Summary
As well as for topically used dermatological agents, studies performed according to the rules of evidence-based medicine (EBM) are also needed for cosmetics. Although the concept of evidence-based cosmetics has been only partly developed so far, there are some agents and preparations available that can be considered as evidence-based. In this paper we present data from several studies that claim to have examined and demonstrated the efficacy of cosmetic preparations for the management of solar damage and aging skin as well as lentigo and melanosis according to EBM criteria. Certainly, further controlled studies are needed to cover the main application areas of dermocosmetics. Retinol and antioxidant agents such as vitamin C and coenzymes that positively act via several mechanisms on collagen biosynthesis can be considered evidence-based substances for the management of aging skin. According to the same criteria, the preventive effect of regularly applied dermocosmetic sun screens on the development of actinic keratosis could also be shown. Dermocosmetic sun screens should offer adequate protection against UV-B and UV-A light by combining compatible organic and/or non-organic UV-filters and at the same time be well tolerated. Furthermore, they may contain some additional agents such as antioxidants, DNA repair enzymes, dexpanthenol, glycerin or hamamelis distillate. In the treatment of melanosis, a substantial bleaching effect corresponding to that of 0.1% topical tretinoin can be achieved with 10% all-trans-retinol gel. Preparations containing urea, ammonium lactate or glycerol in different concentrations are considered the best characterized and most effective substances for the care of dry skin. However, the lack of controlled studies confirming the efficacy of dermocosmetic products as well as the superiority of the preparation incorporating the active agent over the corresponding base is a problem yet to be solved. Undoubtedly, the efficacy and the sustainability of the achieved effects have to be examined and proven accordingly to EBM criteria in further active cosmetic agents. Moreover, generally accepted guidelines for the examination of efficacy and tolerability of dermocosmetics have to be developed.
Zusammenfassung
Wie bei Dermatika erscheinen auch bei Kosmetika Studien zur Überprüfung der Wirksamkeit erforderlich, die den Ansprüchen der Evidenz-basierten Medizin (EBM) genügen. Obwohl das Konzept einer Evidenz-basierten Kosmetik bislang nur in Ansätzen entfaltet worden ist, gibt es doch bereits Präparate, die als Evidenz-basiert gelten können. Daten aus verschiedenen Studien werden dargestellt, welche den Anspruch erheben, die Wirksamkeit kosmetischer Zubereitungen zur Behandlung einiger ausgewählter Hautprobleme wie Lichtschädigung und Altershaut sowie solare Lentigo und Melasma nach EBM-Kriterien zu dokumentieren. Weitere wissenschaftlich fundierte Studien sind notwendig, um alle wichtigen Einsatzgebiete von Wirkkosmetika abzudecken. Als Evidenz-basierte Substanzen zur Minderung der Hautalterungszeichen können Retinol und Antioxidantien wie Vitamine oder Coenzyme, die über verschiedene Mechanismen einen positiven Effekt auf den Kollagenstoffwechsel ausüben, bezeichnet werden. Entsprechend den gleichen Kriterien wurde auch die präventive Wirkung eines regelmäßigen Gebrauchs von dermokosmetischen Sonnenschutzmitteln auf die Entwicklung aktinischer Keratosen gezeigt. Ein beträchtlicher Bleich-Effekt, größenordnungsmäßig 0,1%igem Tretinoin entsprechend, kann mit einem 10%igen All-trans-Retinol-Gel erzielt werden. Dermokosmetische Sonnenschutzmittel sollen durch eine geeignete Kombination von organischen und/oder mineralischen Filtern eine ausreichende Schutzwirkung im UV-B- und im UV-A-Bereich und eine gute Hautverträglichkeit aufweisen. Außerdem können sie ergänzende Wirkstoffe wie Antioxidantien, DNA-Reparaturenzyme oder hautberuhigende Substanzen wie Dexpanthenol, Glycerin oder Hamamelis-Destilat enthalten. Als besonders gut charakterisierte und als wirksam belegte Substanzen zur Behandlung der trockenen Haut gelten entsprechend dem gewünschten Effekt unterschiedlich hoch konzen trierter Harnstoff, Ammoniumlaktat sowie Glycerin. Nach wie vor stellt der Wirksamkeitsnachweis eines dermokosmetischen Produkts auf Grund von Mangel an kontrollierten Studien, die die Überlegenheit der Applikation eines Wirkstoff-haltigen Mittels gegenüber der einer korrespondierenden Grundlage ein Problem dar. Umso mehr gilt es in der Zukunft, die Wirksamkeit weiterer Wirkstoffe nach EBM-Prinzipien zu erfassen und weitergehende Fragen zu beantworten wie die nach der Nachhaltigkeit erzielter Wirkungen sowie anerkannte Richtlinien zur Wirksamkeits- und Sicherheitsprüfung von Dermatokosmetika zu etablieren.
Similar content being viewed by others
Literatur
Sackett DL, Rosenberg WMC, Gray JAM, Haynes RB, Richardson WS (1996) Evidence based medicine: what it is and what it isn't. Br Med J 312: 71–72
Eccles M, Freemantle N, Mason J (1998) North of England evidence based guidelines development project: methods of developing guidelines for efficient drug use in primary care. Br Med J 316: 1232–1235
Serup J (2001) Efficacy testing of cosmetic products. A proposal to the European Community by the Danish Environmental Protection Agency, Ministry of Environment and Energy. Skin Res Technol 7: 141–151
Korting HC (2004) Evidenzbasierte Dermatika und Kosmetika. In: Plewig G, Kaudewitz P, Sander CA (Hrsg) Fortschritte der praktischen Dermatologie und Venerologie. Band 19. Springer, Berlin, S 548–554
Krutmann J, Diepgen T (2003) Hautalterung. Springer, Berlin, Heidelberg, S 46–59
Kligman AM, Grove GL, Hirose R, Leyden JJ (1986) Topical tretinoin for photaged skin. J Am Acad Dermatol 15: 836–859
Olsen EA, Katz HI, Levine N, Nigra P, Pochi PE, Savin RC, Shupack J, Weinstein GD, Lufrano I, Perry BH (1997) Tretinoin emollient cream for photodamaged skin: results of 48-week, multicenter, double-blind studies. Am Acad Dermatol 2: 218–230
Varani J, Werner RL, Gharaee-Kermani M, Phan SH, Kang S, Chung JH, Wang ZQ, Fisher GJ, Vorhees JJ (2000) Vitamin A antagonizes decreased cell growth and elevated collagen-degrading matrix metalloproteinases and stimulates collagen accumulation in naturally aged human skin. J Invest Dermatol 114: 480–486
Kafi R, Kwak HS, Schumacher WE, Cho S, Hanft VN, Hamilton TA, King AL, Neal JD, Varani J, Fisher GJ, Voorhees JJ, Kang S (2007) Improvement of naturally aged skin with vitamin A (retinol). Arch Dermatol 143: 606–612
Fisher GJ, Wang TQ, Datta SC, Varani J, Kang S, Voorhees JJ (1997) Pathophysiology of premature skin aging induced by ultraviolet light. N Engl J Med 337: 1419–1428
Humbert PG, Haftek M, Creidi P, Lapière C, Nusgens B, Richard A, Schmitt D, Rougier A, Zahouani H (2003) Topical ascorbic acid on photoaged skin. Clinical, topographical and ultrastructural evaluation: double-blind study vs. placebo. Exp Dermatol 12: 237–244
Cloven RM, Pinnell SR (1996) Topical vitamin C in aging. Clin Dermatol 14: 227–234
Darr D, Dunston S, Faust H, Pinnell S (1996) Effectiveness of antioxidants (vitamin C and E) with and without sunscreens as topical photoprotectants. Acta Derm Venereol (Stockh) 76: 264–268
Murray J, Darr D, Reich J, Pinnell S (1991) Topical vitamin C treatment reduces ultraviolet B radiation-induced erythema in human skin. J Invest Dermatol 96: 587
Bisset DL, Chatterjee R, Hannon DP (1991) Photoprotective effect of ultra violet radiation-induced chronic skin damage in the hairless mouse. Photodermatol Photoimmunol Photomed 7: 56–62
Mays PK, Mc Anulty RJ, Campa JS, Laurent GJ (1991) Age-related changes in collagen synthesis and degradation in rat tissues. Biochem J 276: 307–313
Phillips CL, Combs SB, Pinnell SR (1994) Effects of ascorbic acid on proliferation and collagen synthesis in relation to the donor age of human dermal fibroblasts. J Invest Dermatol 103: 228–232
Fitzpatrick RE, Rostan EF (2002) Double-blind, half-face study comparing topical vitamin C and vehicle for rejuvenation of photodamage. Dermatol Surg 28: 231–236
Haftek M, Creidi P, Richard A, Humbert P, Schmitt D, Rougier A (2002) Topically applied ascorbic acid helps to restructure chronically photodamaged human skin: Cosmetics as adjunctive therapy in dermatology: some applications. Eur J Dermatol 12: 27–29
Nusgens B, Humbert P, Rougier A (2001) Topically applied vitamin C enhances the mRNA level of collagen I and III, their processing enzymes and Timps in the human dermis. J Invest Dermatol 116: 853–859
GD Gesellschaft für Dermopharmazie e. V. (2006) Vergleichbarkeit wirkstoffidentischer Topika. www.gd-online.de/german/veranstalt/images2006/GGTSPU-hydra3.fw.med.uni-muenchen.de-23253-577525-DAT/GD-Stellungnahme_Vergleichbarkeit_wirkstoffidentischer_Topika_2006.pdf
Beitner H (2003) Randomized, placebo-controlled, double-blind study on the clinical efficacy of a cream containing 5% alpha-lipoic acid related to photoaging of facial skin. Br J Dermatol 149: 841–849
Panigrahi M, Sadguna Shiva Kamar BR (1996) Alpha-lipoic acid protects against reperfusion injury following ischemia in rats. Brain Res 717: 184–188
Perricane NV (2000) Topical 5% alpha-liponic cream in the treatment of cutaneus rhytides. Aesthetic Surg J 20: 218–222
Heaphy MR Jr, Ackerman AB (2001) The nature of solar keratosis: a critical review in historical perspective. J Am Acad Dermatol 43: 467–469
Fu W, Cockerell CJ (2003) The actinic (solar) keratosis: a 21st century perspective. Arch Dermatol 139: 66–70
Thompson SC, Jolley D, Marks R (1993) Reduction of solar keratoses by regular sunscreen use. N Engl J Med 329: 1147–1151
Armstrong BK, Kricker A (2001) The epidemiology of UV induced skin cancer. J Photochem Photobiol B 63: 8–18
Kligman AM, Willis I (1975) A new formula for depigmenting human skin. Arch Dermatol 111: 40–48
Yoschimura K, Momosawa A, Aiba E, Sato K, Matsumoto D, Mitoma Y, Harii K, Aoyama T, Iga T (2003) Clinical trial of bleaching treatment with 10% all-trans retinol gel. Dermatol Surg 29: 155–160
Hermanns JF, Petit L, Piérard-Franchimont C, Paquet P, Piérard GE (2002) Assessment of topical hypopigmenting agents on solar lentigines of Asian women. Dermatology 204: 281–286
GD-Gesellschaft für Dermopharmazie e.V. (2003) Leitlinie: Dermokosmetischer Sonnenschutz. www.gd-online.de/german/fgruppen/kosmetik/Sonnenschutz2003_d.htm
Europäische Union (2006) Empfehlung der Kommission vom 22. September 2006 über die Wirksamkeit von Sonnenschutzmitteln und diesbezügliche Herstellerangaben. Amtsblatt der Europäischen Union, Aktenzeichen K 4089, (2006/647/EG)
Maier T, Korting HC (2005) Sunscreens – which and what for? Skin Pharmacol Physiol 18: 253–262
COLIPA, European cosmetic, toiletry and perfumery association. COLIPA SPF test method, 94/289 (1994)
Bissonnette R, Allas S, Moyal D, Provost N (2000) Comparison of UVA protection afforded by high sun protection factor sunscreens. J Am Acad Dermatol 43: 1036–1038
Korting HC, Schäfer-Korting M, Hart H, Laux P, Schmid M (1993) Anti-inflammatory activity of hamamelis distillate applied topically to the skin. Influence of vehicle and dose. Eur J Clin Pharmacol 44: 315–318
Hughes-Formella BJ, Bohnsack K, Rippke F, Benner G, Rudolph M, Tausch I, Gassmüller J (1998) Anti-inflammatory effect of hamamelis lotion in a UVB erythema test. Dermatology 196: 316–322
Hughes-Formella BJ, Filbry A, Gassmüller J, Rippke F (2002) Anti-inflammatory efficacy of topical preparations with 10% Hamamelis distillate in a UV erythema test. Skin Pharmacol Appl Skin Physiol 15: 125–132
Jakobi OK (1959) Moisture regulation in the skin. Drug Cosmet Ind 84: 732–812
Loden M (1996) Urea containing moisturzers influence barrier properties of normal skin. Arch Dermatol Res 280: 103–107
Ademola J, Frazier C, Kim SJ, Theaux C, Saudez X (2002) Clinical evaluation of 40% urea and 12% Ammonium lactate in the treatment of xerosis. Am J Clin Dermatol 3: 217–222
Loden M (2003) Role of topical emollients and moisturizers in the treatment of dry skin barrier disorders. Am J Clin Dermatol 4: 771–788
Pavicic T, Korting HC (2006) Xerosis and callus formation as a key to the diabetic foot syndrome: dermatologic view of the problem and its management. J Dtsch Dermatol Ges 4: 935–941
Schölermann A, Banké-Bochita J, Bohnsack K, Rippke F, Hermann WM (1998) Efficacy and safety of Eucerin 10% Urea Lotion in the treatment of symptoms of aged skin. J Dermatol Treatm 9: 175–179
Bohnsack K, Tausch I, Gaßmüller J, Rippke F (1997) Wirksamkeit auf das Symptom "trockene Haut" und Langzeitverträglichkeit von Laceran Lotion 10% Urea bei Patienten mit atopischem Ekzem. Z Hautkr 1: 34–39
Hashimoto-Kumasaka K, Takahashik Tagami H (1993) Electrical measurement of the water content of the stratum corneum in vivo and in vitro under various conditions; comparison between skin surface hygrometer and corneometer in evaluation of the skin surface hydration state. Acta Derm Venereol (Stockh) 73: 335–339
Hoppe U, Lunderstädt R, Sauermann G (1986) Quantitative Analyse der Hautoberfläche mit Hilfe der digitalen Signalverarbeitung. Ärztl Kosmetol 16: 13–37
Schatz H, Kligman AM, Manning S (1993) Quantification of dry (xerotic) skin by image analysis of scales removed by adhesive discs CD-Squames. J Soc Cosmet Chem 44: 53–63
Miller DK (1995) Sticky slides and tape techniques to harvest stratum corneum material. In: Serup J, Jemec GB (eds) Handbook of non-invasive methods and the skin. CRC Press Inc, Boca Raton (FL), pp 149–151
Serup J (1992) A double-blind comparison of two creams containing urea as the active ingredient. Acta Derm Venereol (Stockh) [Suppl] 177: 34–38
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Pavicic, T., Steckmeier, S., Kerscher, M. et al. Evidenz-basierte Kosmetika: Konzept und Anwendung bei den Zielstellungen Licht-geschädigte Altershaut und Xerosis. Wien Klin Wochenschr 121, 431–439 (2009). https://doi.org/10.1007/s00508-009-1204-9
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s00508-009-1204-9