Want cheap skincare that actually works? Ask your doctor

Last November, I spent $73 in one transaction on 20 acne treatment stickers. That the product promised to be a pimple “killa” should have been enough warning of its efficacy. But after spending the better part of two decades lathering my skin with a slew of products, hoping to get the kind of glow one would otherwise achieve with an Instagram filter, what was one more?

It’s a trap that many of us fall into when shopping for skincare, with Research and Markets estimating the global market for cosmetic skincare was worth US$145.3bn in 2020, projected to rise to $185.5bn by 2027.

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But we might be shopping harder rather than smarter. The dizzying array of skincare brands and their accompanying clever marketing, on top of thousands of internet reviews, can lead to decision fatigue when it comes to figuring out what works.

In Australia, one shortcut to finding an effective skincare treatment is to ask one question: is this product actually registered on the Australian Register of Therapeutic Goods (ARTG)?

“Registered medicines are always evaluated for efficacy [to ensure] that the medicine can do what it says it will, while listed medicines are not,” says dermatologist Dr Shreya Andric. “The biggest differences are the concentration of ingredients as well as the specific ingredients themselves.”

Registered products can be prescription-only or over-the-counter, and include mild-potency steroids, topical anti-fungal and anti-acne treatments, and treatments for the management of hair loss.

Despite being lower risk than prescription-only products, active over-the-counter products still come with possible side effects and warnings, which vary depending on their ingredients.

“An example of a registered over-the-counter medication is azelaic acid [most commonly sold as Azclear and Finacea], which is used in the treatment of acne, rosacea and pigmentation,” Andric says. “The main side effect of azelaic acid is skin irritation, but nothing too devastating will occur if it is used ‘inappropriately’. Retinoids are known to be harmful to an unborn baby [however], so their use should be monitored.”

In fact, it’s the key ingredient in retinols and retinoids – commonly used to fight acne and improve skin texture – that illustrates the difference between products that are simply listed on the ARTG (which means they are safe to use) versus those that are registered.

“The terms retinoid and retinol are often used interchangeably [but] retinoids are prescribed by a doctor whereas retinols can be purchased over the counter,” Andric explains. “The difference … is that retinoids are already in their active state [retinoic acid] whereas retinols require a two-step process to be converted into the active retinoic acid. The more conversions required, the weaker the product.”

It’s a minefield for the average consumer, who could easily fall for clever or gimmicky marketing terms like “cosmeceutical” or “medical-grade” in an industry that’s already oversaturated with jargon.

“Statements like ‘dermatologically tested’ and ‘clinically proven’ don’t really mean anything,” Andric warns. “‘Dermatologically tested’ means that a single dermatologist reviewed the study and signed off on it. They may have just reviewed the formula or a study report and not even been involved in the study or analysis of results. ‘Clinically proven’ can be written on anything that has had a clinical study performed but the sample size can be as little as 10 people.”

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If it all sounds a little complicated, don’t fret. Incorporating more potent ingredients into your regime could actually make things easier, by paring back your skin routine to the bare, effective essentials, says Andric. “The key to seeing results from your skincare is to be consistent with it.” She says that sunscreen, which is strongly regulated in Australia, is “the number one product you should be using”.

Andric recommends a simple skincare routine that includes medicinal and standard beauty products such as a cleanser, vitamin C serum (to brighten and fight pigmentation), moisturiser and sunscreen for day, and a cleanser, retinoid and moisturiser for night. She says none of these need to be expensive in order to work.

“Registered products are often cheaper than store-bought products,” she adds. For example, a 50g tube of tretinoin, an acne and ageing treatment, costs $50-60 and lasts around six months with typical use. “It will certainly be more efficacious than an over-the-counter product,” Andric says, and will result in changes to the skin after six- to-12 weeks.

It also helps to think about your skin as what it actually is: an organ. Dermatologist Dr Annika Smith says seeking a medical review with a GP or dermatologist if a specific concern (such as pigmentation or acne) arises ensures appropriate treatment. The right advice could prevent long-term scarring or pigmentary disturbance.

Provided a root cause has been diagnosed by a qualified professional, Smith lists a multitude of ingredients available to treat everything from ageing (tretinoin to repair and replenish; hyaluronic acid and ceramides to moisturise and assist with fine lines; and hydroquinone to combat hyperpigmentation); to acne (benzoyl peroxide for its antibacterial properties; salicylic acid to unblock pores; anti-inflammatories such as azelaic acid; and niacinamide to help reduce sebaceous gland activity).

Andric says it’s best to ease into such treatments, given all their active ingredients.

“There can be too much of a good thing and they can be irritating,” she advises. “Start one at a time and then introduce new ones when the skin is not irritated. It is always worthwhile checking to make sure you are using a product appropriately, including what time of day to apply, and if there are any contraindications with any of your other products.”

Recognising the power of these ingredients, and the intimidation factor they bring to shoppers, scientist and former nurse Dr Michele Squire founded an online service Qr8 MediSkin, offering it all – the diagnosis, the prescription, the how-to – in the one place. “There is a tendency to self-diagnose and treat – often inaccurately, ineffectively and expensively – using the internet,” she says.

“We want people to think about effective treatments first, rather than when all else has failed.”