There are approximately 5,391 dermatologist businesses in the US, according to a recent report from IBIS World. These medical professionals are on the frontlines of skin health and aesthetic matters, remedying issues from acne to rosacea to skin cancer.

Many also funnel their knowledge into formulation, launching their own lines or assisting brands during research and development. They recommend healthy skin care regimens to their patients and help educate the population at large about ingredients and which of the myriad products on store shelves will provide the greatest benefit.

Doc Via a Box

There are many subscription beauty boxes in the US market. While all have their own spin, none have been curated by a dermatologist—that is, until The Box by Dr. Ava arrived. Its creator, Dr. Ava Shamban, MD, is the founder and director of Ava MD, a full-service dermatology clinic with locations in Malibu and Beverly Hills, CA, and SkinxFive, a tech-based provider of face and body treatments located in Pacific Palisades and Century City, CA.

When users subscribe to the box, they have access to products and a professional team through exclusive digital events, a private Facebook community and tele-aesthetic consultations, according to the brand.

“When we select products for The Box By Dr. Ava, we select brands with product founders who share my enthusiasm in consumer and patient education. We host regular Instagram Live sessions with product founders after business hours,” she said. “When it comes to ingredients, we look for products that contain high quality ‘holy grail’ ingredients, and I only include solutions that I would share with both my inner circle and patients. It goes without saying, we offer SPF in every box.”

Inside Shamban’s first box, which debuted during holiday season 2020, were TIZO3 by Tizo (a mineral sunscreen), U.SK Under Skin Precious Elixir and one body fat treatment called TruSculpt Flex. More recently, The Box by Dr. Ava Spring 21 included MySkinBuddy (a facial device); Restorsea Therapeutic Neck Decolletage Treatment; Theraderm NuPeel; Aforé Effusive Mist (a CBD facial toning product); and Tiege Hanley products.

According to Shamban, her subscriber community is vocal, and by connecting with them through direct response, Facebook, Instagram and Clubhouse, she garners insight about what should be included in subsequent boxes.

“Our spring box really helped us boost our subscribers and we will use the Q2 feedback to amplify offerings in our Q3 box,” she said. The next Box by Dr. Ava will be unveiled sometime this month.

Why not formulate her own products?

“I’ll never say never, but for the foreseeable future, my focus is The Box By Dr. Ava,” she told Happi. “I am certainly busy but I love what I do, and developing The Box is just an extension of what I do every day in my practice.”

Shamban’s goal is to “bring dermatological curated skin care and advice, making it accessible and approachable.”

Maybe not approachable for everyone; individual boxes are $250 (the brand says they are a $600 value) and a yearly subscription is $850, which includes access to the online community, and a tele appointment.
All products in Dr. Ava’s curated box are full size.

“I don’t think sample sizes give consumers enough time to really experience a product or see it take effect,” she said. “I firmly believe in every product I curate for the box so I want subscribers to love them and watch them truly take effect.”

Democratizing Dermatology
During the first four weeks of the COVID-19 pandemic when her physical offices were shut down, Shamban said her medical team virtually treated more than 300 patients.

“The pandemic showed me how many more patients I was able to see by connecting virtually and made me realize that people want to speak with a dermatologist but don’t always have time to come in for an appointment and multiple follow ups. This crazy time and the change in the way we communicate gave me perspective on how I want to take care of all patients who seek guidance, including those with aesthetic/skin needs who live in a different state than I do,” she said.

According to Shamban, the box fills a need, especially for consumers living in what she called “derm deserts.”

“I want to elevate the field of dermatology and help people across the nation realize that help is accessible—whether it be remote or in person,” she said. “My end goal is to empower consumers to evaluate skin care they may not otherwise discover and help them feel confident in their skin.”

Access to a dermatologist is by no means universal. In fact, research conducted by Neutrogena found that 62% of Americans (ages 18+) recently experienced a situation where they were unable to access the skin care or medical expertise needed to help with a skin issue, and American adults earning less than $25,000 per year are 1.7 times less likely to have ever seen a dermatologist.

But medical experts agree that regular skin checks are a must.

“I believe every person should have regular annual visits to see a dermatologist after age 40 to catch possible skin cancer development or other changes early,” noted Dr. James Beckman, a board-certified plastic surgeon, biochemist and adjunct associate professor dermatology at UAMS Medical School in Arkansas.

Beckman is also the founder of Theraderm Clinical Skin Care, which recently netted NewBeauty’s Best Post-Sun Treatment award for its OPC Reparative Serum.

According to Beckman, OPC Reparative Serum uses oligomeric proanthocyanidins (OPCs) to reduce redness and inflammation while also protecting skin from free radical damage and visibly reducing signs of aging.

OPC is harvested from a special French Maritime Pine bark that contains a saturated content of highly active antioxidant particles, which are preserved during their harvest, ensuring the active ingredient remains pure and potent.

According to Beckman, the results of free radical damage to cells are injuries that are cumulative over the years, although acute sun exposure causes the redness and inflammation associated with sunburn. As the years pass, skin simply begins to show the effects of repeated injury and damage, he insists.

And many might have been unintentionally increasing their exposure over the past 15 months.

“With lifestyle changes from the COVID-related pandemic I would expect most Americans are getting even more sun exposure. Many are working from home and can wear leisure clothing. They are perhaps even more able to ‘soak up a few rays on the patio.’ It is a given that getting more sun exposure to skin increases skin injury, and probably results in more incidence of skin lesions including skin cancers.”

While vitamin C is a natural substance that can capture a free radical, there are two problems, according to Dr. Beckman.

“Vitamin C is only able to capture one free radical and must then ‘hand-off’ the radical to another storage molecule before it can ‘catch’ another radical. OPC captures and holds up to 20 separate free radicals at one time. This makes OPC 20 times more effective as a free radical protector than vitamin C,” asserted Beckman. “Equally important is the fact that vitamin C cannot be manufactured by the human body. It must come from external dietary sources such as fruits and vegetables, especially the yellow and orange-colored ones, or be supplied via vitamin supplements.”

According to Beckman, Theraderm OPC Serum has the maximum amount of OPC possible, which effectively recharges/restores one’s vitamin C function. As an additional benefit, it also contains alpha lipoic acid, which has the unique ability to shrink skin capillary size, thereby diminishing the skin redness of rosacea and laser or micro-needling treatments.

Working Together
Dermatologists and plastic surgeons aren’t the only medical experts with their own skin care brands. Take Dr. Anne Beal, MD, MPH, a physician who took matters into her own hands when she and her daughters experienced continuous skin irritation and ineffective results. She founded AbsoluteJOI Skincare, an inclusive clean beauty brand that offers people with all skin types and skin tones simple, but effective skin care.
But Beal didn’t go it alone when creating products like her popular Daily Hydrating Moisturizing Cream with SPF 40 Mineral Sunscreen.

“I am physician and know what skin needs, but it was important to work with chemists who know how to create formulas that deliver what I wanted for skin. From a medical perspective, the product needed to provide broad-spectrum coverage to protect against both UVA and UVB light, while from an aesthetic perspective I wanted a mineral sunscreen that doesn’t leave a white cast, especially on darker skin tones. The chemists were able to adjust the size of the mineral particles so they are less visible on skin, while providing protection from 98% of UV radiation.”

Beal continued, “I am happy to admit, I am a science geek and love when great minds can create great solutions.”

Skin Solutions
Consumers have access to more skin care solutions than ever before. They are shopping for products across all channels and researching ingredients and reviews online. To elevate their offerings, savvy brands enlist dermatologists to educate and inform.

High profile OTC brands have tapped dermatologists to spread the word about sun protection. For example, board-certified dermatologists Dr. Angelo Landriscina and Dr. Adeline Kikam joined the Sun Bum team to provide education on skin health and skin cancer prevention. Last month, Cetaphil kicked off a campaign that featured dermatologists on social media platforms like Instagram and TikTok as the brand made its foray into the sun care category with its new Sheer Mineral Sunscreen collection.

Medical professionals can also relay reliable information about beneficial ingredients that have been around for years, like witch hazel.

“Witch hazel can be a very helpful ingredient to incorporate into a skin care routine as it has multiple skin benefits, making it an option for all skin types, including reducing inflammation making it helpful for acne, sunburns, bug bites, post-shaving irritation and more,” said Dr. Marisa Garshick, MD, FAAD, Manhattan Dermatology and Cosmetic Surgery Centers.

Garshick, who is also a clinical assistant professor of dermatology at New York Presbyterian-Cornell, recently took part in discussion about witch hazel hosted by Thayers.

She said despite its long history of use, this natural ingredient isn’t one size fits all, and even professionals could benefit from guidance.

According to Garshick, there are various ways to incorporate witch hazel into a skin care routine, but the many different formulations available over-the-counter have made it more complicated for professionals to know which are formulated in a way to achieve maximum benefits.

“For this reason, it is important to focus on brands like Thayers Natural Remedies that are transparent about how the witch hazel is made and other ingredients. Additionally, because there are limited large randomized controlled trials using witch hazel products, professionals may not have a great understanding of exactly what to use and how to use it,” Garshick told Happi.

Thayers grows witch hazel on a certified organic farm located at brand headquarters in Connecticut. The company uses a distillation process that reduces the potential for any skin irritation and sensitivity and allows the witch hazel to retain 195% more tannins.

According to Garshick, tannins improve the appearance of the skin through antioxidant effects. She pointed to studies that have shown witch hazel to be an effective and tolerable treatment of inflammation and some forms of dermatitis, and its antioxidant properties may help to protect the skin from photoaging, too.

Additionally, Thayers Natural Remedies pairs witch hazel with other ingredients to improve tolerability as well as enhance benefits. For example, Thayers Natural Remedies Facial Toner is paired with aloe vera and glycerin, allowing the product to help tone the skin while leaving the skin feeling hydrated.

Favorites & Future Needs
Every dermatologist has a list of favorite ingredients and go-to brands. And as clinicians, their direct access to patients can provide valuable insight that can aid in NPD.

For Beal of AbosoluteJOI, her favorite skin care ingredients are the “Holy Trinity”—retinol, vitamin C and sunscreen.

“If there are only three products you can invest in, I would say it is these three,” she said.

When it comes to product development, Beal sees value in multi-taskers.

“People do not have time for complicated, multi-step routines,” she said. “I would love to see more products that combine several steps, or several ingredients into one useful formula. It would help people stick to their skin care routines and simplify their regimens.”

Beckman wants to delve even deeper into issues related to sun exposure.

“Biological aging occurs at the same rate over the entire body surface. However, areas that get daily sun exposure get significantly more UV energy injury and cumulative damage to face, arms, etc. that we attribute to age. We expect to see more skin lesions, benign, pre-cancerous and cancerous, in skin areas that normally get more exposure like face, neck, decollete, chest, and even legs in Southern climates where year-round swimming or wearing shorts is common,” he told Happi.

Garshick’s favorite ingredients include retinoids to help with acne, scarring and anti-aging concerns; humectants such as glycerin to help boost skin’s moisture levels; and sunscreen to help protect the skin from sun damage.

“But it is always important to remember that skin care should be personalized and what works for one person may not work for someone else,” she insisted.

Garshick joins others in wishing for greater clarity around natural and organic.

“I think standard definitions for natural and organic would be helpful for skin care formulation to help companies and consumers better understand what it is that they are getting,” she said, pointing out that Thayers Natural Remedies only considers an ingredient to be of natural origin if it is unchanged from its natural state or has undergone processing, but retains greater than 50% of its molecular structure from its original natural source.

And there’s the “clean” movement, too.

According to Barbara Roll, chief marketing officer at Derma E, as the clean beauty movement has taken center stage, dermatology clients are more commonly seeking products that are clean and safe for both the body and the environment.

This, no doubt, was an impetus behind the brand’s new “Derms for Derma E” program, which was unveiled in March with three US dermatologists (Dr. Gervaise Gerstner, Dr. Alexis Stephens and Dr. Andrea Suarez). The board-certified dermatologists will help support clean ingredients among their recommendations, said the brand.

From clean beauty to a delivering a clean bill of skin health, dermatologists will continue to play a role in the future of skin care treatment, formulation and marketing.