Breaking Down Terminology

Holistic

The term holistic, sometimes referred to as wholistic, is the philosophy and practice of healing that has to do with constantly keeping the whole body (meaning the physical body, the mind and the spirit) at the highest level of total wellness. This concept draws from the universal natural laws that state a whole is made up of the sum of all of its parts and that the parts cannot function properly if the whole is not functioning properly. Conversely, if there is a problem with one of the parts, the entire whole is affected.1

Pertaining to skin care, this concept implies that one cannot treat the skin as a separate entity from the entire body. The skin (being the largest organ of the body) performs many functions, all of which either work in partnership with or depend upon the functions of the internal vital organs. While many in the industry consider holistic skin care to simply be the practice of using non-invasive treatments and products containing mostly natural and organic ingredients, this is just the tip of the iceberg. The concept of holistic skin care must go deeper than just the skin if sustainable results are to be achieved.
In holistic skin care, as well as traditional holistic healing modalities such as Ayurveda and traditional Chinese medicine, a person’s skin is a reflection of his or her inner health. These philosophies, as well as others like homeopathy and naturopathy, state that conditions such as rosacea, acne, seborrhea, eczema, keratosis pilaris, psoriasis, loss of collagen and elastin, et cetera all begin inside of the body, like the digestive tract, or due to other issues like stress. Simply treating the skin itself as a separate unit from the whole might make short-term improvements, but without addressing the cause of the problem, true resolution will never occur. Depending on his or her education, an aesthetician might be able to treat the skin in this way, she might need to draw on the expertise of a certified or licensed nutritionist, TCM/acupuncturist, Ayurvedic, naturopathic or other type of holistic practitioner.
In terms of skin care products, holistic might refer to topical products or internal supplements termed nutriceuticals. Topical products that claim to be holistic are characterized by containing almost 100 percent natural ingredients such as herbs, plant extracts, phytonutrients and antioxidants, and essential oils. They are often preserved by using ingredients that have fewer associations with toxic reactions than more commonly used and controversial parabens. More holistic preservatives might include specific essential oils, colloidal silver, Geogard® Ultra (a proprietary blend of sodium benzoate and gluconolactone)2, ethylhexylglycerine or potassium sorbate. Internal supplements might include nutrients that are known to benefit the skin, such as collagen, hyaluronic acid and antioxidants such as green tea, grape seed extract, vitamin C, Resveratrol or Pycnogenol®. Ingredients for holistic products, whether topical or internal, aim to be sourced from all-natural, organic, cruelty-free, wildcrafted, sustainably grown/processed, and often vegan origins.
While this may seem rather straightforward, the truth is that terms organic and all-natural are really quite vague in the skin care industry since there is little to no government regulation on these types of ingredients or products. Other types of products containing active ingredients considered to be over-the-counter drugs might have more government intervention.

Organic

The word organic has several definitions since it is used in many different contexts. In chemistry, the term organic describes a class of chemical compounds that formerly comprised only those existing in, or derived from, plants or animals; that now includes all other compounds of carbon.3 If a skin care product contains the ingredients benzene, petrolatum or cetearyl alcohol, it could be considered organic in chemical terms since they are derived from carbon-containing substances.
In medicine, the word may include anything pertaining to an organ or the organs of an animal, plant, fungus or living tissue.3 When applied to skin care, this definition might be used to describe ingredients like human-derived growth factors, which are cultured from the living tissue of human beings. Although these examples could be considered organic in some way, they are ingredients that are commonly avoided by aestheticians and consumers wishing to use organic, natural and holistic products.
The word organic is a labeling term that indicates that the food or other agricultural product has been produced through approved methods that integrate cultural, biological and mechanical practices that foster cycling of resources, promote ecological balance, and conserve biodiversity. Synthetic fertilizers, sewage sludge, irradiation and genetic engineering may not be used.4 Farms and food companies wishing to use the green USDA Organic seal on their products must undergo specific procedures, tests and inspections in order to make sure that their products meet the USDA National Organic Program’s standards.5 There are several other organic certifying organizations around the world that certify foods, herbs and other plants as organic, including EcoCert, OneCert, The Oregon Tilth and the Global Organic Alliance.
One might ask what this has to do with skin care. It is important to understand that these organic certifications only pertain to a food or plant in its whole form – not its extract, concentrate, essential oil, et cetera. Once the ingredient has changed from a whole food or plant to a topical skin care or nutriceutical product, it can no longer be considered organic. It is rare to look at a product label and see the words apple, lemon, sugar beet, rooster, cow, grapes or lavender. Instead, you would likely see the end product form of the ingredients which might be listed as apple (Malus domestica) stem cells, vitamin C or citric acid (both can be derived from lemons), hyaluronic acid (can be synthesized from sugar beets or derived from rooster combs), Types I and III collagen (derived from cows), Resveratrol (antioxidant derived from grape skins) or lavender (Lavandula angustifolia) essential oil.

Natural

Unlike organic products, the FDA and USDA do not have any standards or requirements for labeling products as natural or all natural. The FDA defines natural ingredients as ingredients derived from natural sources (for example, soybeans and corn provide lecithin to maintain product consistency; beets provide beet powder used as food coloring). Some ingredients found in nature can be manufactured artificially and produced more economically with greater purity and more consistent quality than their natural counterparts. For example, vitamin C, or ascorbic acid, may be derived from an orange or produced in a laboratory.7 Clearly, the latter would not be considered natural to a holistically-minded consumer; however, there are no laws requiring manufacturers to differentiate between natural sources versus bio-identical laboratory synthesis of natural ingredients.
This is where things get vague for both manufacturers and consumers alike. Unfortunately, deceptive practices tend to occur because less than one percent of all ingredients listed as natural actually are. The definition of natural, just like the definition of organic, can be used in different contexts where an ingredient might be considered natural in the sense that it was derived from a whole natural ingredient, but in truth, the ingredient itself has gone through so much processing that its end structure bears no resemblance to the whole food or plant from which it was derived. An example of this is sodium laureth sulfate. According to the Environmental Working Group’s Skin Deep® Cosmetics Database, this ingredient is considered to be an irritant to the skin and has been linked to contamination and organ toxicity.8 Clearly, this is an ingredient that a holistically-minded practitioner or consumer would avoid. However, it can be manufactured from coconut oil, allowing it to technically be considered natural.

Natural Versus Scientifically Altered

Are natural ingredients that have been scientifically altered still considered to be holistic? This question does not necessarily have a correct answer, since the terms natural and holistic have different meanings in different contexts. Holistic purists typically do not want any products that contain ingredients that have been altered from their original state, though most are unaware of how few ingredients actually meet those criteria. If they are aware, they often choose to make their own products, using raw whole foods based on traditional home remedies. On the other hand, more progressive holistic enthusiasts recognize the benefits of scientific enhancements of natural ingredients.
It is important that aestheticians and consumers understand the difference between applying plants, raw fruits or other food products directly to the skin with applying a skin care product containing an extract, essential oil, antioxidant, peptide, exfoliant or other active ingredient derived from that food. Consider the following: lactic acid is a gentle alpha hydroxy acid (AHA) that is derived from a whole food – milk. Milk has a long history of being beneficial to the skin with consistent use. For example, milk baths have been used for thousands of years to smooth and hydrate the skin. We now know that the reason it works is because it contains lactic acid. Science has given us lactic acid as an isolated ingredient and its hydrating and mildly exfoliating effects can be seen with as little as one treatment.
It is a fact that certain ingredients (whole foods and chemicals alike) are known to cause skin irritation and allergies. Some people are intolerant to the sugar in milk (lactose), or are allergic to the protein it contains (casein). While using it topically may be less likely to cause a reaction than ingesting it, its original state may still cause some sort of reaction since some of it will likely be absorbed through the skin. However, science has the ability to remove the lactose and casein in the chirally correct ingredient l-lactic acid. In a correct formulation, one can benefit from the positive aspects of the ingredient without experiencing the likely negative reactions from the whole food ingredient. Furthermore, l-lactic acid is more stable on its own than whole milk which would quickly spoil.
Depending on how the consumer personally defines holistic, 1-lactic acid may or may not be considered a holistic ingredient. It is important to explain the difference to clients, but also be mindful that they may not consider a product containing l-lactic acid to be natural or holistic.

Regulation and Labeling

Are cosmeceuticals and nutriceuticals really more effective? When selecting products for professional use or as part of a home care regimen, efficacy is certainly one of the most important criteria to consider. The terms cosmeceutical and nutriceutical sound great to consumers since the suffix ceutical sounds more authoritative and legitimate than the term professional-strength. So what are they?
A cosmeceutical is simply a topical skin care product that claims to have a targeted, therapeutic effect on the skin. It is a hybrid of the word cosmetic, a product that aims to increase the beauty of or improve the overall appearance of the skin. The word pharmaceutical refers to a drug that actually affects the structure (anatomy and histology) and function (physiology) of the skin and is intended to diagnose, treat or prevent a specific disease or condition. The FDA recognizes the terms cosmetic and pharmaceutical and regulates both under the Food, Drug, and Cosmetics Act, albeit very differently. One product may be considered both a cosmetic and a drug; however, the FDA does not use or consider cosmeceutical as a valid term.
Similarly, nutriceutical, a hybrid of the terms nutrition and pharmaceutical, refers to an internal supplement which claims to have a therapeutic effect on the body in part or as a whole. Like the word cosmeceutical, the word nutriceutical has no meaning in United States law or regulation. The FDA considers a substance to be either a food (including dietary supplements and food ingredients) or a drug (including pharmaceutical and over-the-counter drugs). A product may be considered both, but the FDA does not consider nutriceutical a valid term.
Drugs such as benzoyl peroxide or citric acid, both topical products and internal supplements, may contain active ingredients that are regulated. Cosmetics and dietary supplements do not require FDA approval and manufacturers must be careful how they word their packaging, labeling and marketing to make sure that no drug-like claims are made. However, most companies get around this by adding the following disclaimer: “These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.”
Drugs, on the other hand, must generally receive premarket approval by FDA through the New Drug Application (NDA) process or conform to a monograph for a particular drug category, as established by FDA’s Over-the-Counter (OTC) Drug Review.9 If a product, topical or internal, contains an FDA-approved drug ingredient, the product must contain a Drug Facts box, listing the approved drug ingredient, with its percentage as an active ingredient, preceding any other ingredients. Non-drug ingredients may be listed as Other Ingredients or Supplement Facts.
The only other ingredients that are not drugs which require FDA regulation and specific labeling are color additives. Soaps are not regulated by the FDA, but are regulated by the Consumer Product Safety Commission (CPSC). Note that, due to potential photosensitivity issues, there are specific labeling considerations for any topical product that contains AHAs. While not mandatory, the FDA encourages manufacturers to use the following statement in products that contain AHAs. Sunburn Alert: This product contains an alpha hydroxy acid (AHA) that may increase your skin’s sensitivity to the sun and particularly the possibility of sunburn. Use a sunscreen, wear protective clothing, and limit sun exposure while using this product and for a week afterwards.10
While a product may contain both drug and cosmetic or food ingredients, the words cosmeceutical and nutriceutical are terms that only have meaning in marketing – not in regulation. While some of these products may contain ingredients that show improvement or affect changes in the skin or the body, companies are not required to actually substantiate these claims. They are only required to prove that the product meets the FDA’s safety requirements.

Beyond Labels

What happens once the product is opened? Though a product’s safety must be verified before it is released into the market, there is little control over its safety and/or stability once it is opened. This is an issue that is typically handled by the addition of preservatives to a formulation, but remember that the use of preservatives is kept to the absolute minimum in most products that are considered natural, organic or holistic.
The purpose of adding preservatives to a product is to inhibit oxidation and prevent chemical changes that happen due to exposure to air, moisture, contamination from use, or just time itself, causing the product to become desirable to microorganisms. Even so, every product has a shelf life.
Nationally advertised commercial products are mass produced in huge quantities and might sit in warehouses and stockrooms for months, or even years, before they hit the shelves of retail stores. These products often contain greater quantities and concentrations of preservatives. Holistic, natural, or organic products must contain a preservative – the amount and strength, however, depends on the batch sizes. Most holistic products are produced in smaller batches, using fewer and lower-strength preservatives, assuming that the products will not sit in storage as long and will be consumed faster. While a commercial product might have a shelf life of three years, a holistic product might have a shelf life of 18 months. This is why expiration dates are essential, especially for natural or holistic products.
Often, expiration dates are printed or stamped onto the product’s tube or container; however, this is not yet required by the FDA, so not every product will show an expiration date. It is also important for manufacturers to differentiate whether their expiration dates are from the date of manufacture or if they begin once the product is opened.

"I highly recommend that aestheticians, spa owners and consumers do not purchase a product simply based on the use of the terms cosmeceutical or nutriceutical. It is more important to gain accurate information about the sources and formulation of the ingredients, manufacturing practices, and third-party research that might demonstrate results on real people."

Even the most preserved product will eventually go bad, meaning it will start to break down on its own and will become the residence of bacteria, fungi and viruses. Liquid or cream products in jars are constantly exposed to air and moisture by being opened and closed often, as well as those which contain wands or applicators like mascara or lip glosses, which are most susceptible to contamination and degradation. Proper usage, storage and replacement every three months are necessary.
It is equally important that aestheticians educate their clients about expiration dates and product shelf life. No client, holistically-minded or otherwise, wants to contract an infection from using a contaminated or spoiled product. Expired or spoiled cosmetic products can cause bacterial infections of the skin such as acne, contagious viral infections like herpes simplex 2 (cold sores) and impetigo, viral or bacterial conjunctivitis (pink eye), and irritant reactions like contact dermatitis. If the contaminant enters into the bloodstream through a weakened area of the skin’s barrier, more serious infections like staph can occur either locally in the form of a cyst or boil, or systemically like MRSA.11
Travel and sample sizes are less likely to include expiration dates, so it is important to take as much care when storing and using them as you would with full-sized products, especially ones that are not packaged in single-use packets. Many people tend to use travel and sample-sized products sporadically. Small bottles of cleansers, toners, serums and moisturizers are often opened for use during a weekend getaway and not discarded if product remains. Instead, they remain packed with other travel essentials for use on a future getaway. Often, the product spoils before its next use, so it is a wise idea to inform clients to discard any unused product, in a travel-sized container, if it is not going to be used again for a while.
The widespread growth of the holistic, natural and organic skin care industry has caused many wonderful opportunities for new products, treatments and services for spas, as well as for consumers. However, due to the fact that definitions, standards, regulations and legislation are still vague, opportunities for dishonesty and poor business practices have also grown.

"Whether you are a spa owner or aesthetician looking to incorporate holistic, natural or organic products and treatments, it is important to look beyond the packaging and marketing campaigns and really research the manufacturer’s philosophy, the product ingredients, how they are sourced, the product formulation, what safety and quality testing measures they take, and how transparent they are with providing documentation in order to fully understand what you are buying."

References

1 Pontillo, Rachael. “Holistic, Naturopathic, Homeopathic, Alternative...What Does It All Mean?” Holistically Haute with Rachael Pontillo. Holistically Haute, LLC, 30 Mar. 2011. Web. 29 July 2013.
2 “Geogard™ Ultra.” Lonza SPS Store. Lonza SPS Store, n.d. Web. 29 July 2013.
3 “Organic.” Dictionary.com. Dictionary.com, n.d. Web. 29 July 2013.
4 “National Organic Program.” Agricultural Marketing Service - National Organic Program. The United States Department of Agriculture Marketing Service, 5 June 2013. Web. 29 July 2013.
5 “ECFR — Code of Federal Regulations.” ECFR — Code of Federal Regulations. GPO U.S. Government Printing Office, 25 July 2013. Web. 29 July 2013.
6 “National Organic Program: Understanding Organic Labeling.” United States Department of Agriculture Agricultural Marketing Service. USDA, 5 Feb. 2010. Web. 29 July 2013.
7 “Overview of Food Ingredients, Additives & Colors.” U.S. Food & Drug Administration. FDA, Apr. 2010. Web. 29 July 2013.
8 “SODIUM LAURETH SULFATE.” || Skin Deep® Cosmetics Database. Environmental Working Group, n.d. Web. 29 July 2013.
9 “Is It a Cosmetic, a Drug, or Both? (Or Is It Soap?).” U.S. Food & Drug Administration. FDA, 30 Apr. 2012. Web. 29 July 2013.
10 “Guidance for Industry: Labeling for Cosmetics Containing Alpha Hydroxy Acids.” U.S. Food & Drug Administration. FDA, 10 Jan. 2005. Web. 29 July 2013.
11 Pontillo, Rachael. “Even Good Cosmetics Can Go Bad.” Holistically Haute with Rachael Pontillo. Holistically Haute, LLC, 15 Mar. 2011. Web. 29 July 2013.

Rachael Pontillo is an award willing AADP board certified Holistic Health Practitioner, licensed aesthetician, published author and public speaker. She is the author of the new book Love Your Skin, Love Yourself, and currently works in private practice as a health and image coach. Rachael is the founder and author of the popular website and blog Holistically Haute™ and is also a featured writer in several leading health and beauty publications. Pontillo also holds a position as skin care expert and speaker for NeoCell™.