Uncovering the truth about skincare: a dermatologist’s perspective [PODCAST]

Listen and followApple PodcastsSpotifyYouTubeMore apps · Browse all episodes

In this episode, we have Fayne Frey, a dermatologist and author of The Skincare Hoax: How You’re Being Tricked into Buying Lotions, Potions & Wrinkle Cream.

We delve into the world of skincare and the billions of dollars spent on products that may not even work. Why do we spend so much money on skincare products that don’t deliver results? Why is there such a strong emphasis on looking a certain way? Fayne shares her insights as a dermatologist and sheds light on the misleading messages perpetuated by the cosmetics industry.

Fayne also provides a historical perspective on the use of cosmetics and how marketing has shaped our cultural beliefs about beauty and skincare. She debunks popular myths about dermatologist-tested products, hypoallergenic products, and the correlation between the cost of a product and its effectiveness.

Fayne Frey is a dermatologist.

She shares her story and discusses her book, The Skincare Hoax: How You’re Being Tricked into Buying Lotions, Potions & Wrinkle Cream.

The Podcast by KevinMD is brought to you by the Nuance Dragon Ambient eXperience.

With a growing physician shortage, increasing burnout, and declining patient satisfaction, a dramatic change is needed to make health care more efficient and effective and bring back the joy of practicing medicine. AI-driven ambient clinical intelligence promises to help by revolutionizing patient and provider experiences with clinical documentation that writes itself.

The Nuance Dragon Ambient eXperience, or DAX for short, is a voice-enabled, ambient clinical intelligence solution that automatically captures patient encounters securely and accurately at the point of care. Physicians who use DAX have reported a 50 percent decrease in documentation time and a 70 percent reduction in feelings of burnout, and 83 percent of patients say their physician is more personable and conversational.

Rediscover the joy of medicine with clinical documentation that writes itself, all within the EHR.

VISIT SPONSOR → https://nuance.com/daxinaction

SUBSCRIBE TO THE PODCAST → https://kevinmd.com/podcast

RATE AND REVIEW → https://kevinmd.com/rate

FOLLOW ON INSTAGRAM → https://www.instagram.com/kevinphomd

FOLLOW ON TIKTOK → https://www.tiktok.com/@kevinphomd

GET CME FOR THIS EPISODE → https://earnc.me/2cnKkU

Powered by CMEfy.

Transcript

Kevin Pho: Hi, and welcome to the show. Rate and review at KevinMD.com/rate. Subscribe at KevinMD.com/podcast. Today on the show, we have Fayne Frey. She’s a dermatologist, and she’s the author of the book The Skincare Hoax: How You’re Being Tricked into Buying Lotions, Potions & Wrinkle Cream. Fayne, welcome to the show.

Fayne Frey: Hi, thank you for having me. It’s really my pleasure.

Kevin Pho: We’ll get into your book in a little bit. First off, briefly share your story and journey to where you are today.

Fayne Frey: Oh, my journey’s uneventful through high school. I come from a great family in New Jersey and fall in love with, well, chemistry, go off to medical school and fall in love with investigative dermatology, where I do plenty of research. I was able to utilize my love of chemistry in the skincare realm. It wasn’t why I got into dermatology, but more importantly, who got me there: I had some really fantastic mentors at New York Hospital and the Rockefeller University, where I did some research, and the rest is history. I became a dermatologist in love with the skincare industry.

Kevin Pho: All right, wonderful. And you mentioned the term investigative dermatology. What exactly is that?

Fayne Frey: I was interested in immunology, and where I was studying, the immunology research was being done at the Rockefeller. It was really a lot of the immunology behind psoriasis, the TNF alphas, and I did some research in leprosy. It’s really bench research. It’s the science behind some of the disease states that we treat and diagnose in dermatology.

Kevin Pho: All right. And you obviously wrote a book on the skincare industry, and we’re going to talk about that, of course, in depth. But tell us the steps that led to your interest in the skincare industry in the first place.

Fayne Frey: Well, that’s a great question. I get into dermatology, and a lot of the drug reps come into the office. And again, I was a chemist, so I really understand the ingredient listing, and I started studying them very thoroughly. A drug rep would come into the office, and she would show me several products. Now, two of the products I was familiar with: One was a body lotion, and one was the body lotion for the baby. And when you looked at the ingredient listing, they were identical.

Now, the ingredient listing is the most important information on any skincare bottle. So we have two identical skincare listings, one’s for the baby and one’s just the regular lotion, and I was enamored of that. But then she came into the office, and she says to me, “Geez, Dr. Frey, here’s a new hand cream.” And I look at the hand cream, and then I look at her, and I look at the hand cream, and she says to me, “I know.” It’s the same ingredient listing as the other two products I was already familiar with. And I said, “Is it the same product?” And she said, “Yeah, it’s actually repackaged.”

And I thought, you know, that’s kind of crazy. And I can’t even tell you that that bothered me that much, because I understand businesses; they want market share. The part that bothered me, though, Kevin, was that they were charging 40 percent more for that hand cream, and I thought, this is not right if consumers don’t understand these ingredient listings. So I knew I had to do something, and I jumped all in.

Kevin Pho: So the ingredients were the same, the proportions of those ingredients were exactly the same, except one was being charged 40 percent more. Is that correct?

Fayne Frey: Well, you don’t know the percentage. That’s a great point. All you know is that on ingredient listings, the ingredients are listed from the most, the highest concentrations, all the way down to the least, until about 1 percent. At 1 percent, the law says they can put them in any order. But the ingredient listings were identical. Could the proportions have been different? Yes, although she said to me it came from the same vat. Now, I don’t know how she knew, but this is what she told me. The consumer would have no way of knowing that information.

Kevin Pho: All right. And you wrote a book on this titled The Skincare Hoax: How You’re Being Tricked into Buying Lotions, Potions & Wrinkle Cream. So tell us the next steps of this story that led to you writing this book.

Fayne Frey: Well, here I’m now studying skincare ingredient listings, and I’m finding there are a lot of products on the market with identical ingredient listings that are on different parts of the market, one for a normal, average consumer and then one that would be labeled for baby, also with the same ingredient listing. And I decided, geez, how are these products working? So I actually purchased a Corneometer, which is a machine that measures how well a product moisturizes. It measures water content through electrical conductance, electrical charge, if you will.

And I started testing products. I would have patients put a moisturizer on one forearm and a separate one on the other forearm, and they would use them twice a day for a week. I’d invite them back, and after doing a baseline measurement, a week later I would re-measure them, and I would identify which moisturizers were actually working, which products were actually lifting the water content of the skin.

And what does anybody do with this information? So now I’m studying ingredient listings, and I know what products are working. I actually started a website. The website is called FryFace, F-R-Y-F-A-C-E, and the sole purpose was to allow my patients to go to the website and select products that I knew were working. They were products manufactured by reputable, nationally and internationally known brands, because I think they have the best resources to make the best products. The products were safe and effective, I’m testing them, affordable, and available everywhere. Because my patients were always asking me, and I’m sure many clinicians feel this way, “What’s the best moisturizer? What sunscreen should I use?” So I was trying to solve that problem for my consumers, for my patients.

Kevin Pho: So as you were going through this experiment, how many moisturizers did you test, and what kinds of moisturizers? You mentioned mostly ones commercially available in drugstores. What about things that are very expensive, super specialized?

Fayne Frey: Well, I started this so many years ago. I started testing the products that I had access to, which were, like you said, the name-brand products: products by Johnson & Johnson, the Aveenos, Neutrogena, Beiersdorf, so Eucerin and Aquaphor. And then I started expanding into the more expensive products. We tested organic products, we’ve tested the high-end products, some direct-line products, and then anything patients wanted to test. They would come in and bring in a product of their own and test it against one that we knew was working. And to answer your question, we’ve done hundreds, hundreds of these comparisons now. I mean, this has now been almost 10 years in the making.

Kevin Pho: So tell us some conclusions from your 10 years in the making, in terms of what proportion of these moisturizers in general do what they say they do, and tell us anything surprising that you found.

Fayne Frey: Well, I don’t know that it’s surprising, but I would tell you there’s absolutely no correlation between what you pay for a product and how well it works. That was a realization that I just tried to put out there for every consumer: You don’t need to spend a lot of money. A lot of the products that are labeled as eye creams, night creams, anti-aging creams, anti-wrinkle creams, age-defying creams, primers, a lot of these products, how well they work depends on their ability to moisturize, and so we test them.

Remember, these are cosmetics, which is a whole other conversation in and of itself. Cosmetics, by law, are not intended to treat disease, mitigate disease, or prevent disease. These are cosmetics that are not intended to change the structure or function of any organ, in this case the skin, or by law they’d be drugs. And as most clinicians know, drugs have to go through the FDA and get premarket approval and proof of safety and efficacy, which is not the case for cosmetics. So that was probably the other realization: how powerful marketing is.

Kevin Pho: So do most of the moisturizers out there in fact moisturize? Would you say the vast majority?

Fayne Frey: The vast majority, well, they moisturize, but not adequately, I would say. There are plenty that do. With the machine itself, there are levels that we like to get that will give you an objective number, and when it hits that number, we know you are adequately hydrated. It correlates with the percentage of water in the skin, according to the machine manufacturers.

So I would say there are many that work effectively, there are many that are moisturizing but not sufficiently or adequately, and then there are plenty that hardly moisturize at all. And we also test ones like coconut oil and some of the oils, and they rarely test adequately. So it’s not just moisturizers, but it’s other products that people use because they think they’re moisturizers.

Kevin Pho: So if I go to a drugstore and I’m looking for a facial moisturizer, tell us what kinds of things we should be looking for.

Fayne Frey: Well, the first four or five, six ingredients give you 90 to 95 percent of that product. So I can tell you the overwhelming majority of these products are water-based, so the first ingredient a consumer would look for, they’d see water as the first ingredient. The best well-formulated moisturizers, we find, are a combination of ingredients that constitute humectants. Those are ingredients that hold on to water, and that would be maybe glycerin, and you’ll commonly see that in the first four or five ingredients.

Hyaluronic acid is another real popular one right now. It’s an expensive ingredient compared to glycerin, so the cost of the product will probably be elevated, but it is a good humectant. It won’t enter the skin; it’s way too big a molecule. It won’t get in there and do all those anti-aging fancy claims, you know, into the dermis. It’s not going to get there, but it will serve a good function in the formulation as a humectant.

They also contain occlusives, which are ingredients that create a film so that water can’t evaporate. Petrolatum is a big one; that’s a common one. And of course, water and oil don’t mix, so within the first four, five, six ingredients, you’re likely going to see an ingredient like cetearyl alcohol, something that’s going to emulsify and keep the water and oil components together, from separating. So those are the kinds of things. I think when you see a product that has 60, 70, 80 ingredients, if you can really dissect the first five, six, or seven, you’re going to get a good sense of whether that product works.

Kevin Pho: So one of the things that you mentioned earlier was the marketing, right? So tell us some marketing techniques that the industry uses, you know, specifically with moisturizers, and some myths that perhaps you want to clear up.

Fayne Frey: Well, first of all, the skincare companies make great products. I’m not going to sit here and villainize them. They really make great products. But you have to remember, as a good business, Kevin, they’re advocating for their shareholders, which makes sense. We also have a consumer base that doesn’t understand the ingredient listing. So we have a clever, well-intentioned skincare industry advocating for consumers, and we have a consumer base who doesn’t understand the most important part of a skincare product, which is the ingredients. Of course, that leaves a field day for the marketing.

So on the front of the label, it’s imperative by law that the product is identified. You have to know what it is, if it’s a cleanser or if it’s a moisturizer. You also have to know how much is there, so you’re going to see a fluid ounce. After that, there’s a lot of real estate there for marketing, and the terms are endless.

A common one is “dermatologist-tested.” Now, who’s this guy who’s testing these products, or gal? Is it one doctor? Is it multiple doctors? Are they testing it on one person? Are they testing it on 10? If the budget allows, 50? Are they the person testing it themselves? And they may even be the person selling that product. So because there’s no federal standard or guideline for that term, it’s a marketing term. It doesn’t hold much weight. And there are lots of these kinds of marketing terms. I think the best, most effective, most brilliant marketing term is probably anti-aging.

Kevin Pho: Tell us more about that industry and how misleading that could be.

Fayne Frey: Well, doctors know, there are scientists all over the planet that are trying to figure out what causes aging. We have the free radical theory, you know, the antioxidant theory. We have the telomerase theory, we have the hormonal theory, we have the Hayflick theory. There are so many theories of aging. We haven’t figured out what causes aging yet, and it’s probably multifactorial, let alone a single ingredient that can reverse the aging process. We haven’t found that yet.

So anti-aging, to me, on a cosmetic, remember, this is a product that isn’t intended to permanently change the structure or function of your skin. There is no anti-aging ingredient in any of these cosmetics. So it’s a lot of marketing, and it’s powerful, and it does feed into our insecurities, and it’s unfortunate. But again, it’s a great industry that makes great products, but also causes a lot of confusion.

Kevin Pho: So we spent a lot of our time on moisturizers. What’s another big category of skincare products that you tackle in your book?

Fayne Frey: Well, sunscreen is my sweet spot. I happen to think sunscreen is the most important single skincare product to prevent sun damage and skin cancer. It is regulated as a drug in this country. It is a cosmetic in Europe, but they do have to premarket approve the sunscreen filters. But in the United States, it is regulated as a drug. And I think there’s more and more science that shows it is the most beneficial single skincare product that is available, and unfortunately, only about one in 10 Americans use it every single day. So I try to encourage my patients to jump on that bandwagon.

Kevin Pho: So just like moisturizers, you go to a drugstore or some cosmetics aisle, and there are literally hundreds of brands of sunscreen products, right? So tell us what we should look for as consumers, or even as a physician like myself, in terms of recommending one.

Fayne Frey: Well, this is one of the reasons I put FryFace out there. Sunscreens should be broad spectrum, which means they protect against both UVA and UVB, the spectrum of ultraviolet light that’s emitted that’s causing the skin damage. Sunscreens should have an SPF of 30 or higher. If those criteria aren’t met, they’re not on the website, which is sort of how we make it simple.

But the truth is, which kind of sunscreen somebody chooses is preference. Remember, these are drugs, which have passed safety and efficacy requirements. I happen to like a stick formulation. I have patients who love a lotion. I have patients who love a spray. I will say, never spray into the face. Spray into your hand and then apply it on the face. But the most important thing is putting it on daily and putting it on liberally, so that you get the SPF that is put on the front label. And again, nationally and internationally known brands have the resources to make the best products, and they have a reputation to uphold, so that’s why I recommend those.

Kevin Pho: Now, what about the different chemicals within sunscreens? Because there are different ways that they can protect the skin. So when you’re looking at the ingredients, are you looking for a specific type of ingredient, a specific type of sunscreen, or do they all work similarly?

Fayne Frey: Well, that’s a great question. So there are basically the mineral and non-mineral sunscreens. The mineral sunscreens, everyone knows, are zinc and titanium, zinc oxide and titanium dioxide. There’s huge marketing to push toward those. Honestly, if you look historically, Consumer Reports, for example, has tested the most effective sunscreens year after year, and the top most effective sunscreens are never the mineral sunscreens. They’re always the non-mineral sunscreens.

But there’s been a lot of publicity around absorption in higher quantities, and in studies by the FDA that have been done recently, what we call maximal-use studies, sunscreen was applied to individuals four times a day on 75 percent of their body, and there was an increased level of non-mineral sunscreens, just above the level at which the FDA said, “Hey, we’ve got to look at this and just make sure they’re safe.” They never said not to use them, and they never said they’re not safe. They just said, “Look, we’re getting absorption under maximal use. Let’s look at this a little closer.” To me, that was not a reason to not encourage people to use sunscreen.

I happen to like non-mineral sunscreens because I don’t like the white cast it leaves on my face, and anybody with a darker pigmentation to their skin, they actually despise, you know, that white cast on their face. It’s just not comfortable. So I don’t think it matters whether you use mineral or non-mineral, unless you’re a child or you have sensitive skin, because the mineral sunscreens are much less likely to give you an allergic reaction. So there are some conditions where I would encourage people to use the mineral products, but for most people with healthy skin, I think it’s personal preference.

Kevin Pho: We’re talking to Fayne Frey. She’s a dermatologist, and she’s the author of the book The Skincare Hoax: How You’re Being Tricked into Buying Lotions, Potions & Wrinkle Cream. Fayne, what are some of the other high points from your book that you want readers to come away with?

Fayne Frey: Well, one, for healthy skin you only need a really simple regimen. You don’t need a complex regimen. Sunscreen’s a must. If the skin is dry, use a moisturizer, because skin functions optimally when it’s hydrated. It is an organ, and it’s the barrier to the environment, so it will protect you from bacteria, mold, fungus, allergens, and ultraviolet light, and it will do that best when it’s hydrated. So a moisturizer if and when you’re dry, and a cleanser if you choose.

You know, we always have this conversation, Kevin, about cleansing, and I’m not talking about hand washing. There’s a lot of good evidence that shows hand washing around food preparation and using the facilities is beneficial to preventing gastrointestinal disease, and I think we see that worldwide, as water supplies and hand washing go hand in hand. But as water supplies get healthier and cleaner, aside from hand washing, there is very little science that shows using a cleanser on your face is beneficial for somebody with healthy skin.

So if women wear makeup, or men, and they want to wash the makeup off so they don’t soil their pillowcase, I encourage it with a mild, soap-free cleanser. But there’s very little science that says you’re going to have healthier skin for it. If anything, there’s more science that says the more cleansing we do, the harder it is on the skin, so I would argue the opposite. But that’s an important point.

And the other issue is this: A healthy skin mimics a healthy body. And Kevin, it’s not the sexy answer, and it’s not the answer people want, or the quick fix, but healthy skin mimics, aside from getting good genetics, which we have no control over, a healthy lifestyle. And I’m sure you’ve podcasted with plenty of people who give you the benefits of exercise and a healthy diet and a good night’s sleep. I’m a firm believer in a lot of laughter. I don’t have the science to prove it, but I believe it, in addition to your daily sunscreen.

And I guess my last bit of advice would be to be cognizant and mindful of the influences that a lot of these marketing ads have on our psyches, that make us feel inadequate, not pretty enough, not handsome enough. You have too much hair, I’ll give you something to get rid of it. You don’t have enough hair, I’ll sell you something to grow it. Those are feelings of inadequacy that oftentimes accompany the marketing, and if you’re mindful of them, I think you’ll be a wiser consumer.

Kevin Pho: And my final question: Tell us some of your take-home messages that you want to leave with the KevinMD audience.

Fayne Frey: My take-home message is you’re probably awesome the way you are. Take care of yourself and enjoy every day. And I hope you enjoy The Skincare Hoax. It’s a labor of love for me, and my goal, again, is to advocate for the consumer who doesn’t have the knowledge base to understand ingredient listings in skincare products.

Kevin Pho: Fayne, thank you so much for sharing your time and insight, and thanks again for being on the show.

Fayne Frey: Kevin, my pleasure.

Listen and followApple PodcastsSpotifyYouTubeMore apps · Browse all episodes