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    A new product category: pharmacoids

    Dermatologics are entering a new era. The first agents that were developed to treat skin disease were cleansers, originally known as soaps. Soaps were first discovered by man upon examining the ashes of an animal carcass cooked over a wood fire. The combination of potash from burnt wood ash and hydrolyzed animal fat triglycerides yielded potassium soap and glycerol observed as a waxy material in the fire remains. 

    Commercially available hand made soap sold in the ninth and tenth centuries was a possession of the rich with mass use of soap beginning in the early 1900s.  As a matter of fact, soap was a major import of the US from France and Italy until 1878 when domestic mass manufacturing began.  Today soap is an unclassified substance that is neither a cosmetic nor a drug, since the federal government decided that the regulation of cleansers would possibly increase the cost limiting access to this important mechanism for infection prevention.

    The second agents that were developed to treat skin disease were cosmetics. While we presently think of eye shadows, eyeliners and lipsticks as products to color and adorn the face, indeed they were originally purposed to prevent infection through the use of ground natural materials with antibacterial properties.  Today we recognize cosmetics as items used for appearance purposes only that do not modify the structure or function of the skin.

    The third category of skin products developed were the pharmaceuticals that dermatologists presently prescribe encompassing more variety in formulation than any other area of medicine. While most physicians prescribe only pills or injections, dermatologists prescribe creams, ointments, lotions, gels, suspensions, powders, and sprays, in addition to pills and injections.

    Over-the-counter drugs that are formulated based on ingredients, ingredient combinations, ingredient concentrations specified in a monograph, are a subset also widely utilized by dermatology to include sunscreens, antiperspirants and skin protectants.

    A new category of products

    A newer category of dermatologic products includes active cosmetics, also known as cosmeceuticals. The term cosmeceuticals is not recognized by the United States government and thus has no regulatory meaning, as cosmeceuticals are simply cosmetics described previously, and nothing more.

    But, we now enter the new era of dermatology where we have prescription products that temporarily change the color of facial skin. These products are indeed pharmaceuticals, as they have been approved by the Food and Drug Administration, are only available for purchase with a prescription, and are covered by many insurance companies. They are temporary in nature, much like a cosmetic, requiring daily application to maintain the optimal effect, yet addressing the appearance need of reduced facial redness. Indeed, rosacea is a disease where facial redness is part of the disease presentation; thus, this is the indication for which these drugs are prescribed.

    These unique pharmaceuticals are in many ways the newest category of products to grace our armamentarium. They are drugs that improve appearance temporarily in those with disease. What are they?  They are pharmacoids! A word I propose to linguistically convey the concept that these pharmaceuticals bridge the borders of the newest dermatologic medicinal frontier.

    Zoe Diana Draelos, M.D.
    Zoe Diana Draelos, M.D., is a consulting professor of dermatology, Duke University School of Medicine, Durham, N.C. She is investigator, ...

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    • Anonymous
      While this category sounds like an interesting addition, there needs to be a clear distinction between "skin disease" and cosmetic improvement. Improving the appearance of the skin does not automatically mean treatment of disease. Cleansers were not specifically invented as a skin disease treatment. The pursuit of beauty is as natural as breathing and should not require a visit to a dermatologist to pursue. We need our well trained health care providers to help fight the ever rising cases of cancer and other skin conditions.

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