Skin Care Products: What do they promise, what do they deliver

Abstract

The industry offers a vast armamentarium of skin care products to clean, soothe, restore, reinforce, protect and to treat our skin and hence to keep it in “good condition”. Skin care products are readily available and their promotions with fanciful claims are omnipresent. The promotions are based on effects, evoked by actives that are delivered through vehicles that rely on specific technologies. Due to the fact, that these products are in direct contact to the target tissue, their vehicle and ingredients are able to profoundly modulate the characteristics of the skin and some of its functions. This makes products for the skin absolute unique and versatile delivery systems. This paper discusses the concept of skin care and skin protection, the choice of skin care products, their vehicles, their functionality and their regulatory status.

Full text

Skin care products: What do they promise,
what do they deliver
Christian Surber
a,b,
*, Jan Kottner
c
a
Department of Dermatology, University Hospital Basel, Switzerland
b
Department of Dermatology, University Hospital Zu
¨rich, Switzerland
c
Clinical Research Center for Hair and Skin Science, Department of Dermatology and
Allergy, Charite
´-Universita
¨tsmedizin Berlin, Germany
KEYWORDS
Skin care;
Vehicle;
Topical administration;
Nursing;
Cosmetics/administra-
tion & dosage;
Cosmetics
Abstract The industry offers a vast armamentarium of skin care products to
clean, soothe, restore, reinforce, protect and to treat our skin and hence to keep
it in “good condition”. Skin care products are readily available and their promotions
with fanciful claims are omnipresent. The promotions are based on effects, evoked
by actives that are delivered through vehicles that rely on specific technologies.
Due to the fact, that these products are in direct contact to the target tissue, their
vehicle and ingredients are able to profoundly modulate the characteristics of the
skin and some of its functions. This makes products for the skin absolute unique and
versatile delivery systems. This paper discusses the concept of skin care and skin
protection, the choice of skin care products, their vehicles, their functionality
and their regulatory status.
ª2016 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.
1. Introduction
Our skin reflects our origin, lifestyle, age and state
of health. Skin color, tone and evenness, pigmen-
tation, as well as skin surface characteristics are
signs of our skin’s health. The cosmetic and phar-
maceutical industry offers a vast armamentarium
of skin care products and procedures to clean,
soothe, restore, reinforce, protect and to treat our
skin and hence to keep it in “good condition” [1,2].
Skin care products are readily available in daily life
and they play a major role in health and nursing
care. The promotion of skin care products
including their claims are often based on an effect
(e.g., moisturizing, antioxidant), evoked by an
active (e.g., urea, tocopherol) that is delivered
through a vehicle (e.g., lotion) that relies on a
specific technology (e.g., nanotechnology). In
addition “without”claims (e.g., without para-
bens) often accompany nowadays promotions.
* Corresponding author. Department of Dermatology,
Gloriastrasse 31, CH-8091 Zu
¨rich, Switzerland.
E-mail address: christian.suber@unibas.ch (C. Surber).
http://dx.doi.org/10.1016/j.jtv.2016.03.006
0965-206X/ª2016 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.
Please cite this article in press as: Surber C, Kottner J, Skin care products: What do they promise, what do they deliver, Journal of
Tissue Viability (2016), http://dx.doi.org/10.1016/j.jtv.2016.03.006
Journal of Tissue Viability (2016) --,-e-
www.elsevier.com/locate/jtv

Some of the effects, actives, vehicles and tech-
nologies have become well-known. The pharma-
cologic, immunologic or metabolic effect of
medicinal products ee.g., to treat hand eczema
or acne eis assigned to an active pharmaceutical
ingredient (API), e.g., corticosteroids, retinoids. It
is common knowledge that the vehicle housing the
API plays a crucial role in delivering the API to its
target site. Unfortunately many assign the vehicle
effect to its entirety (e.g., ointment, cream, gel)
and not to the sum of ingredients forming the
vehicle that remains on the skin after application
(see section Metamorphosis of the Vehicle). Skin
care products rarely house APIs but rather so-
called actives or cosmetic actives. These prod-
ucts are classified in some specific cases as medical
devices but in a majority as cosmetics. In all these
cases, too, the vehicle plays a crucial role in
unleashing an effect on the skin. This is due to the
fact, that the target tissue is directly treated and
the vehicle and their ingredients are able to pro-
foundly modulate the characteristics of the skin
and some of its functions. This makes products for
the skin absolute unique and versatile pharma-
ceutical and cosmetic delivery systems.
Against this background we discuss the concept
of skin care and skin protection, the choice of skin
care products and their vehicles, their function-
ality and their regulatory status.
2. Concept of skin care and skin
protection
The concept of skin care is not well defined. It is a
kind of umbrella term covering cleansing,
perfuming, changing appearance, changing body
odor, protecting and keeping the skin in “good
condition”. In the last decades our perception of
skin care has broadened and soothing of skin
symptoms/conditions, and improvement and
restoration of the skin’s barrier function and
integrity have been added. Today, modern skin
care includes cleansing,soothing,restoring,rein-
forcing and protecting. With increasing age the
emphasis on skin care is changing [3,4]. The
importance of soothing, restoring, reinforcing in-
creases and cleansing should be executed with
particular care. The character of skin care shifts
from more cosmetic objectives esmooth, healthy
looking skin eto more therapeutic and preventive
objectives esoothing, restoring, reinforcing and
protecting stressed skin. Even though skin care and
skin protection plays an important role throughout
lifetime the noxes and the skin areas in primary
need of care and protection also change. In
younger years environmental noxes (e.g., UV ra-
diation) are of primary importance whereas in
advanced years age-related noxes (e.g., prolonged
exposure to various sources of moisture, including
urine or feces, perspiration, wound exudate, and
their contents) become more important. Subse-
quently the skin areas in need of care and pro-
tection also change einitially skin areas (e.g.,
face, arms, legs) exposed to the the external
environment and later enclosed skin areas (e.g.,
skin folds, perianal, perigenital skin, groin, feet)
become the vulnerable zones (hot spots) [5,6].
Ageing per se changes the skin structure and
function across the life course increasing its sus-
ceptibility to numerous clinical relevant skin
problems (e.g. xerosis cutis) [7]. Skin diseases
(e.g., bacterial/fungal infections), accumulating
effects of systemic diseases (e.g., diabetes melli-
tus, renal insufficiency) or pharmacotherapies
(e.g., cancer therapies) also necessitate special
skin care.
3. Skin care procedures and skin care
products
The information on skin care procedures is plen-
tiful but little scientifically documented and the
number of products available for cleansing,
soothing, restoring, reinforcing and protecting is of
an almost infinite variety. Nonetheless their func-
tionalities may be described as
Removal of dirt, sebum, microorganisms,
exfoliated corneocytes and other non-wanted
substances from the skin
Reduction of unpleasant skin symptoms (e.g.,
pruritus, burning, odor)
Restoration of (subclinically) damaged skin
(e.g., dry and inflamed skin)
Reinforcement of undamaged but vulnerable
skin (e.g., skin surface pH balance, germ
reduction)
Protection of damaged, undamaged and
vulnerable skin from various noxes
Providing a pleasant skin feel (well-being).
The functionality of the skin care products
ranges from mono-functional, e.g., protecting
barrier creams to poly-functional, e.g., soothing
and restoring cleansers. They unfold their func-
tionality as leave-on products (e.g., moisturizing
or skin barrier products), or as rinse-off products
(e.g., cleansers). Skin care procedures ewashing/
2 C. Surber, J. Kottner
Please cite this article in press as: Surber C, Kottner J, Skin care products: What do they promise, what do they deliver, Journal of
Tissue Viability (2016), http://dx.doi.org/10.1016/j.jtv.2016.03.006

drying and the application of leave-on products e
should be as benign as possible. The unduly
removal of natural skin component (e.g., lipids),
prolonged exposure to water (e.g., long-term im-
mersion in full-baths), a (repeated) disruption of
the physiological skin surface pH, and excessive
and/or prolonged occlusion of the skin should be
avoided.
Skin care delivered to improve, e.g., the
outcome of an eczema therapy or to reduce, e.g.,
the adverse effects of a cancer therapy are often
termed as adjuvant skin care. Nonetheless, adju-
vant or the above described classic preventive skin
care pursues the similar goals.
4. The choice of vehicle
There is an overwhelming range of skin care
products on the market with a multitude of
promises and application recommendations. The
latter often includes recommendations regarding
the choice of vehicle. However, these recommen-
dations are unfortunately often founded on faulty
science. One reason is the absence of a clear and
persuasive terminology for vehicles. Current rec-
ommendations rarely differentiate between
vehicle effects (moisturizers, emollients, humec-
tants, etc.) and vehicle formats (ointments,
creams/lotions, gels etc.), e.g., “a moisturizer is a
cream for application on face and body”. From
many recommendations suspicion may arise that
the essence of the vehicle is not fully understood,
e.g., “.unlike lotions, which do not maintain
moisture in the skin, cream moisturizers donate
moisture and aid in retention of moisture on the
skin surface .”[8]. The terms “moisturizer” and
“emollient” are often used interchangeably,
despite the fact that they describe different
mechanisms. Conceptually a moisturizer adds
moisture to the tissue whereas an emollient
softens a tissue and makes it flexible. Both, mois-
turizers and emollients may, or may not have
softening and moisturizing effects.
4.1. The concept of vehicles
Without going into physicochemical details one
may define a vehicle as a mixture of a series of
ingredients that forms a three dimensionla matrix
or format, e.g., ointment or cream, etc. The
physicochemical character of the ingredients
chosen and the manufacturing process determine
the final format of the vehicle ethe three
dimensional matrix. E.g., when two immiscible
liquid phases, each may contain several
ingredients, are mixed and stabilized an emulsion
results. In pharmaceutics and cosmetics the
emulsion is termed as a cream or a lotion. Creams
are semisolid whereas lotions are more liquid. The
difference between these two forms is primarily
viscosity. Depending on the ingredients (emulsi-
fiers) chosen to stabilize the emulsions, the
emulsion may become an oil in water (o/w) or a
water in oil (w/o) emulsion (Fig. 1).
4.2. The metamorphosis of the vehicle: the
primary and secondary vehicle
In the case of an oil in water (o/w) emulsion the
lipophilic (inner) phase is dispersed in the hydro-
philic (outer) phase. In the case of a water in oil
(w/o) emulsion the hydrophilic (inner) phase is
dispersed in the lipophilic (outer) phase. It is easy
to imagine that the sensory character of the
emulsion on the skin may be very different. Due to
evaporation of water the oil in water emulsion may
convey the immediate impression of “cooling”. A
considerable number of ingredients that are used
in many current topical formulations are volatile,
e.g., water, alcohol and even propylenglycol. Once
applied to the skin, the evaporation of volatile
ingredients may dramatically change the character
of the vehicle once applied to the skin. This phe-
nomenon is termed as metamorphosis of the
vehicle (Fig. 2)[9].
This phenomenon becomes often recognizable
as the visual aspect of the skin surface is changing.
It gives the false impression to both consumers and
Fig. 1 Depending on the ingredients (emulsifier) cho-
sen to stabilize the emulsions, the emulsion may become
an oil in water (o/w) or a water in oil (w/o) emulsion.
Semisolid emulsions are termed as creams whereas more
liquid emulsions are termed as lotions. The difference
between these two formats is primarily viscosity. It is
also easy to imagine that the sensory character of the o/
w and the w/o emulsions on the skin may be very
different. Due to evaporation of water the o/w emulsion
may convey the immediate impression of “cooling”.
Skin care products 3
Please cite this article in press as: Surber C, Kottner J, Skin care products: What do they promise, what do they deliver, Journal of
Tissue Viability (2016), http://dx.doi.org/10.1016/j.jtv.2016.03.006

professionals that the product is well absorbed,
even though only volatile ingredients are evapo-
rating. Absorption into or through the skin of any
ingredients eactive or inert edemands much
more time.
As a consequence one may differentiate be-
tween two types of vehicles ethe primary vehicle
in the tube, bottle or jar and the secondary vehicle
that forms after application on the skin. The latter
has lost all or significant amounts of its volatile
ingredients. In addition the original three-
dimensional matrix may have completely
changed. The primary vehicle is responsible for the
application sensation whereas the secondary
vehicle is responsible of the subsequent skin feel
and long-term effect.
4.3. The polarity (hydrophilicity vs. lip-
ophilicity) and viscosity of vehicles
The properties of ingredients ehydrophilic (solu-
bility in water) or lipophilic (solubility in oil) e
chosen to formulate the vehicle, determine its
final character. This means etheoretically and
practically ethat for most of the vehicles (e.g.,
ointments, creams/lotions, gels and pastes) a hy-
drophilic and a lipophilic form exist, e.g., hydro-
vs. lipolotion or hydrogel vs. oleogel. From a
practical point of view, it is important to note,
that lipophilic formulations are often less effec-
tively removed from the skin than hydrophilic
formulations. In the case of stressed skin topical
formulation must be easily removable and an
appropriate cleansing product/procedure has to
be chosen. Viscosity is another important product
feature that should be considered. Low viscosity
products are preferably used on larger skin areas,
whereas high viscosity products are used on
smaller areas. As a consequence for the future one
may expand previous criteria of vehicle choice
(ointment, cream/lotion, gel, paste) and also use
polarity (hydrophilic vs. lipophilic) and viscosity
(low vs. high). Hydrophilic vehicles are more suit-
able for moist and lipophilic vehicle are more
suitable for dry skin conditions. Low viscosity ve-
hicles are more suitable for larger whereas high
viscosity vehicles are more suitable for smaller skin
areas (Fig. 3)[9].
For daily practice, healthcare professionals,
patients and consumers may put more emphasis on
polarity and viscosity of the vehicle rather than
the vehicle format. As these features are rarely
mentioned on the product labeling or in the
accompanying information only own previous
experience or recommendations from third parties
may help to choose the adequate product of
preference. Another option is to rely on the func-
tionalities claimed on the product.
5. Product functionality
5.1. Cleansing products
Skin cleansing includes washing, showering and
bathing. It removes dirt, sebum, microorganisms
15 seconds
after application
30 seconds
after application
1 seconds
after application
Fig. 2 In clinical situations, most topical vehicles (structural matrix and ingredients) undergo considerable changes
after they are removed from the primary container and are applied onto the skin. The fast breaking foam spray is a
distinctive example for the metamorphosis of the vehicle. This phenomenon tempts both consumers and professionals
to believe that the product is well absorbed, even though only volatile ingredients are evaporating. Relevant pene-
tration into and permeation through skin (absorption) of any ingredient may demand more time than for the meta-
morphosis of the vehicle [9].
4 C. Surber, J. Kottner
Please cite this article in press as: Surber C, Kottner J, Skin care products: What do they promise, what do they deliver, Journal of
Tissue Viability (2016), http://dx.doi.org/10.1016/j.jtv.2016.03.006

and exfoliated stratum corneum cells from the
skin. Cleansers are products that are used as such,
added to the washing water or are part of wipes to
remove debris from the skin in an emulsified form.
The key cleansing ingredients are the “surfac-
tants” ea term derived from the words “surface”
and “active” ethat lower the surface tension on
the skin and hence remove the debris. “Syndet” is
another portmanteau word created by combining
the words “synthetic” and “detergent”. Soaps
were the first surfactants people used for
cleansing. They are made by reacting fatty acids
with a base (e.g., sodium hydroxide) ea process
that is called saponification. All the terms are
often used as linguistic synonyms even though the
physicochemical difference between the classic
soap and syndets/detergents is distinctive. Tradi-
tional soaps have a pH of 9 to 10 whereas syndets/
detergents show a pH of 5 to 6 [11]. The latter pH
is preferable for the skin and it was shown that the
artificial reduction of the skin surface pH promotes
the skin integrity in aged and compromised skin
e.g. [12]. Depending on the emulsifying capability
of the surfactants, they may disturb or disrupt the
skin barrier and hence aggravate unfavorable skin
conditions [13,14]. Cleansers may contain antimi-
crobials (e.g., benzalkonium chloride or iodine) or
humectants (e.g., glycerin) or occlusives (e.g.,
paraffin) to compensate cleansing-induced dam-
age. Because cleansers are rinse-off products the
effectiveness of antimicrobial additives has been
questioned [15]. The effect of other additives may
also be questioned because significant amounts
are lost during cleansing. Acidic cleansers with
“mild” surfactants (non-ionic/silicone-based sur-
factants) eminimal disturbance/disruption and
yet high rinsibility eare generally recommended
to cleanse vulnerable skin [2,6]. There may be
situations in clinical practice, in which the expo-
sure to water and cleansers must be restricted to a
minimum, e.g., severe xerosis cutis [16].
5.2. Soothing, restoring, reinforcing
products
Even though there are linguistic differences be-
tween the terms soothing, restoring, and rein-
forcing, it is difficult to subcategorize products
accordingly. The soothing character of a product
can rarely be awarded to a single substance in the
product. Products restoring the skin (e.g., mois-
turization) will most likely soothe the skin (e.g.,
pruritus). Reinforcing products will create or sup-
port natural and healthy skin conditions (e.g.,
acidic skin pH, limit bacterial/fungal growth).
5.3. Protecting products
“Barrier cream” is the colloquial term for topical
products that are placed as physical barriers be-
tween the skin and contaminants that may harm the
skin. “Barrier creams” may also be intended as
products that may restore damaged skin. In this
sense, any moisturizing or emollient product can
Polarity
Viscosity
high
low
lihpopillihpordyh
1
2
3
4
56
7
8
9
10
Area to be treated
small
large
Skin / Dermatosis yrdtsiom/tew
Fig. 3 From a theoretically and practical point of view polarity (hydrophilic vs. lipophilic) (x-axis bottom) and
viscosity (low vs. high) (y-axis left) are relevant vehicle features to consider when choosing a product. Hydrophilic
vehicles are more suitable for wet/moist and lipophilic vehicles are more suitable for dry skin conditions (x-axis top).
Low viscosity vehicles are more suitable for larger whereas high viscosity vehicles are more suitable for smaller skin
areas (y-axis right). Typical vehicles are: (1) aqueous solution; (2) o/w- or hydrolotion; (3) o/w-cream; (4)
hydrogel, hydrophilic ointment; (5) cross-linked hyaluronic acid gel (cubed water); (6) lip stick; (7) lipogel,
lipophilic ointment; (8) w/o-cream; (9) w/o- or lipolotion; (10) oil [10].
Skin care products 5
Please cite this article in press as: Surber C, Kottner J, Skin care products: What do they promise, what do they deliver, Journal of
Tissue Viability (2016), http://dx.doi.org/10.1016/j.jtv.2016.03.006

also be considered as potential skin barrier im-
provers [17]. Unfortunately, the terms are used
vaguely eboth in guidelines and scientific papers.
Furthermore “cream” is just one possible vehicle
format of such products eother forms such as
ointments, pastes, sprays or foams also exist. To
avoid linguistic misunderstandings one may differ-
entiate between “barrier products” and “barrier
repair products” (see also restoring products). The
first is defined as a product that provides primarily a
barrier against noxious agents, the latter is defined
as a product with the clear intention to restore and
reinforce the skin. However, barrier products obvi-
ously do not work only based on a physical shielding
of the skin; they may also alter the biochemistry of
the potential irritant [18]. Barrier products cannot
simultaneously provide a barrier against all noxious
agents. It is generally believed that more lipophilic
formulations are effective against hydrophilic so-
lutions of irritants, and hydrophilic formulations are
more effective against lipophilic materials. Even
though studies have shown effects of barrier prod-
ucts in age-associated skin conditions (prevention of
superficial pressure ulcers and incontinence-
associated dermatitis) their general benefits are
still debated [2]. Functionality is an adequate mean
to describe a skin care product and alleviate the
product choice. However, the industry is prone to
exaggerated embellishments of the product func-
tionality and reliable choices are often difficult.
6. The vehicle and the actives
A vehicle is something that carries, delivers,
transports etc. A vehicle for topical application
may carry, transport or deliver APIs or cosmetic
actives. While often expected, the effect of most
skin care products cannot be assigned to one single
“active” ingredient. The following example may
illustrate this fact. A skin care lotion may contain
glycerin, dimethicon and/or paraffin. They are
concurrently integral part of the vehicle and active
ingredient. Glycerin (hydrophilic ingredient)
termed as humectant attracts water from the
environment and from within the skin once pene-
trated into the stratum corneum. Dimethicone
and/or paraffin (lipophilic ingredients) are termed
as occlusives keep the moist within the skin by
decreasing transepidermal water loss of the skin
through occlusion. These ingredients formulated
into emulsions (moisturizing creams or lotions)
serve concurrently as vehicle ingredients and as
actives.
The range of generic and branded actives that is
offered worldwide is overwhelming. Examples are
allantoin, ascorbyl palmitate or ubiquinone
(CoQ10) etc. for generic actives and Soothex

(soothing action for sensitive or over-reactive skin
types) or Yogurtene

Balance (probiotic efficacy;
promotes beneficial bacteria) etc. for branded
actives. Unfortunately the claim substantiation is
often poor and do not comply with current scien-
tific standards.
7. Regulatory issues
Skin care products can theoretically be assigned to
three different regulatory classes emedicinal
products, medical device and cosmetics. For me-
dicinal products and medical devices a health
promise is allowed whereas for cosmetics a health
promise is prohibited. The health promise refers to
the preventive and/or therapeutic purpose of the
medicinal product or the medical device. They
achieve their principal intended action in or on the
human body by pharmacological, immunological or
metabolic means (medicinal products) or by non-
pharmacological, non-immunological or non-
metabolic means (medical device), respectively.
Cosmetics are meant to clean, to perfume, to
change appearance, to correct body odor, to pro-
tect and to keep in good condition [1]. Currently
the majority of skin care products are cosmetics.
For medicinal products and medical devices the
indication are clearly labeled, e.g., xerosis cutis or
pruritus. In cosmetic products claims often
describe their functionalities and may be as simple
as “soothe signs of dry skin” but may also be more
fanciful like “Multi-Ingredient Anti-Aging Moistur-
izer Designed to Improve the Appearance of Facial
Skin” [19]. It is important to note, that while the
boundaries of the three regulatory classes seem
well defined, there are many examples to
demonstrate that these boundaries are not as well
defined as one may assume. For instance identical
products are marketed as cosmetics or medicinal
products in different European countries. Occa-
sionally, you will find that regulatory bodies will
question promotional claims and require commer-
cial suppliers to provide additional substantiation
or change the products’ claim. To increase pro-
fessional credibility and reputation some com-
mercial organizations promote their products as
cosmeceuticals and more recently started to
conduct clinical trials with their cosmetic products
[20,21]. It is obvious that the label “clinical
proven” has a promoting and valorizing effect.
However, it does not change the regulatory status
of the product and the permitted claims. A well-
known example ingredient is Aloe vera
6 C. Surber, J. Kottner
Please cite this article in press as: Surber C, Kottner J, Skin care products: What do they promise, what do they deliver, Journal of
Tissue Viability (2016), http://dx.doi.org/10.1016/j.jtv.2016.03.006

incorporated in many topical formulations. The
authors of a recent Cochrane Review on the effect
of Aloe vera topical agents or Aloe vera dressings
as treatments for acute and chronic wounds came
to the conclusion that there is currently insuffi-
cient clinical trial evidence available [22]. This
was primarily due to the lack of high quality trials
with adequate methodology. Currently, this judg-
ment also applies to many of the “active” cosmetic
ingredients and their supposed effects.
This regulatory situation is unknown to most of
the consumers and healthcare professionals. They
have to trust the current regulations on cosmetic
products and quality standards used by the
manufacturer.
8. Concluding remarks
Today a vast armamentarium of skin care products
to clean, soothe, restore, reinforce, protect and to
treat our skin and hence to keep it in “good con-
dition” is available. Skin care products are char-
acterized by effects, evoked by actives that are
delivered through vehicles that rely on specific
technologies. Due to the fact, that these products
are in direct contact with the target tissue, the
vehicle ingredients are able to profoundly modu-
late the characteristics of the skin including
causing adverse effects. This means that profes-
sional healthcare practitioners have a substantial
responsibility for skin health while delivering skin
care [23]. Essential for any effect are the vehicles
and the actives. It is suggested when choosing a
skin care product, that other criteria than just the
classic vehicle terminology (ointment, cream/
lotion, gel, etc.) should be considered. It is pro-
posed to include polarity (hydrophilicity vs. lip-
ophilicity) and viscosity of the vehicles to better
address the actual skin condition/situation. It
should also be pointed out, that vehicles contain-
ing volatile ingredients would profoundly change
their character once applied to the skin. The res-
idue of a vehicle after application (secondary
vehicle) determines the vehicle ingredient
dependent effects on the skin. An incredibly large
amount of generic and branded actives are offered
to enhance topical skin care. However the scien-
tific data to support these effects and the
concomitant claims are often vague and do not
comply with current scientific standards. Current
recommendations are often based on personal
experience, opinions or at best on consensus doc-
uments rather than on scientific data retrieved
from controlled clinical trials. Today most skin
care products are classified as cosmetics. Despite
the fact that no health claims are allowed for skin
care products classified as cosmetics this product
category is successfully promoted in the skin care
business.
Conflicts of interest
There are no conflicts of interest.
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8 C. Surber, J. Kottner
Please cite this article in press as: Surber C, Kottner J, Skin care products: What do they promise, what do they deliver, Journal of
Tissue Viability (2016), http://dx.doi.org/10.1016/j.jtv.2016.03.006