“Science is the most important element of Cosmetic Dermatology”

Scientifically conducted clinical trials are essential before using any drug or substance for cosmetic treatment, stresses Dr Rekha Sheth, the well-known Dermatology and Cosmetic Dermatology practitioner. Being the founder and president of Cosmetic Dermatology Society of India (CDSI), the organizers of CosdermIndia 2018 show, Dr Rekha even encourages the scientific community to use platforms like CosdermIndia to present their research papers. A practicing Dermatologist and Cosmetic Dermatologist who runs two clinics in Mumbai, Dr Rekha has several firsts to her credit. Besides being India’s first Cosmetic Dermatologist, she was the first individual to start a Medi-Spa in India. Dr Rekha has worked with globally acclaimed Dermatologists including Prof Dr Günter Stüttgen from Freie Universiy, Berlin and Prof Dr Albert Kligman from the University of Pennsylvania, USA. Being a socially responsible practitioner, she uses her knowledge and professional relationships for the benefit of India’s Dermatology community. In an interview to CosdermIndia 2018 Show Daily editorial team, Dr Rekha emphasizes on the importance of education and wants CDSI to focus on awareness building programs and reach out to the Dermatology practitioners in India’s semi-urban towns.

When you started off, who were the early participants at CosdermIndia events?

Initially, it was only the dermatological practitioners who came for our event. Later, we saw people from the formulations side, and even the healthcare and pharmaceutical product companies showing interest. We had guests from Unilever, Marico and many such reputed firms.

Please take us through your experience of organizing the first CosdermIndia event.

We started this activity in 1998. Our first event was inaugurated by Lt Dr Albert Kligman. Considered as the father of dermatology, Dr Kligman is credited with the identification and use of Tretinoin (Retin A) as acne medication. From thereon, we have been conducting CosdermIndia annual events for the past 21 years.

What was the initial response of the community?

I faced a lot of resistance due to my ideas about dermatology and cosmetics. The dermatologists thought that cosmetics and dermatology are unrelated subjects. They would say that beauty is not a derma concern. Senior dermatologists would be upset when I spoke about Cosmetic Dermatology. According them there was no science behind cosmetics. But I could see the relationship between the two streams. Various conditions that are recognized under dermatology are also cosmetic concerns. There are areas where these two domains overlap. I wanted to bring in an awareness about the scientific aspects behind cosmetics. Acne and hair fall, for example, are cosmetic concerns, but there are scientific reasons behind these. There can be no remedy to acne or hair fall unless their root causes are detected and treatment provided accordingly. Today, the scenario is different. Dermatologists and medical practitioners in general, have understood and accepted that these two fields are inter-related.

So awareness building was the main challenge for you then?

Yes. When we started out, although we got some response, people largely lacked the awareness, and therefore, did not want to participate. So we started out small with a few like-minded practitioners. Fortunately, there was support from the industry. Hindustan Unilever Ltd (HUL) backed us.

You always stress on importance of scientific studies. You even encourage researchers to present their papers at CosdermIndia shows.

Absolutely. Science is the most important element of Cosmetic Dermatology. In the past, people could be seen haphazardly using all kinds of remedies for acne, hair fall, or pigmentation. I opposed such unscientific practices always. The best option is to conduct randomized control trials (RCTs). Although every time you cannot conduct an RCT, at least there should be ample documented scientific proof studies available before you can use any drugs or substances.

I always propagated that unless there is science to it, unless there are scientifically carried out studies, papers, and publications in reputed journals which document the effects of a given drug on human body and its side-effects, we should not use it. No product or substance should be used unless all the tests and checks are duly conducted and their results validated and documented.

When did you start receiving good response?

We started out with merely 40 members. But when we added pigmentation as our focus area, more than a hundred Dermatology practitioners signed up.

Does CosdermIndia event get participation of the researchers and scientists from the industry and educational institutes?

Being the pioneers in this field and due to the dedication of our team, the CosdermIndia brand’s reputation has grown phenomenally over the years. All major companies have tie-ups with CosdermIndia today. Many companies send their best researchers and scientists to speak at our seminars.

What do you see as the key trends in the dermatology space?

Skin care and hair care are the two biggest areas today. Skin lightening—procedures and products—has a broad demand-base. It is gradually being proven that the skin pigmentation disorder is caused partially by pollution. The aging sector is growing too. In early 1980s, when Dr Kligman introduced his tretinoin cream, he had asked me to conduct a small study in India. But in those days, I could not find a single person willing to try out the cream. People did not feel the need to look young! The whole scenario has changed over the years. More and more people want to stay young and look young today.

What do you see as the major causes and trends in hair care?

In many cases, the UV rays is the culprit. UV rays make your hair rough. Earlier nobody thought that a deficiency or hormonal changes in the body could cause hair fall or skin-damage. But there is a growing awareness about these aspects today. Your blood test reveals a host of causes that potentially lead to such disorders.

When I started treating patients with polycystic ovarian syndrome (PCOS), it was not a known ailment. But now we have 18 to 20 PCOS cases every day as compared to two or three in a month in 1990s.

These changes can be attributed to causes such as our changed lifestyles, higher stress levels, and malnutrition. All these lead to ailments and disorders related to skin and hair.

From the remedies point of view, what do you see as the trends today?

The botanicals and naturals are making a huge comeback. For instance, there is a rising interest in tropical antioxidants like green tea or Vitamin C.

Is awareness still an issue today?

It continues to be. Even today, we see people using all kinds of concentrates. I will give you an example. The Indian Association of Dermatologists, Venereologists and Leprologists (IADVL) noticed that people were wrongly using a particular steroid cream. As an effect of the steroid, they were suffering from an unusual fungal infection which did not respond to normal treatment.

T cream was available in the market in many forms and was being sold indiscriminately as an OTC product. So the association did a representation to the government and the government banned it from being sold as an OTC product. The indiscriminate use of drugs continues to be a problem even today.

What about regulations?

The regulatory bodies like FDA exist. But unfortunately, nobody seems to follow them at the ground level. The authorities need to enforce laws with a strong hand to stop such hazardous practices.

Coming back to CDSI’s initiatives, what are your plans?

The cosmetic treatments were not taught in the Dermatology courses till recently. Now laser and other cosmetic treatments are being introduced as part of the course. We want to educate Dermatologists, especially from tier-2 and tier-3 cities to ensure that no unqualified persons offer laser or any other (Cosmetic Dermatological) treatments. A massive educational drive is needed.

Any plans about expanding CDSI’s network?

CDSI is a member of the reputed global body, International League of Dermatology Society (IDLS). We have around 2,500 members. Most of these are the Dermatology practitioners and primarily from Mumbai and other parts of Maharashtra. Considering that there are about 10,000 dermatologists at all India level, we have a good scope of growth.

This year’s event is our 22nd annual event. We usually conduct events in Mumbai only. But in the past we have also organized them at places such as Kochi and Goa. Going forward, we are looking at expanding our reach to the satellite cities and the tier-two towns. Education and awareness are the only ways to progress.