I have been writing Cosmeceutical Critique for more than a decade, and over the years I have received many calls and e-mails about the column. The most frequent question is, "I read your column every month and understand the ingredient science, but I still do not know what products to sell in my practice. Can you help?" For this reason, I will begin to add columns that discuss the process of skin care retail, and how to choose which products to sell. I admit that finding effective products and designing the right regimen for each patient are daunting tasks, but I have simplified the process out of necessity in my own Miami practice.
The goal is to achieve good patient outcomes with minimal side effects, which strengthens the physician-patient relationship. In order to achieve this goal, you need to find the most efficacious products and properly match them to your patient’s skin type. In addition, patients must be compliant with the prescribed regimen. If only it were that simple. The difficulty in separating fact (science) from fiction (marketing claims), time constraints with each patient, and the need for staff training can complicate this process.
In my practice, we use the Skin Type Solutions system that I developed to match skin care products for each skin type (
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Fitzpatricks Dermatology in General Medicine, 8th Ed., 2012, Ch. 250, p. 1343).This system accurately determines a patient’s Baumann Skin Type (there are 16) and provides a preset regimen designed to address that particular skin type’s needs. The system has been tested in more than 100,000 people worldwide, of all ethnicities and ages, as well as both genders, and has demonstrated accuracy in assessing skin care needs (Dermatol. Clin. 2008;26:359-73; J. Cosmet. Dermatol. Sci. Appl. 2014;4:78-84).
The Baumann Skin Typing System saves my staff time by streamlining the process of designing skin care regimens. It works like this:
• The patient takes the skin type questionnaire and is assigned to one of the 16 Baumann Skin types.
• A staff member matches the skin type to the preset regimen.
• The doctor (or designee) reviews the regimen and makes any necessary changes or additions (including prescription medications).
• The patient is given a step-by-step skin care regimen.
• The patient purchases the correct products.
• The patient is given instruction sheets to increase compliance.
• The patient returns in 4 weeks for follow-up with the staff designee to ensure that the regimen is being properly followed.
Sounds easy, right? The hard part is choosing which products to use for each skin type. In order to ethically sell skin care products to patients, you must ensure that they are getting efficacious products to address their skin concerns (Clin. Dermatol. 2012;30:522-7).
Keep these steps in mind when selecting skin care products:
• Know your ingredient science.
There is so much interesting research on cosmetic ingredients, but there is also plenty of hype and misinformation. One key point is that no one ingredient is right for all skin types. It’s essential to know which ingredients work well together and which do not. The order in which ingredients are placed on the skin is crucial as well, because they can inactivate each other and affect absorption. All of my ingredient columns are available at edermatologynews.com and will be published in my new book, Cosmeceuticals and Cosmetic Ingredients (McGraw-Hill).
It is important to understand which ingredients are worthless (like stem cells and peptides) and which ones are crucial (such as retinoids and antioxidants) so that you can arm your patients with products that work. When products do not work, your patients will have poor outcomes, your physician-patient relationships will be damaged, and patients’ trust in you will decrease.
• Choose ingredients appropriate for the patient’s skin type.
It is important to understand the characteristics of various ingredients and match those to your patient’s skin type. The process of assessing the patient’s skin type can be long because you need to ask numerous historical questions (invariably including, "Do you get irritated from skin care products?" and "What happens if you do not use a moisturizer?"). Looking at a patient’s skin at one point in time is not as accurate as asking a series of questions about how their skin has behaved in the past under varying conditions. I use a validated questionnaire to streamline this process in my practice. The questionnaire takes 3 to 5 minutes, does not require a staff member, and is done on a tablet device in the waiting room or exam room.