Those of you who have visited my dermatology practice in Miami know that the art in my office is dedicated to the history of the skin care industry. I collect , and I have written this historical column in honor of the 50th anniversary of Dermatology News.
Courtesy Dr. Leslie S. Baumann
Dr. Leslie S. Baumann stands in her office, in front of a Camay soap ad from the 1920s.
The first doctor to market his own cosmetic product, Erasmus Wilson, MD, faced scrutiny from his colleagues. Although he had contributed much to the field of dermatology, he was criticized by other dermatologists when he promoted a hair wash. The next doctor in my story, William Pusey, MD, was criticized for helping the company that manufactured Camay soap because he allowed his name to be used in Camay advertisements. The scrutiny that these two well-respected dermatologists endured from their colleagues deterred dermatologists from entering the skin care business for decades. The professional jealousy from dermatologic colleagues left the skin care field wide open for imposters, charlatans, and nondermatologists who had no concern for efficacy and patient outcomes to flourish. This is the story of a group of brilliant entrepreneurial dermatologists and one chiropractor who misrepresented himself as a dermatologist and how they influenced skin care as we know it.
Erasmus Wilson, MD1 (1809-1884): In 1840, Erasmus Wilson2 was a physician in London who chose to specialize in dermatology at a time when that specialization was frowned upon. He was a subeditor for The Lancet and wrote several books on dermatology including “Diseases of the Skin – A Practical and Theoretical Treatise,” “Portraits of the Diseases of the Skin,” and “Student’s Book on Diseases of the Skin.” He was the first professor of dermatology in the College of Surgeons and by 1869, was the leading English-speaking dermatologist in the world. He contributed much to dermatology, including his pioneering characterizations of Demodex mites, lichen planus, exfoliative dermatitis, neurotic excoriations, and roseola. Dr. Wilson was knighted in 1881 for his good works and notable generosity. (He was known for giving his poor patients money for food, endowing chairs in dermatology, and donating a famous obelisk in London).
Courtesy of Dr. Leslie S. Baumann
An advertisement in the September 1929 Ladies' Home Journal says that Camay soap has the "unanimous approval" of "72 of the most eminent dermatologists in America."
In 1854, Dr. Wilson wrote a book for laypeople called “Healthy Skin: A Popular Treatise on the Skin and Hair, Their Preservation and Management,” in which he advocated cleanliness and bathing, which led to the popularity of Turkish baths and bathing resorts in Europe. Despite his undeniable contributions to dermatology, he was widely criticized by his colleagues for promoting a “Hair Wash” and a turtle oil soap. I cannot find any information about whether or not he developed the hair wash and turtle soap himself, but it seems that he earned income from sales of these two products, even though he was said to have donated it all to charities.
William A. Pusey MD (1865-1940): Dr. Pusey was the first chairman of dermatology at the University of Illinois College of Medicine, Chicago. He published several books, including “Care of the Skin and Hair,” “Syphilis as a Modern Problem,” “The Principles and Practices of Dermatology,” and “History of Dermatology” among others. He is best known for his work in developing the use of x-rays (roentgen rays) and phototherapy in dermatology, and in 1907, he was the first dermatologist to describe the use of solid carbon dioxide to treat skin lesions. He was president of the American Dermatological Association in 1910, president of the Chicago Medical Society in 1918, editor of the Archives of Dermatology in 1920, and president of the American Medical Association in 1924.
Courtesy of Dr. Leslie S. Baumann
In the early 1920s, skin care companies were beginning to advertise their products using endorsements from celebrities and socialites, and were making misleading claims. Dr. Pusey wanted to work with these companies to help them perform evidence-based trials so they could make scientifically correct claims. Proctor & Gamble asked Dr. Pusey to advise them on how they could advertise honestly about their new soap, “Camay.” In Dr. Pusey’s words,3 “they (Proctor & Gamble) wanted to give the public authoritative advice about the use of soap and water. They suggested that I get a group of dermatologists of my selection to examine the soap and prepare instructions for bathing and the use of soap, and, if they found this soap was of high quality, to certify to that effect.” The research was performed as he suggested, and he allowed his name to be used in the Camay soap ads from 1926 to 1929. He said that he allowed them to use his name hoping to promote the need for evidence-based research, in contrast to the skin care products endorsed by socialites and celebrities that were flooding the market around that time.
Herbert Rattner, MD, at Northwestern University, Chicago, was his friend and one of the many dermatologists who criticized Dr. Pusey for allowing his name to be used in the Camay ads. Dr. Pusey’s reply to the criticism (according to Dr. Rattner) was that Proctor & Gamble was “proposing to do what the medical profession always is criticizing commercial concerns for not doing, namely, coming to physicians for information on medical matters. Could the profession hope to have any influence with business concerns if it was always eager to criticize bad commercial practices but never willing to support good ones?”3
While Dr. Pusey felt his reasons for adding his name to the Camay ads and research were justified, many of his friends stated that in hindsight, he regretted the action because of the negative response of his colleagues. It was years before dermatologists began providing input again into the skin care industry. During that time, radio, television and print ads were rampant with misleading claims – which led the way for a dermatologic imposter to make a fortune on skin care.
John Woodbury (1851-1909): John Woodbury, a chiropractor, never went to medical school, but that did not stop him from claiming he was a dermatologist and cosmetic surgeon. In 1889, he opened the John H. Woodbury Dermatological Institute in New York City, and over the next few years, opened Woodbury Dermatological Institutes in at least 5 states and employed 25 “physicians” who were not licensed to practice medicine. He came out with face soaps, tonics, and cold creams and spent a fortune on advertising these products and his institutes. In 1901, he sold his “Woodbury Soap” to the Andrew Jergens Company for $212,500 and 10% in royalties.
Multiple lawsuits occurred from 1898 to 1907 because he continued using the Woodbury name on his own products, despite having sold the “Woodbury” trademark to Jergens. He was sued for practicing medicine without a medical license and claiming to be a dermatologist when he was not. He lost most of these lawsuits, including one in 1907 in which the court ruled that corporations may not employ unlicensed professionals to practice medicine. In 1909, John Woodbury committed suicide. The Woodbury Soap company flourished in the 1930s and 1940s, as part of Jergens, until the brand was discontinued in 1970 when Jergens was acquired by American Brands.
1916 Ladies' Home Journal vol 33#9
A 1916 advertisement in Ladies' Home Journal: John Woodbury sold the Woodbury trademark to Jergens in 1901.
The next dermatologists to come along did not make the same mistakes as those of their predecessors. They all made scientific discoveries through their basic science research in the laboratory, filed patents, formed skin care companies, perfected the formulations, and conducted research trials of the final product. Their marketing focused on science and efficacy and only rarely used their names and images in advertising, allowing them to maintain their reputations in the dermatology field.
Eugene Van Scott, MD (1922-present): Dermatologist Dr. Van Scott and dermatopharmacologist Ruey Yu, PhD, filed a method patent in the early 1970s on the effectiveness of alpha hydroxy acids to treat ichthyosis. They invented the abbreviation “AHA” and have continued their work on organic acids to this day. They now have more than 125 patents, which they have licensed to 60 companies in the cosmetics and pharmaceutical industries.
In 1988, 14 years after their initial publication, they founded the company they named Polystrata, which grew into today’s NeoStrata.4 Over the years, they had to defend their patents because many personal care companies used their technologies without licensing them. In 2007, they won a $41 million settlement in a patent infringement suit against Mary Kay filed in March 2005. They have both been very philanthropic in the dermatology world5 and are highly respected in the field. Among many other honors, Dr. Van Scott was named a Master Dermatologist by the American Academy of Dermatology in 1998 and received the Dermatology Foundation’s Distinguished Service Medallion in 2004.
Sheldon Pinnell, MD (1937-2013): After Dr. Pinnell completed his dermatology residency at Harvard Medical School, he spent 2 years studying collagen chemistry at the Max Planck Institute in Munich, Germany. In 1973, he returned to Duke University where he had earned his undergraduate degree before attending Yale University. He remained at Duke for the duration of his career and was professor and chief of dermatology there for many years. Early in his career, he focused on the role of vitamin C in collagen biosynthesis and discovered some of the mechanisms by which sun exposure causes photoaging. He described the use of the first (and most popular) topically applied L-ascorbic acid (vitamin C) to prevent and treat skin aging.
Dr. Pinnell’s many discoveries include showing that the addition of ascorbic acid to fibroblast cultures increases collagen production and that topically applied L-ascorbic acid penetrates into the skin best at a pH of 2-2.5. Dr. Pinnell changed the way the world uses topical antioxidants today; he was widely respected and was a member of the American Dermatological Association and an honorary member of the Society of Investigative Dermatology. He published more than 200 scientific articles and held 10 patents. He started the skin care company Skinceuticals, based on his antioxidant technologies. It was acquired by L’Oreal in 2005.
Richard Fitzpatrick, MD (1944-2014): The dermatologist affectionately known as “Fitz” is credited with being the first to use lasers for skin resurfacing. He went to medical school at Emory University and did his dermatology residency at the University of California, Los Angeles. He authored more than 130 publications and was one of the first doctors to specialize in cosmetic dermatology. He realized that fibroblast cell cultures used to produce the collagen filler CosmoPlast (no longer on the market) generated many growth factors that could rejuvenate the skin, and in 1999, he launched the skin care brand SkinMedica. In 2000, he received a patent for fibroblast-derived growth factors used topically for antiaging – a formula he called Tissue Nutrient Solution. In 2001, the popular product TNS Recovery Complex was launched based on the patented growth factor technology. It is still the most popular growth factor technology on the market.
Dr. Leslie S. Baumann
What can we learn from these pioneers? I have had several interesting discussions about this topic with Leonard Hoenig, MD, section editor for Reflections on Dermatology: Past, Present, and Future, in Clinics in Dermatology. (Dr. Hoenig told me the interesting story that Listerine mouthwash was named in honor of Joseph Lister but accounts vary as to whether he gave permission to do so. This makes Dr. Lister the most famous physician to endorse a personal care product.) When Dr. Hoenig and I discussed the ethics of dermatologists creating a skin care line or retailing skin care in their medical practice, he stated my sentiments perfectly: “We should rely on professional, ethical, and legal guidelines to help us do what is right. Most importantly, we should have the best interests of our patients at heart when recommending any treatments.”
Dermatologists have unique knowledge, experience, and perspective on treating the skin with topical agents and have the true desire to improve skin health. If we do not discover, research, patent, and develop efficacious skin care products, someone else will do it – and I do not think they will do it as well as a dermatologist can.
Dr. Baumann is a private practice dermatologist, researcher, author, and entrepreneur who practices in Miami. She founded the Cosmetic Dermatology Center at the University of Miami in 1997. Dr. Baumann has written two textbooks and a New York Times Best Sellers book for consumers. Dr. Baumann has received funding for advisory boards and/or clinical research trials from Allergan and Burt’s Bees. She is the CEO of Skin Type Solutions Inc., a company that independently tests skin care products and makes recommendations to physicians on which skin care technologies are best. Write to her at dermnews@mdedge.com.
References
1. Everett MA. Int J Dermatol. 1978 May;17(4):345-52.
2. Moxon RK. N Engl J Med. 1976 Apr 1;294(14):762-4.
3. Rattner H. Arch Derm Syphilol. 1937;35(1):25-66.
4. Neostrata: More than Hope, by Elaine Strauss, U.S. 1 Newspaper, Feb. 24, 1999.
5. Two legends in the field of dermatology provide $1 million gift to Temple University school of medicine’s department of dermatology, Temple University, June 5, 2015.