How to Responsibly Recommend OTC Skin Care Products to Patients
Updated: Mar 25, 2020
Do you want to make more money in your medical practice? Today with insurance reimbursements going down, many physicians are looking for alternative sources of income. You may be considering selling skincare products; if so, there is a right way and a wrong way to do this. Here are some tips on how to ethically and scientifically sell skincare products in your practice.
If you decide to retail skincare products in your medical practice, you must do so in a way that does not jeopardize the physician-patient relationship. (2009: Ethics of selling skin care.Clinics in Dermatology, 27(4), 355-358.) The goal is to achieve good patient outcomes with minimal side effects, which strengthens the physician-patient relationship. In order to achieve this goal, you need to find the most efficacious products and properly match them to your patient’s skin type. In addition, patients must be compliant with the prescribed regimen.
Selling efficacious skin care is not as easy as it seems. The difficulty in separating fact (science) from fiction (marketing claims) takes time because there is a lot of background science to know. If you are a dermatologist, you have a huge head start because you already know the skin science, but the cosmeceutical science is daunting unless you have a degree in cosmetic chemistry. Customizing the proper skincare regimen for a patient is also difficult because of time constraints with each patient in a busy medical practice. In addition, the need for staff training and patient communication can complicate this process.
In my practice, we use the Skin Type Solutions® system that I developed to make my practice more efficient in customizing skincare regimens for patients. (Fitzpatrick’s Dermatology in General Medicine, 8th Edition, 2012, Ch. 250, p. 1343). This system accurately diagnoses a patient’s Baumann Skin Type® (there are 16) and prescribes a pre-set regimen that is designed to address that particular skin type’s needs. The system has been tested in over 100,000 people around the world of all ethnicities and ages, as well as both genders. It was shown to improve patient outcomes by giving patients clear instructions about what products to use for their Baumann Skin Type. (Dermatol Clin. 2008;26(3):359-73; Journal of Cosmetics, Dermatological Sciences and Applications. 2014;4:78-84).
Using the Baumann Skin Typing System to prescribe skin care regimens saves my staff time by streamlining the process. It works like this:
The patient takes the Baumann Skin Type Indicator (BSTI) questionnaire and is diagnosed as one of the 16 Baumann Skin Types.
A staff member matches the Skin Type to the pre-set regimen.
The doctor (or designee) reviews the regimen and makes any necessary changes or additions (including prescription medications).
The patient is given a printed step-by-step skin care regimen.
The patient purchases the correct products.
The patient is given instruction sheets to increase compliance.
The patient returns in 4 weeks for follow-up with the staff designee to ensure that the regimen is being properly followed.
Sounds easy, right? The hard part is choosing what products to use for each skin type. In order to ethically sell skin care products to patients, you must ensure that they are getting efficacious products to address their skin concerns (Clin Dermatol. 2012;30(5):522-7).
The following are the important steps to consider when choosing skin care products:
Step 1: Know your ingredient science
There is so much interesting research on cosmetic ingredients, but there is also plenty of hype and misinformation. One important point is that no one ingredient is right for all skin types. It’s essential to know which ingredients work well together and which do not. The order in which ingredients are placed on the skin is crucial as well, because they can inactivate each other and affect absorption. All of my ingredient columns are available at SkinandAllergynews.com and will be published in my book Cosmeceuticals and Cosmetic Ingredients (McGraw-Hill). It is important for you to understand which ingredients are worthless (like stem cells and peptides) and which ones are crucial (such as retinoids and antioxidants), so that you can arm your patients with products that work. When products do not work, your patients will have poor outcomes, your physician-patient relationships will be damaged, and patients’ trust in you will decrease.
Step 2: Choose ingredients appropriate for the Skin Type
It is important to understand the characteristics of various ingredients and match those to your patient’s skin type. The process of assessing the patient’s skin type can be long because you need to ask numerous historical questions (invariably including “Do you get irritated from skin care products?”, “What happens if you do not use a moisturizer?”) Looking at a patient’s skin at one point in time is not as accurate as asking a series of questions about how their skin has behaved in the past under varying conditions. I use a validated questionnaire to streamline this process in my practice. The questionnaire takes 3 to 5 minutes, does not require a staff member, and is done on a tablet device in the waiting room or exam room.
Step 3: Properly identify the Baumann Skin Type® using a validated questionnaire
To determine a patient’s true skin type, a scientifically-validated questionnaire is used to assess skin oiliness, dryness, sensitivity, uneven skin tone, and risk factors for wrinkles. When these parameters are combined, there are 16 possible Baumann Skin Types, which yield an accurate history of the patient’s skin characteristics.
Step 4: Choose products for each skin type
There are many factors to consider in choosing what brands and SKUs (“stock keeping units”, in industry parlance, but particular products for our purposes) to use for each skin type. I use a brand-agnostic approach to choose the best technologies from various brands from around the world. I believe that brands often have a core competency, such as sunscreen technology, but that not all of the products in a particular line are superior. I select the best products (SKUs) from each brand, and combine and test them on various skin types to see which products and what combinations of products work best. The following are the factors that I take into account when choosing SKUs for each Baumann Skin type:
A: The importance of the ingredient recipe
Although the product label lists ingredients, it does not list the formulation’s recipe, which is proprietary and often patented. The “recipe” includes the order that ingredients are added in the process, the pH, the amount of each ingredient, the temperature at which the ingredient is added, and many other important factors that determine the final chemistry. Ingredients like vitamin C, green tea, and argan oil are expensive when formulated properly. Many “copycat” brands, such as the Walgreen and CVS knock-offs, use the same ingredients. However, they cannot use the patented recipe and therefore their end product is different.
B: The manufacturing and packaging process
How a product is made and packaged is crucial. For example, retinol breaks down when exposed to light and air. I once visited a manufacturing plant that was stirring its “anti-aging” retinol preparation in open vats. The retinol was losing its activity, which is why the product was “less irritating.” The process of packaging the completed product is also important. In some cases the product is formulated in one place and shipped to another location for final packaging—and several ingredients can lose their potency during transit. Finally, the container that the product is packaged in is important. Air and light can get into tubes, affecting the efficacy of a product.
C: Know ingredient interactions
The order of application and the combination of ingredients affects stability, efficacy, safety, and the chemical structure. Master formulators understand that every ingredient in the formulation matters and there is really no such thing as an inactive ingredient. Ingredients can affect penetration and render other ingredients more or less effective depending on the order in which the ingredients are used on the skin. For example, olive oil actually increases penetration of other ingredients because it has a high content of oleic acid, while safflower oil can decrease penetration by strengthening the skin barrier.
Step 5: Design the regimen and order of application of products
Once you have determined your patient’s skin type and matched the proper products to their skin type, you must tell them exactly how to apply them. The order in which products are applied makes a difference. Consider ingredient interactions, ingredient penetration times, and cross reactions, plus skin type factors such as the condition of the skin barrier, sebum production, thickness of the stratum corneum, and sun exposure and bathing habits. I recommend providing a printed regimen with step-by-step instructions for morning and night.
Step 6: Patient education
Take the time to educate your patients on their skin issues. If you explain why you chose each product and why the particular ingredients are important, they are more likely to be compliant and get better results (and return to you for product recommendations and repurchases). Because we do not have the time to sit and explain all of these issues to each patient, we use educational newsletters that we send to patients based on their Baumann Skin Type. This helps keep them engaged and educates them about new technologies and products that are appropriate for their skin type.
Step 7: Encourage compliance
Schedule a follow-up visit after one month to check on their progress. If you prescribed a retinoid, patients may experience irritation and stop using it. This follow-up visit is important to ensure compliance. If you have an imaging system, baseline and follow-up photos help illustrate patients’ progress and keep them vigilant. Four weeks is a good time frame because patients tend to lose interest at 4 weeks. Emphasize how important the follow-up visit is at the initial appointment.
Step 8: Sell skin care products
I was against selling skin care products for ethical reasons for several years. However, in 2005, I surveyed my patients and 100% of them wanted me to sell products so that they could feel sure that they were purchasing the proper products. (They said that even with samples they would get confused.) I realized that you can ethically sell skin care products when you take the time to identify the patient’s skin type and use products and prescribe regimens proven to work on that skin type. In fact, patients appreciate medical advice on skin care. As a practitioner, you can make more educated choices about their skin based on such facts than they can by guessing or buying products from a charismatic salesperson. You essentially save them both time and money by avoiding products that don’t work or cause harm.
Step 9: Contact me for more information
In order to improve patient outcomes, you must ensure that you stay current on the skin care science so your patients get the advantage of your expert knowledge. I recognize that not everyone has the time and inclination to stay current on the various skin care ingredients, products, and brands. Over 70 doctors (mostly dermatologists) have adopted my skin typing system in their practices and, in the process, observed better patient outcomes and increased profitability, while reducing the burden on their staffs. Feel free to email me at DrB@skintypesolutions.com or visit STSFranchise.com if you want to learn more.
I will be sharing more advice on in-office skin care retail and will continue my review of new cosmeceutical ingredients on this Skin Type Solutions Blog. My goal is to help you increase profitability of your practice, maximize efficiency, improve patient outcomes and strengthen the patient/ physician relationship.
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.