Doctor Martina Kerscher
Head, Division of Cosmetic Science- University of Hamburg

With a skin-deep passion for Cosmetics Science, Dr Martina Kerscher, tells us about EVIDENCE-BASED skincare ingredients and the growing scientific attention given to Cosmetic Dermatology & Skincare over the past 10 years.

BEHIND THE WOMAN

About your career and the people who inspired you: Very early in my career, I got fascinated with skin and the fact that I did not need any devices, or any kind of technical assistance to diagnose skin diseases but just my eyes, my hands to feel and to touch skin lesions and skin surface together with my knowledge and my experience to help patients get rid of dermatoses. Along the way, many people have inspired me and among them, my first dermatological teacher, Professor Otto Braun-Falco, played a significant role in THE turning point of my career, when I accepted to spearhead the future department of Cosmetic Science at the University of Hamburg. We were in the late 90s’, so the field of Cosmetic Dermatology did not exist yet in a broad extent like nowadaysbut it was about to blossom. At that time, Cosmetic Dermatology was not present at German Universities, it has just started to be part of the AAD meetings with a few lectures.  This was the beginning of a fabulous but – at least in the beginning – risky journey. Despite the skepticism of some of my mentors and colleagues, I decided to partly leave “classical dermatology” and to be part of something that would contribute to advance the science of skin, skin aging and its preventative approach.

YOUR VIEW ON SKINCARE INNOVATIONS

About your patients’ skincare concerns along the years and across generations

In general, I would like to distinguish between several groups of patients. There is one substantial group of patients suffering from sensitive skin which is very often the first problem that patients bring up during their visits. Furthermore, being in their mid 30’s or beginning 40’s these patients often want to use anti-aging products to improve the appearance of their skin. They are looking for advice, fearing that they cannot use anti-aging ingredients without increasing the risk of adverse skin reactions due to their skin sensitivity.

Another group is suffering from skin-aging, often combined with pigmentation disorders like aging spots or hyperpigmentation and melasma. They are looking for specific treatment options combining topical treatments and minimally invasive procedures to improve their skin condition and to make their skin looking better.

A third group is looking for advice concerning prevention, as they are looking for preventative treatment approaches to maintain skin health and to protect their skin from premature ageing. This is – so far – a smaller group as compared to those searching anti-aging advice, however, it is a growing group being very well informed about possible treatment options and always looking for the best preventative approach, even if this means to combine e.g. botulinumtoxin injections with topicals.

The most exciting skincare innovations over the past 10 years

To me, the most exciting thing that happened in skincare over the past 10 years is the growing scientific ATTENTION given to Cosmetic Dermatology and skincare as well as cosmeceuticals. At the beginning of the years 2000, there was only a small number of scientific publications on cosmetic ingredients, at least in peer reviewed dermatological journals. Nowadays we find a huge number of scientific articles about new ingredients, their effects on skin and their benefits for our patients. Concerning skin care innovations, for me, peptides and biotechnology, allowing, for example, plants or bacteria to produce specific proteins that can be used in cosmetics belong to the most exciting skincare innovations as they could offer tailor-made solutions for specific cosmetic skin problems.

ABOUT EVIDENCE-BASED SKINCARE INGREDIENTS

What is your definition of Evidence-based skincare ingredients?

Claiming “from xx patients having used the product, a percentage of X % has noticed wrinkle reduction” is still a common approach to communicate efficacy of a specific products in the beauty industry. However, this is far away from evidence, even if we know the high importance of users’ acceptance.

Evidence in skin care ingredients means to provide scientific based data from randomized controlled in vivo trials assessing a specific ingredient or a mixture of ingredients against the pure vehicle.  Moreover, the mode of action should be known as well as the concentration that is necessary to obtain best results in vivo after you have got first in vitro or ex vivo data about safety and efficacy of the ingredient/ingredients. And if there is no vehicle controlled study available, a first step could be a controlled before and after study, to get first data that a specific ingredient works in vivo. In my opinion, an evidence-based approach is what I would expect from brands visiting dermatologists. It is not to just talk about exotic sounded compounds but it is about in-vitro, ex vivo and in-vivo proofs of scientific evidence.

What is your favorite skincare ingredient?

It is not possible to pick only one as it depends on the age, on the aging signs of the patient, his/her skin phototype and skin condition. I usually recommend specific treatment regimens for my patients depending on their skin phototype, their skin condition, the region they live and their individual signs of skin aging.  However, there are some ingredients that I have selected over time based on my experience as a dermatologist and their level of scientific evidence that are really helpful for a broad majority of patients besides a daily photoprotection at least on days with an UV index > 3.

First of all, antioxidants like Vitamin C in concentrations of 5 % and higher are an important step to prevent and repair oxidative stress and first aging signs – and therefore helpful for all patients and all age groups. Vitamin C has been studied extensively for its role as topical antioxidant in prevention¹, but also for its adjunctive role at lightening hyperpigmentation^2,3, and more recently it has been shown to significantly improve fine lines, dyspigmentation and surface roughness without adverse side effects.^4,5

On the other hand, hyaluronic acid provides instant skin surface gratification with a healthy skin glow, acting as a powerful humectant.  When it comes to the use of hyaluronic acid, the recent popularity of HA fillers to be injected injections to correct wrinkles has led to a plethora of HA-containing moisturizers that have been shown to provide significant benefits in skin hydration, skin firmness and elasticity.⁶

In addition, I often recommend so-called “wrinkle boosters” that means ingredients that increase collagen and extracellular matrix synthesis and this is either a retinoid derivative⁷ or a peptide e.g. a signal peptide that is able to directly stimulate collagen synthesis whilst being very well tolerated ^8,9.

Now, as well scientifically documented as they are, it is important for patients to understand that not all skincare products are equal. Many ingredients need to be manufactured, formulated, and packaged properly to avoid oxidation and loss of potency and the concentration of the active needs to be high enough to be effective – so I educate my patients on the importance of selecting the right products for better results and superior satisfaction.

 

Is there any promising evidence-based ingredients on the Horizon?

As I said earlier, peptides are making my list of favorite skincare ingredients. This group of actives gets me excited. Signals peptides (like matrikines or palmitoylpentapeptides for example) are really interesting as they could manage to improve cross talk in between keratinocytes and fibroblasts and they work ! Moreover, peptides and proteins that have been produced in plants or bacteria and have been extracted using modern biotech procedures are one of the most exciting group of ingredients today and in the future¹⁰.

 

What is your dream cosmetic ingredient? What do you miss in your skincare arsenal today?

To be honest, I do not need one more ingredient; what I would love to have is some additional, easy to handle and not too expensive tools to get to the best individualized and customized skincare treatment. In the future, it would be great to have a screening test to get an idea about the individual genomics, to understand for example whether there is special predisposition for hyperpigmentation or for photoaging. The footprint of the individual genetic profile would allow me to evolve my approach from an individualized one to a more customized one. For now, it is unaffordable and time consuming but certainly it could be an important part of cosmetic science of the future.

ABOUT EMERGING TRENDS IN SKINCARE

What is inspiring you to contribute to advancing the knowledge and the education on Skincare?

In my opinion and in my clinical experience it is so interesting to see how many patients seek for minimally invasive treatments such as fillers, toxins and how much they ignore – at least in the beginning – the impact their daily skincare regimen can have on their skin. I am really convinced that small changes in skin surface and pigmentation are very important for patients to feel better, to look better and to appear more attractive. To further illustrate this point, the best example is a patient with pigmentation irregularities and a high skin surface roughness undergoing a facelift, which certainly results in a firm and tight skin, without volume loss and wrinkles, but also in a skin without any significant radiance and glow.…. until this patient uses an individualized and highly effective cosmetic regimen on a daily basis.

Using the correct cleansing, adding some antioxidants, moisturizing agents and regularly stimulate skin cell turnover is critical to getting a healthy vibrant skin. It is just like with other organ systems: Actions taken to promote/maintain health are more likely to be effective when they are consistent. With skin – being the largest organ of the human body – it works just the same way, if you want to see results and promote/maintain your skin health, you have to use your skincare regimen on a regular basis.

When my patients come back and tell me they have been asked about their healthy glowing skin, I know that they have understood the value of a good skincare regimen.

 

Your secret to Healthy Vibrant Skin

The secret – if you want to call it that way – is an individualized and customized skincare regimen, which not only takes account of patients’ needs and expectations, but is also based on science and scientifically proven ingredients. Using a skin regimen consisting of antioxidants, moisturizers and peptides on a regular basis, together with a daily UV protection will certainly promote skin radiance and a healthy skin glow.

 

BIBLIOGRAPHY

1. Murray JC, Burch JA, Streilein RD, et al. A topical antioxidant solution containing vitamins C and E stabilized by ferulic acid provides protection for human skin against damage caused by ultraviolet irradiation. J Am Acad Dermatol 2008;59:418-425.
2. Alexis AF, et al. Natural ingredients for darker skin types: growing options for hyperpigmentation. J Drugs Dermatol; 2013
3. Espinal-Perez LE, Moncada B, Castanedo-Cazares JP. A double-blind, randomized trial of 5% ascorbic acid vs. 4% hydroquinone in melasma. Int J Dermatol 2004; 43:604-607.
4. Crisan D et al. The role of Vitamin C in pushing back the boundaries of skin aging: an ultrasonographic approach. 2015 Clinical, Cosmetic and Investigational Dermatology
5. Humbert PG et al. Topical ascorbic acid on photoaged skin. Clinical, topographical and ultrastructural evaluation: double-blind study vs. placebo. Exp Dermatol. 2003 Jun;12(3):237-44 Dermatol. 2002 Jul-Aug;12(4):XXXII-XXXIV

6. Farwick M et al. Efficacy of cream-based novel formulations of hyaluronic acid of different molecular weights in anti-wrinkle treatment. J Drugs Dermatolo, 2011 Sep; 10(9) :990-1000.
7. Randhawa M et al. One-year topical stabilized retinol treatment improves photodamaged skin in a double-blind, vehicle-controlled trial. J Drugs Dermatol. 2015 Mar; 14(3):271-80.
8. Farwick M, Grether-Beck S, Marini A, et al. Bioactive tetrapeptide GEKG boost extracelilar matrix formation: In vitro and in vivo molecular and clinical proof. Exp Dermatol 2011;20:602-604.
9. Zhang L, Falla TJ. Cosmeceuticals and peptides. Clinics in Dermatology 2009;27:485-494.
10. Malerich S, Berson D. Next generation cosmeceuticals:the latest in eptides, growth factors, cytokines and stem cells. Dermatol Clin 2014; Jan 4:32 (1).