Can skincare cure acne? The difference between drugs and cosmetics | Doctor Anne

You know I love skincare. I really do.

But even the things we love the most do sometimes have limitations, and it is really important to know and accept them in order to avoid disappointment and frustration.

And yes, I am really talking about skincare here, this is not disguised marriage counseling! Even though you could probably apply that statement to both.


Can skincare cure acne?
Is it all just a waste of money?


Many people approach me after my reviews with the question: „Will *insert random product* cure my acne/ erase my wrinkles/ heal my eczema?“

And in the majority of cases the answer is no. It has to be!

Why? That is what we are going to talk about today!

What is the difference between cosmetics, over-the-counter drugs and drugs?

Well, cosmetics are products designed to be applied to the skin in order to cleanse, beautify or alter the appearance, while drugs are intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease or intended to affect the structure or any function of the body.

I do not review drugs on here, as they are usually prescription and I want you to talk to your doctor for if you have questions about a prescription rather than turn to an internet platform, so the majority of products I talk about here are not able to cure acne. Or eczema. Or psoriasis. Or skin cancer.

The small exception are what is referred to as „over-the-counter drugs“ (OTC) in the US, something we do not have in Germany. (As in, we DO have the products, we just don´t make that distinction in naming them.)

„Over-the-counter drugs“ are products that contain an ingredient with known therapeutic benefits that is considered safe to be sold without a prescription. They are regulated in terms of what they claim and at what percentages the therapeutic ingredient can or needs to be used in order to make that claim.

Common examples are Salicylic Acid products, sunscreens and fluorid toothpaste. In some countries (not in the European Union) the exact listing of active ingredients and their percentage on the packaging is required.

So OTC drugs could treat and possibly cure diseases, which makes them different from your usual cosmetic product.

But what a product is is not only is determined by the ingredients, but also by the claims.

If a product claims to alter your body in any shape or form, „increase collagen production“ for example, it is a drug, because it claims to alter your body. If on the other hand it claims to „help increase collagen production“ it still is a cosmetic, because „help“ is not a drug claim.

And just as a reminder: Acne, psoriasis and eczema are skin diseases. Wrinkles, dullness and dehydration are not, generally speaking they are cosmetic concerns.


Why is it unlikely that cosmetics will alter your body and heal diseases?

Other than the ingredients used, it is the area they are working at. Skincare products usually are not designed to penetrate deep into the body, a typical ingredient in an effective skincare product can break up the dead stratum corneum cells and can cause a reactive proliferation of the basal keratinocytes, but most creams do not penetrate through the epidermis.

Put simple: They affect the outer layer of the skin, where they can have a tremendous effect in terms of hydration and „beautifying“, but they will not reach areas of the body where they initiate structural changes.


Does that mean that skincare is pointless?

Absolutely not!

Well formulated skincare products go exactly where they need to go to deliver the results they are designed for – a chemical exfoliant for example makes a huge difference in texture ridden skin, and for that effect it doesn´t need to go any deeper than the upper layers.

Same is true for hydration, for smoothing and for reduction of Transepidermal Waterloss (read more about that here), all of which have more than a temporary effect on your skins appearance and, in the long term, health.

Another aspect is how skincare makes you feel. Not how it makes your skin feel, how it makes YOU as a person feel: relaxed, happy, appreciated…

Skincare is selfcare, and skincare should be a pleasant experience.

If I were to focus on results exclusively, I would stick to a basic cleanser, my Tretinoin and sunscreen and I would probably get at least 90% of the results I achieve now, with much less time and money invested.

No more dabbling with various lotions and potions, no more face masks and treatment nights. But where is the fun in that? And who can say that the fact that I am taking time to look after myself isn´t beneficial for me in the long run?

All I am saying is that to treat skin diseases, you should rely on drugs rather than cosmetics. But if you either don´t have any skin diseases or they are taken care of by a professional with prescription products, cosmetics is what you should turn to to support the results these drugs give you and even help counteract the side effects of your treatment, like dry and flakey skin during retinization (tips on introducing Retin-A with minimal irritation are here), or simply to make your skin look even better.


What would you be able to notice anyway?

We often hear claims like 5% reduction in wrinkle depth, 7% reduction in redness – all that sounds pretty impressive. But the question is: How big of a difference would you actually be able to notice in your daily life?

If you don´t have the habit of staring at your wrinkles with a magnifying glass all day – and if you have, you should seriously consider getting help – 5% will go completely unnoticed. You will not see these changes when you look into the mirror, at least not as much as you will see the results of a night with uninterrupted as opposed to a night with broken sleep.

Don´t believe me? Reduce the redness intensity of a square by 7% on your favorite picture alteration tool – would you see a difference if you didn´t know and didn´t have the side by side comparison? I don´t think you would, and that is a space much larger than the areas of redness on your face.

Taking into account now that the changes in skin happen gradually over several weeks, how would you be able to spot the difference, other than a „I like what I see“ when you look in the mirror?


And where does Retinol fit in here?

I mentioned that Tretinoin aka Retinoic Acid is a drug and can increase collagen production. At the same time Retinol creams usually are considered cosmetics, not drugs, even though Retinol will, after two conversion steps, convert into Retinoic Acid (here is an overview about the different kinds of retinoids). How is that possible?

Well, technically retinol creams do not contain an ingredient with known therapeutic effect, that would be Retinoic Acid, so they are not drugs. And second, the claims are usually something along the lines of „help increase collagen production“, which is, as we learned before, NOT a drug claim.

They are cosmetics by definition, even though they may have a (significantly weaker) similar effect as a drug would have. Or, translated to consumers needs: they may help prevent premature aging in a weaker, but at the same time much better tolerated way, but they will not be enough to treat severe acne – you need a drug and a doctor for that.


Bottom line

All the things you can do to your skin are minor compared to sun protection — and that doesn´t only mean sunscreen, it means being sun smart with protective clothing, hats and avoiding the midday sun.

The next step would be to decide if you have a severe skin condition or a skin disease or if you simply want to improve the appearance of your skin, both in the short and in the long term.

For the first, go see a doctor and rely on their advice and prescriptions. For the second, knock yourself out with whatever brings you joy and makes your skin look and feel better.

Just don´t feel the need to go in debt to buy skincare products you can´t otherwise afford.


Can skincare cure acne?
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