DERMATOLOGY

By DANIELA LAMAS
KNIGHT RIDDER NEWSPAPERS
CHANCES ARE YOU'VE NEVER SEEN DR. Fredric Brandt bounce through his Coral Gables, Fla., offices in designer Pumas. Maybe you've never met Dr. Angelo Thrower, either.
No matter. Just take a jaunt to Nordstrom, Sephora or Wal-Mart.
There, stacked atop the cosmetic counters are the eye creams, cleansers and wrinkle-reducers developed by these and countless other dermatologists. Called cosmeceuticals, they're the latest in the intersection of cosmetics and medical science. The doctors say they're at the trend's forefront, using medical expertise to formulate skin-care products that not only conceal, but claim to "cure" flaws.
"Everybody wants to have radiant skin," said Brandt, 54.
But at what cost?
Brandt and his colleagues are navigating an ethical minefield, some doctors say. They're using their M.D.s for marketing campaigns, pushing patients into buying their products, and falling into a gray area not always regulated by the U.S. Food and Drug Administration.
"There's a terrible conflict of interest," said Dr. Irwin Freedberg, chairman of New York University's dermatology department. "Patients may feel forced to buy things in the doctor's office that shouldn't be there. It is a threat to the medical profession."
Profits and trust
It's a profitable one.
The cosmeceutical industry grossed $3.4 billion in 2002 and is expected to hit $5.1 billion in 2007, according to the Freedonia Group, an industrial market research firm.
The "cosmeceutical" category was born more than 20 years ago, when Vitamin A was formulated into creams to help fight wrinkles.
But FDA guidelines haven't kept up. To the FDA, products are either drugs or cosmetics. A cosmetic doesn't affect the body's structure or function; a drug does.
Drugs require expensive, time-consuming tests before government approval; cosmetics don't.
"It's the manufacturer's responsibility to ensure that cosmetic ingredients are safe," said Allen R. Halper, a senior compliance officer in the FDA's Office of Cosmetics and Colors.
When the drug and cosmetic spheres intersect, rules blur.
"When you're saying cosmeceutical, you're kind of cheating because you're not picking a real category," said Dr. Leslie Baumann, director of cosmetic dermatology at the University of Miami/Jackson Memorial Medical Center. "You're implying that the ingredients have a biologic action without having to prove it to the FDA."
'Taking the leap'
In offices across from the Gables' village of Merrick Park, glass cases in Brandt's waiting room display his skin-care line, oil-free cleansers and wrinkle-reducing gels that sell from $25 to $95.
Brandt, who splits his time between New York and South Florida, started experimenting in the early '90s. He consulted with chemists and worked nights and weekends, testing samples on 20 staff members in his "in-house laboratory."
In 1998, he "took the leap," marketing his line to upscale department stores, including Nordstrom and Neiman Marcus.
In Miami Shores, Fla., Thrower is developing cleansers, astringents and skin lightening moisturizers aimed at black men and women. Marketed under the Heritage Skin Care brand, they're sold at his office and through Wal-Mart, Kmart and Eckerd. Sales have grown exponentially -- from 400 outlets in 1999 to approximately 1,750 stores nationwide. Price: $6.99 to $9.99.
Thrower, who began experimenting with formulas over his bathroom sink in 1991, says he uses ingredients regulated by the FDA as over-the-counter drugs.
He doesn't consider his products cosmeceuticals. "They're drugs," he says. "There's no in-between."