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Several factors important when recommending moisturizers

Dermatologists should consider price, preference and allergy-related factors when recommending moisturizer to their patients, according to recent findings.

The current cohort study included 109,713 reviews of 174 best-selling moisturizer products from Amazon, Target and Walmart. Researchers excluded moisturizers that were recommended for use on a specific body part. Reviews through August 2016 were included in the analysis.

The investigators evaluated median price per ounce by comparing products with similar marketing claims, such as those that were dermatologist recommended, fragrance free or hypoallergenic.

Results showed that the median price per ounce was $0.59 (range, 0.10-9.51). The range was 9,400%, according to the data sets.

Lotions comprised 59% of the products, while 13% were creams, 12% were oils, 8% were butters and 2% were ointments.

North American Contact Dermatitis Group (NACDG) allergen-free products comprised 12% of the moisturizers. In analysis by allergen, fragrance mix was present in 87 of the products, while 75 contained paraben mix and 74 contained tocopherol.

The median price of products that claimed “dermatologist recommended” was $0.79 per ounce (interquartile range [IQR], 0.56-1.27), whereas those without the claim cost $0.59 per ounce (IQR, 0.34-0.92).

Similarly, products with the claim “phthalate-free” ($1.38 per ounce; IQR, 0.86-1.63) were more expensive compared with those without the claim ($0.59 per ounce; IQR, 0.35-0.91).

Researchers also reported the following median per-ounce costs: oils, $1.30 (IQR, 0.64-2.43); butters, $1.20 (IQR, 0.76-1.63); creams, $0.80 (IQR, 0.69-1.25); and lotions, $0.49 (IQR, 0.31-0.68).

At least one fragrance cross-reactor or botanical ingredient was found in nearly half (45%) of products with a fragrance-free claim.

Products with no ingredients from the NACDG carried a median cost of $0.83 (IQR, 0.47-1.69) per ounce, which the researchers noted was not statistically more expensive than the median cost of those containing one or more allergens ($0.60; IQR, 0.35-1.06).

“Best-selling moisturizers vary widely by price and product characteristics,” the researchers concluded. “Given the lack of readily available comparison data on moisturizer efficacy, dermatologists should balance consumer preference, price and allergenicity in their recommendations.”

In an accompanying editorial, Matthew J. Zirwas, MD, of North American Contact Dermatitis Group, Bexley, Ohio, commended the investigators for raising awareness of the challenges facing dermatologists and consumers in making sense of moisturizing products.

“Their original approach of using sales data provides a snapshot of what consumers are actually using (lotions!), and their assessment of commonly used marketing terms and their connection to cost and product composition are innovative,” he wrote, and noted that the study design set a high bar for what should be considered hypoallergenic. “This is probably excessive because the NACDG standard tray includes some uncommon allergens, which when contained in products should not disqualify them from being considered hypoallergenic.”

Slow-moving updates to the NACDG standard tray should be considered, also, according to Zirwas. Clinicians are encouraged to also consult the American Contact Dermatitis tray for other allergy-related information, and to generally be vigilant about what products may or may not contain.

“One of the most challenging aspects of this counseling is teaching patients that they cannot trust the terms hypoallergenic or fragrance free,” Zirwas wrote. “The work by Xu et al. nicely reinforces the importance of emphasizing this.”

In addition, Zirwas provided recommendations for determining whether products are hypoallergenic that include:

Consulting the most recently published American Contact Dermatitis Society core series for a list of potentially allergenic ingredients; and

Stressing that a “nonallergenic product” does not exist, and that the only way to rule out allergic contact dermatitis is with comprehensive patch testing.

Zirwas also wrote that to be considered hypoallergenic, a product must be free from any potentially allergenic ingredients for which there are no published data from the past 5 years; and must not contain any potentially allergenic ingredients that have a 1% or greater frequency of positive patch test results in a patch test data set containing at least 1,000 patients that has been published in the past 5 years. – by Rob Volansky

Disclosures: Xu reports consulting for VisualDx; Xu and Kwa own an equity interest in an online health resource providing safe product recommendations to consumers. Zirwas reports consulting for Fitbit, Genentech, L’Oreal, Regeneron, Sanofi, and Valleant. The other authors report no relevant financial disclosures.