INTRODUCTION

The value of marketing is sometimes not obvious to physicians. But, without marketing, physicians would have a more difficult time learning about many of the treatments they use. Marketing allows manufacturers to educate consumers and/or physicians about the products they make and their benefits. A poor product will not succeed with marketing alone, but many good products have failed as a result of lack of marketing, or from poor marketing.

So, what constitutes good marketing? Concisely, effective marketing helps the physician provide a better outcome for the patient by persuading her or him to use the promoted product. But, when digging just a little deeper into that statement, one will see the challenges of marketing. Which physicians are targeted for promotion? What outcome is sought? Which patient is the right one for this product, likely to have the targeted condition, and seen by the targeted physician? What product should the manufacturer promote? What makes a product worthy of promotion and likely to succeed, and conversely which ones should not be promoted to physicians? Done well, and for a good product, marketing can be a win for manufacturers, physicians, and, ultimately, for the patient.

The physician’s challenge is to sort out from a number of product marketing efforts those products deserving of support. How can the physician make that determination? First, with an admitted bias, it seems that a larger company has more resources to commit to testing to prove their products worthy of support, and more to risk if they were to market a product that does not meet high standards.

There are three categories of concern for any health product, whether intended for skin health or for any other health condition. These categories are safety, efficacy, and compliance. This framework works well for the physician trying to decide which products to support. The manufacturer must make a product that performs well in each regard and persuade the professional and the patient of that fact.

SAFETY

Safety testing done by a research-driven company begins with a four-step process of selecting the right ingredients. First, screening is done on potential new ingredients for a variety of acute and/or chronic toxic endpoints. Examples of screening include tests for acute toxicity, neurotoxicity, developmental and reproductive toxicity, mutagenicity, carcinogenicity, eye and skin irritation, and skin allergic response.

Once a critical toxic event is identified (generally the toxic effect seen at the lower doses of the ingredient), dose–response studies are used to determine the highest dose at which no toxicity is seen. Next, use of a product is studied to calculate the actual exposure to the ingredient a consumer will encounter. Finally, a mathematical analysis will determine a margin of safety, which would compare the level of an ingredient where no adverse event was detected with the expected level of human exposure usage in the real world. If the margin of safety is high, the ingredient can be used.

This ingredient testing is just an example of the thoroughness with which leading companies test products. In addition to ingredient testing, before formulating a product, testing is done for ecological safety. Specifically, testing is done for ecotoxicity and biodegradability. It is not enough to determine that a product has a high margin of safety in use—the environment also needs to be considered and protected.

Finally, a finished product will be tested for irritancy and sensitization potential. Irritancy is tested for both diluted and undiluted products in repeated exposure. Sensitization is tested using models such as a repeat insult patch test. Because light can exacerbate allergic responses in some instances, testing combining ingredient exposure with light exposure is carried out. The product will be tested for stability (Does it work as labeled even after exposure to extreme temperature?) and to be sure the product and packaging prevent bacterial growth from occurring in real world circumstances.

EFFICACY

Efficacy is evaluated in numerous ways. There are two primary categories of measurement for ‘antiaging’ moisturizers: ‘health’ benefits (how good a moisturizer it is) and ‘beauty’ benefits (its effect on appearance of fine lines and wrinkles, skin tone and texture, etc.). For ‘health’ benefits, transepidermal water loss (TEWL) can be measured objectively, as can capacitance, an indirect measure with a correlation to moisturizer efficacy. Expert grading is carried out to evaluate visual dryness and redness.

In the beauty category, leading edge measurement uses digital photography with carefully controlled lighting and facial positioning which allows either naïve graders or expert graders to view side by side pre- and post-treatment images to evaluate improvement. Computer imaging can also be used to evaluate skin topography and tonality changes. To understand how advanced corporate progress is in this regard, the Canfield Visia® computerized imaging system was developed from Procter & Gamble technology. Other measures include the traditional skin turnover evaluation using dye and tracking number of days until the dye is not visible. This can be evaluated either by a trained grader or by using imaging technology to identify the presence of dye.

The leaders in the field, who have written chapters elsewhere in this volume, should be relied upon to understand how these measurements work. However, from a marketing perspective, how can a provider digest what proof is offered if they are not expert in all the measurement methodologies? The following questions may aid in evaluating the quality of the data:

COMPLIANCE

Compliance in the category of cosmeceuticals is most often achieved when the final product is aesthetically pleasing and can be considered overall as a cosmetically elegant product (Fig. 4.1). Such attributes as having superior packaging, a nice feel and spread during application, absorbing readily into the skin, and improving the appearance of the skin immediately in a cosmetic or superficial way are all important when it comes to product usage compliance.

Fig. 4.1 The aesthetics of a cosmeceutical influences compliance

Patients are more inclined to learn about and experience the long-term benefits of a product when there is an initial attraction to the aesthetics and an instant gratification benefit. Some examples of ingredients that provide acute benefits are light diffusers (e.g. titanium dioxide) and visual opacifiers (e.g. micropigments) which are used to diffuse or reflect light away from the skin’s surface, helping to reduce the appearance of fine lines and wrinkles and reduce shininess.

Compliance can also be assured by having clear, concise instructions for the patient to follow. Patient education is a valuable tool for compliance often overlooked by over-the-counter product manufacturers. For example, a product that contains alpha hydroxy acid (AHA) should have clear instructions which state that this product may increase skin sensitivity to the sun, and therefore sun exposure should be limited and protective clothing and accessories be worn while using the product. Recommendations for night usage only may also be included. If the client fails to receive this important information and uses the product unprotected during the day and happens to experience an adverse reaction, it is unlikely that the client will ever use the product again. In fact, this patient may have been an excellent candidate for the product, remained compliant, and obtained the intended benefits had they been properly informed and educated on correct product usage.

MARKETING TRENDS

The demand for cosmeceuticals has exploded since the introduction of hydroxy acids for exfoliation and wrinkle defense in the 1980s. The use of Botox, which began in the late 1990s, also coincides with increased demand from consumers for nonsurgical procedures to address the visible signs of aging. The US is the largest market for cosmeceuticals with sales of $4.2 billion in 2006 (Datamonitor, April 2007). Sales for 2007 exceeded $5 billion, with skin care products remaining dominant at approximately 80% of total sales. Forecasters estimate that demand will grow at an annual rate of between 8 and 11% through 2010.

According to the American Society for Aesthetic Plastic Surgery (ASAPS), the use of Botox increased 3387% from 1997 to 2003. During the same period, nonsurgical procedures increased 430% from about 1.1 million to well over 6 million procedures. Surgical procedures advanced 87% during this time to about 1.8 million.

Although women remain the target group for marketers, men are fast becoming skin care consumers, representing the fastest growing segment of the skin care market. Certainly the Baby Boom generation, which is now in its sixties, is the largest segment of the market seeking products with antiaging benefits. However, it is not just the Boomers who are seeking the proverbial fountain of youth. Generation X, the thirty-plus generation, is taking a cue from the Baby Boomers. Where the Boomers are looking to turn back the clock, Gen Xers see an opportunity to stop the clock and, in doing so, are creating a new target market for preventive care.

Driving market growth is consumer demand for effective and natural solutions. The increased popularity of organic and natural products has generated an increased focus on these properties in the marketing of cosmeceuticals. Marketers are also focusing on product efficacy, which consumers rate as a product’s most important attribute. Consumers want a product that feels good and provides measurable, noticeable results. Therefore, while some consumers favor natural ingredients, others favor products with active ingredients, which they closely link to efficacy and results. Opinion research suggests that consumers are willing to pay a small premium for superior efficacy and benefits that meet their specific needs.

EDUCATIONAL MARKETING

For today’s consumer, health and beauty messages are pervasive in mainstream marketing. Marketers must engage a competitive educational strategy that breaks through the noise of other health and beauty messages while communicating the superiority of their product. Today’s savvy consumer expects products that are going to deliver results and understands that more expensive does not automatically mean better. The following is an overview of the various ways in which marketers educate consumers about their products.

MARKETING DISTRIBUTION CHANNELS

Marketers have looked beyond traditional retail to a variety of distribution channels, offering consumers more purchasing options and differentiating their products from competitors. Many consumers have been receptive and cosmeceutical sales have flourished through this expanded group of distribution channels over the last several years. The depth and breadth of channels account for fast-growing sales and reflect changes in consumer purchasing habits.

SUMMARY

The US cosmeceutical market is growing rapidly and shows no sign of waning in the future. The race to develop new products is highly competitive and innovation is the watchword. The exponential growth of the cosmeceutical industry can be linked to many factors, including:

Some physicians may view the rapidly expanding market as bad news, because it can be difficult to stay up to speed with the wide range of products. But it also represents an opportunity. Patients can readily assess whether a moisturizer has caused their dry skin to stop itching or look better in the short term. However, they are often ill-equipped to know whether a particular anti-aging product delivers on the advertising claims and word-of-mouth hype.

With the multitude of products available, what is the discerning physician to do when a patient seeks expert recommendations? First and foremost, look to companies that are investing in advanced, large-scale clinical research. The increasing amount of science behind product research will help physicians navigate product information and guide recommendations. Second, look for key ingredients that are known to deliver benefits in a safe and efficacious delivery system. Finally, embrace the opportunity to educate patients on products and ingredients. Many consumers lack the knowledge and training to understand the benefits these advanced products offer. For this information, they will always rely on the opinion of a well-informed expert. For most, that expert is the dermatologist.