The Internet has changed many facets of modern life and the practice of medicine has certainly not gone untouched. Patients get medical advice online and buy skincare products online- often from unproven sources. Patients often tell me they are following advice or using products that they found online and there are times when I am horrified with what they have been told. If you see patients for skincare consults- you know what I mean. We need to take the time to educate our patients about why buying products online is not a great idea.
When patients buy skincare products from their physicians, only about 30 percent of patients buy the refills from their doctors the second time and 15 percent the third time around. The patients are usually purchasing the products online from an unknown vendor which carries with it certain risks. The biggest issue is skincare product authenticity and quality when purchased from an unknown source. The only way that you can ensure that your patients get quality skincare products is to sell them to them yourself or refer them to an online store that you trust. These are the reasons that you and your patients should be wary of buying online from an unknown vendor.
Potential Problems with purchasing skincare online from an unknown vendor
I have been seeing more and more patients who have purchased counterfeit skincare products online. According to the California-based The Counterfeit Report, personal care products, including skincare and cosmetics, are among the top five types of products seized by U.S. Customs and Border Patrol agents. Such products include old bottles refilled with inexpensive imitation creams, or bottles made to look like legitimate products that are filled with imitation creams. I once had a patient present with an adverse reaction to a retinol product, which she brought with her to the visit. I sent the bottle to the company, which confirmed my suspicion that the product was a different bottle with a similar label and was counterfeit.
In February 2014, CBS New York ran a segment on the potential inclusion of carcinogenic and other harmful ingredients found in online personal care products touted for their low prices. Not even two weeks later, CNN reported on the arrest of two brothers in New York alleged to have masterminded a multimillion-dollar counterfeit health and beauty product ring. ABC’s Good Morning America followed suit with a segment in April 2014 that exposed aspects of the use of knock-off cosmetic products.
The FBI has also posted memos concerning counterfeit and potentially compromised and hazardous cosmetics and fragrances, offering tips aimed at readily identifying or avoiding unauthorized products. (See sidebar.)
I underviewed various companies who confirmed that they are also seeing a rise in counterfeit online skincare products. Jan Marini Company representative Stuart Mohr noted that their company has received returns with their packaging and empty containers, or products that they had not manufactured as well as their own current or discontinued products returned years after the expiration date. The Jan Marini Co., as other companies in general, will not guarantee any product purchased via non-authorized resellers, as the authenticity and safety of such products cannot be verified.
“These unauthorized resellers are sophisticated, often even working in rings, and find it easy to hide their real identity,” said Mohr. “Addresses are often hidden or vague; emails are not linked to any specific person; and it’s easy to use false names. If a person is caught in an unauthorized online transaction, it’s easy to change the email address or name and start again,” he added.
Some companies report that they have seen their samples and trade size containers being sold on eBay. Joe Ragosta of Topix Pharmaceuticals reports that when his company has asked such sellers if they are obtaining these products—marked as samples—from the company, they hear a range of defensive responses, including: “I got it at a show,” “My doctor gave me samples and I decided to sell them,” and “I work at a doctor’s office and they let me take products as needed.”
Companies representatives offer the following advice: Torie Hardee of EltaMD explained that counterfeit products can be identified by lack of an expiration date on the bottle, discoloration of the packaging or slightly different fonts on bottles and packaging, and lack of the manufacturer’s address on the bottle. NeoStrata representatives are also concerned about the fraudulent use of their products. They recommend that patients purchase their products only from a known physician, ideally from the office. The company understands that customers may want to save money wherever they can and might prefer to buy products on the Internet. NeoStrata urges customers who opt to buy online make such purchases through physician-affiliated websites, where the doctor is clearly identified. At the very least, the company urges patients to choose only sites where they can contact someone and obtain the name of a physician. Further, they strongly discourage using sites which do not vouch for the safety and authenticity of products sold through their services. Many companies do not permit the sales of their products on such sites, however, the “gray market” of skincare products is difficult to control.
Unscrupulous online retailers may slash prices on expired products and remove the expiration date from the package. In my practice, a patient experiencing an erythematous reaction brought in the offending SkinMedica product bottle, which looked suspicious to me. The executive at SkinMedica to whom I displayed the bottle told me that that packaging had been discontinued eight years earlier. It is important to remember that ingredients, particularly retinol, degrade with exposure to air, sun, and heat, and over time. This is doubtlessly what caused my patient to experience her adverse reaction, with her initial savings from the product causing her two to three weeks of irritated skin and the cost of purchasing the correct product.
Diverted Products on the “gray market”
Products are often sold online in the so-called gray market below the manufacturer’s suggested retail price (MSRP). In these cases, the company cannot verify the chain of custody of the purchased product. In other words, there is no guarantee that the products were stored properly and were not adulterated in some way. (Products left in unairconditioned warehouses, trucks and cars may have stability issues. Companies are addressing this problem with an awareness campaign called “Authentic and Authorized” to alert patients of the benefits of a physician-dispensed model of skincare. The best outcomes are achieved when doctors are prescribing a skincare regimen and ensuring that the patients purchase the proper authentic products. SkinMedica emphasizes that no website can guarantee outcomes comparable to a skincare professional and product quality and safety can only be enforced when dispensed through authorized channels.
Potentially Illegal or Toxic Ingredients
Several products that have entered the U.S., marketed as skin lighteners, anti-aging agents, and acne products, have been found to contain mercury, according to the FDA. Arsenic, lead, beryllium, and other harmful toxins as well as allergy-inducing fragrances or preservatives not approved as safe in the U.S. may also be found in such products of dubious origin.
Products purveyed online are often stored in hot warehouses. As mentioned above, heat degrades and alters ingredients, rendering compounds such as retinol, benzoyl peroxide, peptides, and ascorbic acid worthless. Extreme cold can also damage the chemical integrity of products. Notably, organic products are more vulnerable because they lack preservatives to guard them against temperature variations and microbes that grow in hot, damp environments.
Generic formulations are packaged to piggyback off of the success of well-known products. Such products found in drugstores may be packaged to look like Cetaphil or Aveeno items, but cost less… and deliver less. While the ingredients on the copycats are identical to those found in the branded preparations, the order in which ingredients are added, the temperature, pH, and even when and how fast ingredients are stirred are part of the proprietary recipe of the company and play a significant role in the potential of the end product and, in turn, the actions the product exerts on the skin.
What can you do?
Whether or not you sell skincare products in your office you should educate your patients about product safety. Namely, the further a patient gets away from the source of products, the greater the opportunity for encountering fraudulent or counterfeit products. If you choose not to retail skincare products, find a website that verifies authenticity of the product. In my business Skin Type Solutions Franchise Systems, we run the skincare retail website SkinTypeSolutions.com for you so that you can offer an easy place for patients to get refills. Other sites that verify authenticity are the skincare brand’s websites and ExclusiveBeautyClub.com. Amazon has taken great strides this year in trying to assure authenticity and have closed down many unauthorized sellers. EBay is still a risky place to buy skincare in my opinion.
Selling products in your office is the best bet because then patients can leave with the products and get started right away. A study by Feldman ( J Am Acad Dermatol 2007;57:81-3) showed that patients are more adherent to their prescription medications immediately after an office visit. If you sell products in your office, make it easy for your patients to buy refills from you so they do not purchase them elsewhere. In the long run, a compliant patient will have better outcomes so the extra time that you spend educating them about the risks of purchasing skincare from an unknown source will be worth it for you and for them.
Sidebar: Tips for Spotting Counterfeit Skincare Products
The packaging differs slightly from the authentic brand (might be a different color or different lettering on the product).
The product’s wrapping appears haphazard.
The product is being advertised as a “limited edition” even though the authentic manufacturer doesn’t offer it as a limited edition.
The price is either slightly or drastically lower than MSRP.
The product’s consistency or texture just doesn’t feel or look like the authentic brand.
There is something a little off about the scent.
The color of the formulation in the bottle is different than the original.
They are being sold at dodgy non-authorized retailers, including flea markets, mall kiosks, and Ebay.
There is no expiration date on the primary packaging (i.e. the bottle)
There is not a company address on the secondary packaging (the box)
They are marked “Not for resale” or “Sample”.
Developed by world-renowned dermatologist, Leslie Baumann, MD, the Skin Type Solutions® Franchise System is an educational, science-based skincare store that implements a simple and reliable system to maximize skincare product sales and improve patient compliance and results.
Based on Dr. Baumann’s patent-pending Baumann Skin Typing System, this first-of-its-kind retail model provides dermatologists with the scientific methodology, training, and education necessary to prescribe effective, customized skincare regimens utilizing multiple brands of products that have been independently tested and approved by Dr. Baumann. To learn more about what Skin Type Solutions can do for your dermatology practice, visit the STS site here.