Ep 207 – The Rogue Pharmacist: The Truth Behind Comedogenicity Ratings

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0:01:31.3 Maggie Staszcuk: Hello and welcome to ASCP and the Rogue Pharmacist with Benjamin Knight Fuchs. In each episode, we'll explore how internal and external factors can impact the skin. I'm Maggie Staszcuk, ASCP's Education Program Manager, and joining me is Ben Fuchs, skincare formulator and pharmacist. Hey, Ben. 

 

0:01:49.4 Ben Fuchs: Hello, Maggie. Nice to see you. 

 

0:01:51.1 MS: Nice to see you. So the term comedogenic I think is recognized by everybody. 

 

0:01:56.8 BF: Yes. 

 

0:01:57.0 MS: And it correlates to product's ability to clog the pores. But how accurate is this concept?  

 

0:02:02.1 BF: Not. It's an old concept, and the guy who came up with the comedogenicity scale, Dr. James Fulton, did it in the 1980s, and it hasn't really been updated since. There's a lot of controversy around it. He used rabbit ear to detect, and that's typically what people use in the skincare business. They'll use rabbit ears to see, check for irritancy. And there's still some controversy about whether that's accurate, whether the follicles of a rabbit's ear are similar enough to human skin follicles to be relevant. And so there's a lot of controversy around it. And when you look at the comedogenicity scale, it has things like Vaseline as being non-comedogenic and lanolin as being non-comedogenic. 

 

0:02:40.5 BF: And it has things like dyes, FD&C number four, red dye is comedogenic. And so it really, it makes you think about this whole idea of what a comedogenicity really means. So a lot of people will think it means pore clogging from a product, but that's not what it means. I have a lot of people say, oh, I use that product but it clog my pores. And they think, there's this kind of impression that you put a product on and it goes into the pore and it clogs the pores. But that's not what pore clogging really is, and that's not what a comedone is. A comedone is hyperkeratosis, hyperkeratosis meaning cell division of keratinocytes and production of keratin, the hard protein. 

 

0:03:18.4 BF: So comedone is a combination of a hard protein plus skin oils. Comedogenicity is not about the product getting into the pore, it's about the skin's response to that product. So what that tells you is it takes time for a comedone to form. So you can't put a product on your skin and say, oh, that clogged my pores just by one application. It takes weeks. In fact, the skin turnover time is four to eight weeks. So it takes four to eight weeks for a comedone to form, and it takes consistent application of the product in order to stimulate the keratin, the keratinocytes, and the keratin for the final production of the comedone. So point number one is products don't clog pores. Products stimulate the skin or skin cells to grow and produce keratin, which in turn causes the pores to clog. That make sense?  

 

0:04:14.4 MS: Yeah. 

 

0:04:14.8 BF: So there's this myth out there that it's the product getting into the follicle somehow and blocking the pore. That's not what pore clogging is. That's not what comedogenicity is. And when companies test for comedogenicity, it takes four to eight weeks for the test to occur. So you can't put product on your skin one time and clog your pore. That doesn't make any sense. And obviously if Vaseline is a zero on the comedogenicity scale, if pore clogging was really a thing, if product pore clogging was really a thing, Vaseline would be pretty darn pore clogging. That doesn't happen. So then the question becomes is why does a product cause hyperkeratosis? Why does a product cause the secretion of keratin?  

 

0:04:53.7 BF: Well, the secretion of keratin is a protective response. So what's happening is you're getting a little callous inside the follicle. So we know that if you walk funny or you have something going on with your gait or your heel, you'll get callous on your bottom of your foot. What is the callous on the bottom of the foot? It's hyperkeratosis. It's an excess accretion of keratin as a protective response. That's what a callous is. It's a protective response. So inside the follicle you get that same kind of callous like protective response in response to the irritancy of an ingredient. The micro irritancy, not the skin irritancy, but the micro irritancy inside the follicle. 

 

0:05:35.1 MS: So let me just draw a line here if I can really quick. When you're getting comedones, not in relation to product, but in relation to... 

 

0:05:46.0 BF: Acne. 

 

0:05:46.6 MS: Yeah. Acne, hormones. Is that a... 

 

0:05:49.7 BF: It's very similar. 

 

0:05:50.9 MS: Secretion or a response because of the hormones?  

 

0:05:53.8 BF: Yes. That's a hyperkeratotic response, usually due to a combination of hormones plus nutritional deficiencies. We know vitamin A stabilizes keratin, the growth of keratinocytes, and that's why vitamin A is the classic treatment for acne, whether you're talking about topically in terms of Retin-A or retinol, or whether you're talking about internal supplementation or in terms of pharmaceutical supplementation, like with isotretinoin or Accutane. So yes, it's very similar, although acne tends to involve bacteria. And there's much more sebaceous involvement with acne. The typical acne comedones involves a sebum secretion, which in turn is due to nutritional deficiencies as well as hormonal issues. So, acne is a little... An acne comedones is a little different. It tends to be a little bit more sebaceous, although there's probably some sebaceous secretions in a comedogenicity response to a product. 

 

0:06:42.7 BF: But the main point is, number one, it's not the product that's causing the clog pores, it's the response to the product. Number two, that response to a product is a defensive response. And number three, it may be that that defensive response is the end result of a sensitivity. So that if you're deficient in certain nutrients, particularly fats, essential fatty acids, fatty vitamins like vitamin A or niacin vitamin B3, these protective types of nutrients, if you're deficient in them, and most people are, if they're not nutritionally supplementing, they're gonna be deficient in these nutrients. The keratinocytes inside your follicle may be more sensitive to one ingredient, which is why a comedogenicity scale isn't necessarily accurate, because the ingredient that supposedly is causing comedones may cause a comedone in some people who are missing vitamin A or missing niacin and not cause a comedone in other people, which is why you can't go by these comedogenicity scales. 

 

0:07:40.6 BF: And there's really basically one, and this is the one Dr. Fulton did back in the 1980s. So Comedogenicity is not what people think it is, it's a protective response. It's a callous like response, micro callous like response to a product inside the follicle. It may also and seems logically that it is also the result of the health, the overall health of the skin, the overall health of the patient. And it may be that the health of the patient is what's causing the response, the sensitivity response to a specific product. And then if a patient was supplementing an ordinarily comedogenic ingredient would not be comedogenic for that patient. And then also the Comedogenicity scale is based on single ingredients. It's not based on products. So we don't know how the ingredients are interacting in a specific product. Maybe an ingredient is comedogenic, but in a product it's not comedogenic. 

 

0:08:32.0 BF: Maybe something, some other ingredients in the product are protecting against comedone formation or vice versa. Maybe there's an ingredient that's non comedogenic when it's by itself, but in a product, it becomes comedogenic. Yet again, showing why a Comedogenicity scale, a product that's comedogenic or an ingredient that's comedogenic on a Comedogenicity scale is not relevant. In fact, the whole idea of Comedogenicity needs to be individualized. People have to see how they respond, and the response takes time. The idea that I put a product on my skin and all of a sudden I broke out, all of a sudden I got comedones doesn't make sense when you understand the mechanism of Comedogenicity. It takes a while, four to eight weeks for a comedone to form, and it takes constant application of an ingredient in order to stimulate that protective response. 

 

0:09:18.8 BF: If you are finding that a product does cause comedones, I wouldn't blame the product because when you think about it, the skin is a barrier to the outside. It should be resilient enough to be able to withstand ingredients. If you are finding that your skin is sensitive to certain ingredients, I would treat it as a skin barrier issue and start using nutritional supplements. And also, ironically, stimulating ingredients that may be problematic for people who have barrier issues sometimes are the exact ingredients you need in order to strengthen the barrier. Retinol and retinoic acid are the classic examples. A lot of folks say, well, I can't use retinol. It makes my skin too sensitive. It makes my skin break out, whatever. Well, it turns out that if you have a barrier issue, you may be sensitive to using retinol, but the retinol itself can be used to strengthen the barrier. 

 

0:10:05.3 BF: So it's kind of a catch 22. And the way you get around it is you start slowly, with lower dose and you give yourself lots of breaks between application of that stimulating ingredient, between application of the retinol, between doses of retinol, and simultaneously you use barrier strengthening nutrition. And that is so so important. In fact, if you had to pick one single skin health strategy for keeping your skin safe in the sun, safe from comedogenic ingredients, healthy, anti-age, it would be to strengthen the barrier with nutrition. Vitamin B3, which is niacin, vitamin A, vitamin C, essential fatty acids. These are all critical nutrients that tend to be deficient in the standard American diet for strengthening the skin barrier. 

 

0:10:58.6 MS: I have heard before that natural versus synthetic ingredients, and I've heard it for both different types of ingredients, that one is gonna be more of an irritant and ability to clog pores versus the other. 

 

0:11:12.5 BF: I don't... As a chemist, I don't really know what the distinction is between natural and synthetic. I have yet to hear a good definition of that. When you say natural, do you mean plant-based? I think people tend to think that natural is plant-based, and synthetic is made in the lab, but nothing comes right from the plant and goes into a product and goes right on your skin. Somehow it's being extracted from the plant. There are solvents that are being used to extract it from the plant. It's being heated, it's somehow being manipulated, so it's no longer natural. In fact, once you pick the apple off the tree, technically it's not natural anymore because you've now modified it somehow. Certainly after you've heated it up and you've blended it in with other ingredients or you've somehow crushed it or you've used a solvent to extract certain things, you change its status from natural to maybe pseudo natural or semisynthetic. 

 

0:12:05.3 BF: So I don't really know the distinction between natural and synthetic is. So I'm gonna assume that you mean plant-based rather than synthetic. No, it turns out that there's lots of ingredients in plants that could be allergenic, that may be irritating to skin cells inside the follicle. And I would really consider Comedogenicity to be a function of something wrong with the internal milieu of the body that's making the keratinocyte more sensitive, that's requiring the keratinocyte to divide rapidly and produce lots of keratin as a protective response secondary to some kind of nutritional or health issue internally, systemically. It should, comedones should really not happen with a standard ingredient because the skin is designed to be a barrier to the outside. And if the skin is sensitive in any way and based on what we just said, Comedogenicity is kind of a sensitivity issue. 

 

0:13:00.3 BF: You're looking at something that's wrong internally and systemically, and I wouldn't blame the ingredient necessarily. That being said, if you find that an ingredient or a product is comedogenic for you, then you probably want to avoid it, but at the same time, use it as a signal or a sign that you may be deficient in essential fatty acids, for example, or niacin, for example, or vitamin E maybe, or some kind of pigment antioxidant and try to work on the body internally. In fact, that's a rule of thumb for anybody who's dealing with a skin health issue, whether it's acne or psoriasis or even just plain old dry skin is, don't treat it as a topical issue. We say the skin is the body's largest organ, so treat the skin like an organ and work on the body systemically, internally in terms of nutrition, diet, digestive support to make sure that your skin, like any other organ in the body, is healthy enough to be able to use topical products. 

 

0:13:54.2 MS: That concludes our show for today, and we thank you for listening. But if you just can't get enough of Ben Fuchs, the ASCP's Rogue Pharmacist, you can find him @truthtreatments.com. For more information on this episode or for ways to connect with Ben Fuchs or to learn more about ASCP, check out the show notes. 

 

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