Celebrity aesthetician Nerida Joy has been seeing what she refers to as a “sad” skin-care trend of late: Professional products are easier than ever for consumers to purchase online.
While these products are technically considered medical-grade—i.e., they have higher percentages of active ingredients that penetrate deeper into the skin layers—and should only be used by a licensed skin-care professional or medical practitioner, Joy says they are simply “slipping through the cracks” and experiencing a rise in popularity during the stay-at-home order.
The same goes for cosmeceuticals, products considered somewhere in-between over-the-counter and medical-grade when it comes to strength and ingredient purity.
“They do not require regulatory approval through the FDA and, therefore, are sold irresponsibly on websites,” Joy says, calling out high concentrations of “pure actives,” such as glycolic acid with a low pH, and unsupervised use of prescription retinol and hydroquinone, for being especially risky.
“Today, purchasing online skin-care products of high concentrations can be very dangerous—especially when consumers can have cosmeceutical-strength or medical-grade delivered direct to their door the next day.”
Saddle Brook, NJ dermatologist Dr. Frederic Haberman has seen it, too, and contends that chemical peels not intended for over-the-counter use are one of the worst offenders. “I have seen many bad reactions to skin-care items that people should not be applying at home—particularly with chemical peels that have not been used properly.”
One such case: “I had a client purchase a peel product online with 70-percent glycolic and a pH lower then 2,” Joy recalls. “During the quarantine, she used this product as directed and got a severe chemical burn.”
“It is now six weeks later, and she is still dealing with very uneven, blotchy skin.”
Cosmetic chemist Kelly Dobos also warns of acids especially. “When it comes to alphahydroxy, salicylic and glycolic acids, a concentration of 10 percent or less is considered safe for home use—whereas concentrated peel solutions should be reserved for a professional environment,” she says. “Potent trichloroacetic Acid (TCA) peels are an FDA -approved treatment for actinic keratosis, a precancerous skin condition, and should only be used in professional settings where concentration and application can be controlled and tailored to the patient to ensure safety and efficacy.”
Unfortunately, Dobos says, there is nothing to prevent consumers from finding these types of products online or through other unscrupulous means.
“Do a quick Google search and you can find a kit that claims to have a shocking 100-percent TCA peel!”
The Regulation Situation
So why are these products such a special—and potentially skin-disrupting—case? As Palo Alto, CA facial plastic surgeon Jill Hessler, MD breaks it down, skin-care products are considered either cosmetics or pharmaceuticals. “The FDA regulates all cosmetics products, but over-the-counter skin care is placed into the category of foods for regulation. Medical-grade products are considered pharmeceuticals, and are regulated as medicines and held to strict standards. These products must undergo rigorous testing, they must provide scientific studies to show a clinical effect, and demonstrate at least 99-percent purity of their ingredients. Any medical claim of clinical effect must be backed up by scientific research.”
“Pharmaceutical products generally have stronger clinical effects and can have adverse reactions if not used properly. Therefore, these products must be administered under a physician’s supervision to assure patients understand their usage and interactions with other medications.”
Like Joy, Dr. Hessler also stresses how important expert supervision is to the success of certain product types and ingredients. “Topical vitamin A products can make the skin much more sensitive to the sun and can exacerbate other medications that cause skin sensitivity,” she says. “I saw one patient who was on an antibiotic, using a topical retinal product and not using sunscreen properly, and developed a significant sunburn and photosensitivity reaction. It is important patients understand these concerns ahead of time and know the interactions or other medications and also other products. Other topicals, such as sunscreen, can help limit the side effects.”
While a sunburn might not scare off a consumer from clicking to purchase, something more serious might: “I have seen patients try hyaluronic acid ‘pens’ they are getting on Amazon and they have really awful skin reactions—bruising, swelling, granulomatous dermatitis— that take weeks to months to improve,” says Rochester, NY dermatologist Lesley Loss, MD. “They advertise as a ‘needle-less’ device and are not FDA-cleared.”
Dr. Hessler adds that she’s had patients buy prescription-grade products such as hydroquinone, Retin-A and even Latisse from online pharmacies outside the U.S., which can also cause issues.
“Some countries don’t regulate these products as stringently. The problem is you don’t know where the products are coming from and you can’t verify the authenticity,” Dr. Hessler says. “You really have no way of knowing what is inside these tubes. You also don’t know how the have been maintained—they may have been sitting in a hot warehouse or in direct sunlight, which can degrade the products.”
And, while Dobos says there has always been a market for foreign-made cosmetics due to preferences of some for products they are more familiar with or are labeled in their native language, it really becomes a whole other ballgame if those products start to be sold online. “Because products are generally safe and brought over in small quantities for personal use rather than being introduced into commerce, they typically do not draw the attention of enforcement agencies like the CBP and FDA who inspect cosmetic imports.”
One of the scariest sales: “I’ve had patients purchase a box of filler online or bring it back from a trip abroad and ask me to inject it,” Dr. Hessler says. “U.S. physicians are only allowed to inject FDA-approved products and you could lose your medical license for injecting non-approved products.”
“Thankfully, I think it would be challenging to find someone who would be comfortable injecting these products.”