most common of these are so-called cosmeceuticals, which straddle the boundary between dermatology and cosmetics.
Experience & study
Application observations are often the reason for conducting scientific studies and verifying findings. In many cases, however, practical experience – or acquired expertise, as it were – is all that is used because it seems self-evident, there is no interest on the part of the scientific community, or the costs of a study are too high.
The use of practical experience can be just as valuable as basing practical work on a study or guideline. This increases effectiveness and customer benefit in cosmetic practice and pays off in terms of customer loyalty and word-of-mouth advertising.
Practical example
The effect of vitamin C and other antioxidants on free radicals is proven (evident). However, in practice it does not always make sense to destroy radicals, e.g. during healing IR radiation or after sunburn, because in these cases radicals are produced endogenously and serve physical regeneration. This means not just making black-and-white decisions, but looking at the situation in a differentiated way.
The situation is similar with chemotherapy. The formation of radicals is deliberately induced by a drug in order to attack the cancer cells. High doses of antioxidants in the form of dietary supplements, which are also sold by institutes, among others, are then counterproductive.
Treatment without side effects
Radicals are also involved in the formation of melanin in the skin. Topically applied antioxidants can therefore suppress pigment formation. However, free ascorbic acid, to stick with the example of vitamin C, is not very suitable for this purpose due to its instability when exposed to atmospheric oxygen. This also applies to pre- and post-treatment in the course of laser applications, where pigmentation can occur as an undesirable side effect. On the contrary, ascorbic acid causes brown discolouration due to its decomposition.
Here, too, practical experience has shown that using liposomally encapsulated ascorbic acid phosphate ester (INCI: Ascorbyl Phosphate) before and after treatment completely prevents pigmentation of the treated skin areas.
Practical observation
Training seminars not only serve to impart new knowledge from the speakers, but also to exchange experiences among participants. Around twenty years ago, seminar participants reported on the successful use of an echinacea extract in combination with a lamellar barrier cream for customers with couperose – an observation that was later confirmed by other institutes.
Practical experience initiates product optimisation and sustainable treatments. In this case, it led to further research into rosacea beyond couperose.
Unexpected side effects
An interesting aspect of lamellar skincare products, which have a similar physical and largely chemical structure to the lipid double layers of the skin, is their depot properties. Practical experience has shown that prolonged use can result in dose reductions, e.g. when using the temporary wrinkle-reducing agent spilanthol. Pharmaceutical formulations containing hormones exhibit similar behaviour.
On the other hand, repeated use and intensive messaging can reduce or completely eliminate skin conditions such as soft and rough fibromas and seborrhoeic keratoses – a finding that was previously unknown.
Placebo effects
A fundamental difficulty in validating and sharing practical experience is the personal influence that arises when the person making a recommendation is particularly convincing. This has a positive influence on the attitude of the recipient.
This effect is also observed in studies that are not conducted correctly in this regard and is referred to as bias. In other words, a proportional placebo effect is produced.
However, what is unacceptable in a study can be a desirable effect in the salon. This can be particularly helpful in problematic cases where the patient's mental state plays a role, such as stress-related skin rashes. This effect is also of great importance in practical medicine, but is increasingly taking a back seat due to the short time available during consultations. In this respect, beauticians are in a better position than doctors, as they do not have to use difficult medical terminology and have time for conversation during the treatment.
Nocebo effects
Of course, in addition to placebo effects, nocebo effects also occur when a substance is judged negatively from a subjective point of view. A typical case is alcohol in the INCI – even if it evaporates in low concentrations as soon as it is applied. In such cases, some of the salon's customers may not accept a product. The same applies if day creams with sun protection filters are presented as the ultimate solution and everything else as inadequate.
Incidentally, in the pharmaceutical sector, relevant information is often disseminated when it comes to seeding trials, i.e. observational studies including surveys that serve marketing purposes. These naturally influence the results, especially when comparing drugs with each other.
Exchange of experience
From a manufacturer's point of view, practical experience in cosmetics is a valuable basis for driving forward the optimisation of products and sustainable treatments. Conversely, it is just as important to distribute almost finished developments to institutes for practical experience prior to market launch in order to identify any unknown properties of preparations. This can be accompanied by a comprehensive professional exchange that benefits the institutes' know-how.
Links
1) https://www.awmf.org/leitlinien
2) https://www.gd-online.de/german/persoenlich/leitvorstand.htm
Dr Hans Lautenschläger |
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