Author's note: This dialogue, the second of a two-part series (see Part I), is based on a presentation given by Katerina Steventon, PhD, (KS) at the Anti-Ageing Skin Care Conference on June 12, 2012, in London. It establishes a conversation with Steve Barton (SB), a skin biologist, to discuss concerns and perceptions of British consumers related to skin care. Barton has extensive experience working with marketing teams to improve communication of skin care benefits to consumers by initiating communication between the consumer and the formulator.
KS: British consumers want to resolve all concerns, often without understanding the cost and risk involved. Cosmetic procedures, including surgery and injectables are a fast growing business, with £1.3 million procedures bringing in £2.3 billion in the U.K. in 2010. However, the recent implant crisis shows that the risks have been downgraded and there are issues with realistic consumer expectations. Skin care can never be as effective as radical surgery. Air-brushing and enhanced images that mimic the effect of surgery are false promises and are damaging to the skin care industry. The realistic targets include matching the efficacy of retinoic acid, the benchmark prescription therapy for fine wrinkles, and endorsement of skin care routines that deliver noticeable, small differences in reducing skin concerns.
SB: Recent agreements between Cosmetic, Toiletry & Perfumery Association (CTPA) and the Advertising Standards Authority (ASA) in the U.K. have clarified the use of pre- and post-production changes in advertising images. While consumers may compare their skin care to surgery, a review of consumer expectations of “surgical” procedures suggested that people prefer subtle alteration. This may be supported by L’Oréal’s Laser Renew, a product presumably trialed versus laser resurfacing, a less invasive form of “surgical” intervention.
KS: The U.K. consumer responds to media coverage of new launches. A good example is the third party endorsement of Boots Protect & Perfect Serum on the BBC's Horizon in March 2007. The trial has been critiqued by the scientific community; however, the consumer demand brought Boots significant commercial success at the time. Two papers published since the TV program show a significant increase in fibrillin-1 deposition in six months and clinical improvement in facial wrinkles after 12 months (6 month, double-blind, randomized, controlled trial with a further 6 month open phase) compared to the vehicle and vehicle projection, respectively. This was the first clinically proven product that brought a step change in consumers’ expectations.
SB: Cosmetic formulators have a long history of utilizing dermatologist's view of the processes in skin and its changes with age; however, the prevailing view of dermatologists is that cosmetics only providing temporary improvement in skin dryness or protect from UV damage using high SPF products. Accepting this dialogue requires agreement on standards of proof and scientific methodology, focusing on clinical outcome. Can cosmetic performance be tested in a clinical trial? The choice of placebo for placebo-controlled studies is also a challenge, with no real definition of a cosmetic placebo.
Boots was confident that the Protect & Perfect product could influence some skin aging factors from in vitro studies. This hypothesis was tested in a biopsy study investigating fibrillin expression with positive results that were eventually shown on the BBC program. The goal of this study was not provide clinical proof; the consumer (and press) made this extrapolation. Rather, the biopsy study provided the confidence to go into this clinical trial.
Formulator's often find themselves in this position with new ingredients from suppliers that are formulated in bland bases. Amidst the surge in use of the Protect & Perfect product, there was some negative reaction. Interestingly, some customers who had changed from their usual routine to the serum, or started using the serum alone, found that it was not as good as their usual moisturizer. This was not surprising to formulators since it had not been formulated as a moisturizer. The serum was intended to deliver a more intense benefit and serve as an adjunct to a moisturizer. It was clear that the message consumers heard was "the first 'clinically proven moisturizer' rather than the first product to have been tested in this manner. The overall lesson here is the need to ensure that simplifying the communication does not leave some important consumer needs unfulfilled. Education and clear advice at point of sale help this process, which is difficult when a product is selling at a rate of 1 every 10 seconds
KS: Other long-term efficacy studies such as a double-blind, randomized, controlled, split face study, a comparison of a skin care product and a prescription treatment and a double-blind, vehicle-controlled trial followed the Boots trial. Some consumers ask for claims substantiated by an independent, blinded, long-term clinical trial with subjective views of the participants and clinical expert grading and objective scientific data obtained by non-invasive measurement. Initially expensive, this strategy drives commercial success. It differentiates between products with similar benefits, which is important in a purchasing environment without a dedicated sales consultant.
SB: I am interested in your statement that some consumers ask for claims substantiated in complex ways. I would suggest that they are looking for increased confidence, and cosmetic products offer the range of “confidence surrogates” that you describe.
Polling consumers in a number of different ways of communicating scientific claims testing shows little differentiation between terms currently in use, suggesting they have similar value. Who are we trying to convince? I would argue that the cosmetics industry is trying to convince ourselves first. Next, as exemplified above, the cosmetic industry is trying to convince dermatologists, who believe that cosmetics exert little or no permanent or cumulative effects. The cosmetics industry is also trying to ensure that consumers are getting something beneficial. These outcomes must be communicated to consumers, the same consumers who have diverse needs and are driven by emotional as much as rational evidence.
This leaves the product developer with the challenge of identifying novel ways of saying the same thing—this product will help improve the signs of aging in your skin. Formulators are driven to use complex skin assessment methods that rarely measure the identified cosmetic characteristic directly. In panels, volunteers are often selected by age group even though the particular signs of aging are more relevant. The data is then analyzed with a view to arriving at a population mean effect, when it is known that sub-groups and responses will differ. Using these methods and relating the measure to the cosmetic end-point therefore requires a skill in communication to the consumer. The industry is driven in this direction in part as a response to regulatory controls, where a single model (often a clinical trial) is the most trusted model. Formulators need to engage more with the regulators and their advisors to better understand the burden of proof.
KS: The level of evidence required depends on the target consumer group. Sometimes a good case study relates to the consumer better than a clinical trial. Visual clues to “see how a product works” are always important. Irrespective of data, consumers want to test the products for themselves. As demonstrated with the Boots example, a third party endorsement by skin care experts, dermatologists and celebrities (to a lesser degree) is successful. The online community with independent reviews and blogs is also powerful and increasing in popularity.
SB: In the U.K., the CTPA/ASA guidelines are good first reference to understand the differences in required level of evidence. The cosmetics industry is self-regulated, so it must go to some lengths to support claims. The same cannot be said for advice sources on cosmetic products. I cannot be the only developer who has carried out intensive studies on statistically valid numbers of subjects and obtained statistically valid results only to hear that a self-appointed expert on cosmetics has tested the product on 10 people and found it lacking. Underlying such opinion, there may be some useful insights. Formulators should know their consumers’ needs and engage with “independent” reviewers and consumer advocates to find out more.
Scientific Communication and Training
KS: My recommendation to the skin care industry is to communicate differently with the consumers. Communication of complex scientific issues in the media in a short space of time is difficult, but it is important to focus on claims related to well-being and self-esteem promoting skin health. Educating journalists to write competent, scientifically correct, independent articles is key. Peer group driven advertising and awareness of celebrity overuse means encouraging real personalities to share their experiences in social media. Training staff to increase their expertise and revisiting skin analysis with charts, hand held devices or imaging booths leads to higher compliance, customer loyalty and repeat purchase. This will require consolidation of instrumental methods and devices to compare results easily, for the consumers not to get discouraged by the overall complexity.
SB: Having been involved in such initiatives over the last 10+ years, I can only agree. My experience is that there need to be clear objectives and identification of the target customers and their needs. The major challenge is to create realistic expectations arising from such initiatives. This is particularly important in the context of the devices employed. Some do not directly measure cosmetic concerns. In the past, devices have done little more than provide the store advisor with more credibility, and the time spent using them is rarely rewarded financially. Those adopting such methods need to have clear expectations of the business benefits.
The Life-long Process of Skin Care
KS: I also recommend promoting skin care as a life-long process. Skin care (see Part I of the series) delivers benefits if viewed as an enjoyable journey to youthful appearance and skin health. It is important to focus on the quality of the experience, not the age-defying end results. Anti-aging skin care should address the onset of specific concerns in the consumer's 40s or earlier. Improving consumer compliance can be achieved with attention to sensory benefits as well as packaging, formulation, texture and fragrance. Seeing ourselves look better helps us to feel better. Skin care has a role in building self-respect, self-esteem and personal stability.
SB: This idea supports my earlier comment that treating all anti-aging products as a single entity does not help the industry or the consumer. Most formulators have a clear view of the complexities of addressing skin through the ages, as well as the different ethnic, genetic and societal factors that influence attitudes of consumers to how they see their skin. What the cosmetic industry knows about aging skin and how to use this knowledge for today’s consumers may be different for future generations. The debate we’ve had here will continue.