SAN DIEGO — They’re not cosmetics and they’re not FDA-regulated pharmaceuticals. Yet by one estimate, cosmeceuticals — over-the-counter products in the middle ground between agents that purely improve appearance and those with biologic healing powers — make up 30%-40% of a typical dermatologist’s prescription count.

While dermatologists may be incorporating cosmeceuticals in their practices every day, they may not be aware of some of the research that supports the use of these products, Janiene D. Luke, MD, professor of dermatology, Loma Linda University School of Medicine, Loma Linda, California, said at the 2025 CalDerm-Pacific Dermatologic Association (PDA) Joint Meeting.

At the meeting, she provided study-supported tips about the use of cosmeceuticals to treat several dermatologic conditions.

Acne: Evidence for Niacinamide and Acids

Luke described niacinamide (also known as nicotinamide), a water-soluble form of vitamin B3, as a “hero ingredient” with broad usage. “It’s anti-inflammatory, it inhibits melanosome transfer, it reduces sebum. And it’s also a coenzyme in collagen, ceramide, elastin, and keratin production,” she said.

Luke cited a 2024 split-face, double-blind randomized controlled trial from Thailand of 40 patients with mild-to-moderate acne vulgaris. The addition of a moisturizer containing ceramides and niacinamide or a hydrophilic cream to a standard acne regimen (5% benzoyl peroxide plus 0.1% adapalene gel) produced a 77.5% reduction in total acne counts at 8 weeks compared with 63% with the hydrophilic control cream (P = .008). No serious side effects occurred in either group.

Glycolic acid, an alpha-hydroxy acid often used in chemical peels, and salicylic acid also remain important tools in acne, she said. “Glycolic acid accelerates cell turnover and can be used in cleansers and peels. Salicylic acid is lipophilic, penetrates pores, and downregulates the NF-κB [nuclear factor-kappa B] pathway to reduce inflammation.”

Atopic Dermatitis (AD): Barrier Repair a Cornerstone

Niacinamide is also helpful in AD, to help replenish and restore the skin’s moisture barrier, she said. “In studies of the lesional skin of atopic dermatitis patients, both the amount and the properties of stratum corneum ceramides are altered. In lesions, the ceramide levels are reduced, and the carbon-chain lengths of certain ceramide classes become shorter. Topical application of niacinamide increases the biosynthesis of ceramide.”

Another helpful agent is urea, which “is present in the epidermis as a component of the natural moisturizing factor,” Luke said. “It works to increase the water content of the stratum corneum as well as optimize skin barrier function.”

As she noted, “urea-containing preparations have been shown to decrease transepidermal water loss and improve hydration of the stratum corneum and the water-binding capacity of AD lesional skin.”

Luke cited a 2015 Scandinavian study, a randomized double-blind controlled trial, which found that a 5% urea cream was more effective than a reference cream in reducing eczema relapses, with a 37% reduction in the risk for relapse compared with the reference cream. The study also reported that at 6 months, 26% of the patients in the test cream group were still eczema-free compared with 10% in the reference cream group.

Luke also suggested that dermatologists recommend products with the National Eczema Association’s Seal of Acceptance.

Melasma: Hydroquinone Alternatives

While hydroquinone remains the first-line treatment for melasma, “I often incorporate cosmeceuticals during breaks from hydroquinone,” Luke said. “They allow ongoing pigment control without long-term hydroquinone sequelae.”

Cysteamine, which has antioxidant and pigmenting properties, has demonstrated reductions in Melasma Area and Severity Index (MASI) scores, she said. “It blocks and shifts melanin production to a more of a pheomelanin.”

Thiamidol, a tyrosinase inhibitor applied topically, is “a newer kid on the block,” Luke said. “In Brazilian women, 12 weeks of Thiamidol led to a 43% MASI reduction compared to 33% with hydroquinone,” reported Luke, citing a 2021 evaluator-blinded, randomized controlled melasma study. In the study, 0.2% Thiamidol was applied twice a day, and 4% hydroquinone cream was applied at bedtime for 90 days in women with facial melasma.
 

After 90 days, the study found an improvement of 84% in the Thiamidol group and 74% in the hydroquinone group per a Global Aesthetic Improvement Scale evaluation. (The study authors concluded that the improvement in melasma between the two treatment groups was not different, and that Thiamidol can be considered an option for melasma in patients who fail treatment with or have problems tolerating hydroquinone.)

Luke said one option for patients with melasma is to use a triple-combination prescription of hydroquinone mixed in with other ingredients such as tranexamic acid, either topically or orally. “Sometimes you can incorporate your cosmeceuticals into your cleansers or short-contact products, but also into serums or topicals that you’re giving while your patients are on a break from hydroquinone,” she added.

Luke didn’t have any disclosures.