Dermocosmetics: what a cream can really do (and where medical treatment begins)

A cream can improve the texture, tone and hydration of the skin, and it can prevent a good deal of the ageing caused by the sun. What it cannot do is remove excess skin, put tissue back in its place or replace medical treatment: that is not a matter of the quality of the product or its price, but of how deep each tool reaches.

This page explains where that boundary is. It is written by a team that does both — prescribing skincare and operating — and that is why it can say what a manufacturer would rather not: what the ceiling of a jar is.

What exactly a cosmetic is, according to the law

The definition is not a brand’s or a magazine’s: it is in article 2(a) of Regulation (EC) 1223/2009, and it applies throughout the European Union. A cosmetic product is

“any substance or mixture intended to be placed in contact with the external parts of the human body […] with a view exclusively or mainly to cleaning them, perfuming them, changing their appearance, protecting them, keeping them in good condition or correcting body odours”.

It is worth reading slowly, because those six purposes are everything a cosmetic can legally promise. “Changing their appearance” is the broadest and the most honest: it describes exactly what a good cream does.

And then there is what does not appear: treating, curing or preventing disease. The moment a product is presented with that purpose, it stops being a cosmetic and becomes a medicine, with a different regime, a different authorisation and, often, a prescription.

Where the boundary is, with a concrete example

The clearest case is given by two molecules from the same family:

• Retinol is a cosmetic. It is bought without a prescription and is limited by the Regulation itself.
• Tretinoin — retinoic acid — is a medicine. In Spain it is marketed as Retirides at 0.25 and 0.5 mg/g, requires a prescription and its summary of product characteristics authorised by the AEMPS recognises two indications: mild to moderate acne vulgaris and, as adjuvant treatment, the reduction of fine wrinkles, mottled hyperpigmentation and roughness of facial skin.

They are chemical relatives doing similar things, and they are in two different boxes in law. We set it out in the page on retinol concentrations and the European limit, because it is the most frequent confusion in this whole field.

“Cosmeceutical”: a word with no box

You read it everywhere, and it means nothing in legal terms. Neither “cosmeceutical” nor “dermocosmetic” appears in the European Cosmetics Regulation, nor in the frequently asked questions the Spanish Agency of Medicines and Medical Devices publishes about it. For what is applied to the skin, the regulations know only two categories: cosmetic and medicine. There is no box in between.

That does not make the term a deception. It is a commercial label usually used to flag products with higher concentrations of active, more careful formulation or sale through healthcare professionals — and those differences can be real. What is worth knowing is that the word certifies nothing in itself: there is no body that grants it and no requirement that has to be met to use it.

In practical terms: when a product is presented as a “cosmeceutical”, the useful question is not whether it deserves the name, but what it contains, in what concentration and what study backs up what it promises.

And what is swallowed is neither of the two: it is a third thing

All of the above applies to what is put on the skin. The moment a product is swallowed — a capsule, a drinkable collagen, one of those ampoules you take — the whole regime changes: it is neither a cosmetic nor a medicine, it is a food supplement, regulated in Spain by Royal Decree 1487/2009 and notified to the Spanish Agency for Food Safety and Nutrition before being marketed.

And there what can be promised is spelled out by name. The permitted health claims are on a closed list — Regulation (EU) 432/2012 — and they are far more modest than the advertising suggests. For example:

• “Biotin contributes to the maintenance of normal hair.”
• “Biotin and zinc contribute to the maintenance of normal skin and hair.”
• “Vitamin C contributes to normal collagen formation for the normal function of skin.”

🔑 Note the formula, because it is what distinguishes a legal claim from an invented promise: “contributes to the maintenance of… normal”. It does not say it makes hair grow, or removes wrinkles, or repairs anything. A supplement promising more than that is promising beyond what the law allows it — and that is a check anyone can make with the box in their hand.

The yardstick almost nobody uses

There is a second regulation, less well known and very useful to the consumer: Regulation (EU) 655/2013, which sets the common criteria any claim about a cosmetic must meet. There are six: legal compliance, truthfulness, evidential support, honesty, fairness and informed decision-making.

Two of them turn cosmetic advertising into something checkable:

• Truthfulness. If an advertisement states that the product contains a particular ingredient, that ingredient has to be present — and not in token amounts when the promise depends on it.
• Evidential support. Claims, explicit or implicit, must be supported by adequate and verifiable evidence. If a study is used, it must be relevant to that product and that benefit, with a valid, reliable and reproducible methodology.

The same regulation adds two nuances that explain a lot of what you see on a label. First, mere compliance with legal minimums cannot be presented as an advantage — hence “not tested on animals” has stopped being an argument: it has been prohibited throughout the Union for years. And second, obvious hyperbole does not need justifying: an “instant lifting effect” that no average consumer takes literally is not an infringement, it is advertising.

🔑 What is usable in all this: faced with a concrete, measurable promise — “reduces wrinkles by 43%” — you can ask for the study, and the brand is obliged to have it. Faced with a vague promise, there is nothing to ask about, and that in itself says something.

The actives that do have evidence

Not all the ingredients on a label are at the same level. These four hold most of the published clinical evidence, and for all four it is worth knowing what kind of evidence we are talking about, because it is not the same.

Sun protection

It is the one with the most and the best evidence, and the only one with a long-term randomised trial demonstrating that it prevents skin ageing, not just sunburn. In a community study published in Annals of Internal Medicine with 903 adults followed for four and a half years, the group assigned to daily sunscreen use showed 24% less skin ageing than the discretionary-use group.

No other product in a washbag has anything like that behind it. It is set out in how to choose a facial sunscreen.

Retinoids

Retinol really does change the skin: in a randomised, double-blind, vehicle-controlled trial, 0.4% retinol applied three times a week for 24 weeks improved fine wrinkles and increased the expression of glycosaminoglycans and procollagen I in the tissue.

Two qualifications the advertising does not usually give: that study was done on the arm skin of people with a mean age of 87, and at 0.4%, a concentration that today is above the limit the European Union allows in a facial cosmetic. Both points are explained in what retinol does.

Vitamin C

It has clinical support in humans: a double-blind trial against excipient with 5% vitamin C for six months found significant improvement in the global assessment, increased density of the skin’s microrelief, a decrease in deep furrows and ultrastructural signs of repair of the elastic tissue. Here too the detail matters: it was applied to the neck and arms, not the face.

Its weak point is not efficacy, it is stability: it is an active that oxidises, and an oxidised serum does not work. We deal with it in how to choose a vitamin C serum.

Niacinamide

Less famous and with good evidence: in a double-blind trial with half-face application — each woman her own control — 5% niacinamide for 12 weeks in 50 women with signs of facial photoageing reduced fine lines and wrinkles, hyperpigmented spots, redness and yellowing, and improved elasticity measured by cutometry.

It is the active that most often appears inside other formulas rather than as a product in its own right, and that is why it goes unnoticed. It has no page of its own on this site precisely for that reason: almost nobody searches for it by name.

⚠️ One warning that applies to all four. These studies measure what each one measures: a particular concentration, on a particular area, for a particular time and in a particular population. They do not license the conclusion that any product containing that ingredient will do the same. It is exactly what the “evidential support” criterion of the claims regulation requires.

How to read a label without believing the packaging

Four checks you can make in two minutes, before paying:

1. Look for the active in the ingredients list (INCI), not on the front. The list is ordered from most to least down to 1%; below that, the order is free. If the active the product is named after appears after the preservative, it is present in small amounts.
2. See whether the concentration is declared. Declaring it is not compulsory, so when a brand does — “retinol 0.3%”, “vitamin C 15%” — it is taking on a checkable commitment. When it does not, there is no way of knowing.
3. Look at the packaging, above all with antioxidants. Vitamin C and retinol degrade with light and air. A transparent jar with a wide opening is bad news for both; opaque, airtight packaging or a one-way pump is good news.
4. Check the promise against the evidential support criterion. A concrete figure should be capable of being backed up; an evocative phrase promises nothing and therefore breaches nothing either.

Where the ceiling is: what a cream does not do

This is where a surgical clinic can contribute something a perfumery aisle cannot. Each tool reaches as far as it reaches, and that depth is not bought with a better product:

What you want to change	How deep you have to reach	What does it
Texture, tone, hydration, barrier, prevention	Epidermis and superficial dermis	Skincare, every day
Pigmentation, scars, quality of the dermis	Dermis	Peels, intense pulsed light, laser
Lost volume, support, projection	Deep dermis and deep planes	Injectables
Excess skin, sagging tissue, position	Every plane	Surgery

Out of that table come the three sentences most often repeated in the consulting room:

• A cream does not firm sagging tissue. It can improve the quality of the skin covering it, which is another matter and also shows, but it repositions nothing.
• A cream does not remove excess skin. Not from an eyelid, and not from an abdomen.
• A cream with hyaluronic acid does not fill. The hyaluronic acid in a cosmetic hydrates the surface; the kind injected in a hyaluronic acid treatment occupies a plane no cream reaches. They share a name and little else.

And the sentence that goes the other way, which is also true: none of the tools at the bottom of the table replaces the one at the top. After a fractional CO₂ laser, a chemical peel or surgery, the result is maintained by what you put on at home every day. It is the part that depends on the patient, and the one most neglected.

When the answer is not a cream

These situations are assessed before anything is bought:

• 🚨 A new mark, one that changes colour, size or border, or one that bleeds. It is not a cosmetic problem until someone has looked at it. No depigmenting agent should be applied to an undiagnosed lesion.
• Acne, rosacea, dermatitis or psoriasis. These are medical diagnoses and have treatment of their own. A cosmetic can accompany, never replace the consultation.
• Skin that gets worse with everything you put on it. It is usually a skin barrier damaged by too many actives, and the solution is to take away, not to add.
• Pigmentation that comes back every summer despite doing everything right. It may be melasma, which has rules of its own — it is explained in why melasma comes back.

How a product is chosen at ICPM

There is no single routine that suits everyone, and being wary of anyone offering one is a good filter. What there is is an order of priorities that recurs:

1. First, daily sun protection. It is what has the most evidence and what underpins everything else: without it, a depigmenting agent is working against the current.
2. Then one main active, chosen for the problem that bothers you most — texture and wrinkles, pigment, or barrier quality. One, not four.
3. Cleansing and moisturising suited to the skin type, which is what makes the active tolerable.
4. And time. The studies supporting these actives measure at 12 weeks, 24 weeks or six months. A month is not a period over which to judge anything.

The order of application and the combinations worth avoiding are in what order to apply your skincare.

The products we dispense are in the dermocosmetics shop, organised by brand. The specific choice — which active, at what concentration and on what schedule — is made in the consulting room, because it depends on the skin type, on what has been used before and on whether any medical treatment is under way.

For a starting point before the consultation, the skincare routine tool builds a routine from the shop’s products, in two budgets, from eight questions that never leave your browser. Its eight outputs are pages in their own right, by priority: wrinkles and texture, pigmentation, spots and pores and redness; and by skin type: dry, oily, combination and sensitive.

Frequently asked questions

Is an expensive cream worth it?

Price on its own does not predict the result. What does matter is the concentration of the active, the formulation that keeps it stable and the packaging that protects it, and those three things genuinely make a product more expensive. Luxury packaging and the advertising campaign also make it more expensive, and they do nothing for the skin. The practical way to decide is to look at the label with the four points above rather than at the figure.

What is the difference between a pharmacy cream and a clinic one?

Legally, none: both are cosmetics and comply with the same Regulation. The real differences usually lie in the concentration of active, in the fact that a healthcare professional chooses the product and the schedule, and in the follow-up. None of those three things is guaranteed by where it is bought.

Can I use several actives at once?

You can, but it is the most frequent cause of irritated skin arriving at the consulting room. The practical recommendation is to introduce one at a time and wait a few weeks before adding the next: if something disagrees with you, that way you know what it was.

How long does a cream take to show?

It depends on the active and on what is being measured. Hydration and texture can change within weeks. Anything affecting wrinkles, pigment or the quality of the dermis is measured in the studies from 12 weeks onwards, and some at six months. Any product promising a structural change in days is promising something it cannot demonstrate.

Can a cream replace medical treatment?

No, and nor the other way round. Each tool reaches a different depth: a cream works on the surface and in the most superficial dermis; laser, peels, injectables and surgery reach planes no topical product gets to. The usual thing is not to choose, it is to combine — and daily skincare is what preserves the result of everything else.

Are “natural” cosmetics safer?

“Natural” is neither a legal category nor an indicator of safety. Every cosmetic sold in the European Union, natural or not, has to pass the same safety assessment and respect the same lists of prohibited and restricted substances. A plant extract can be irritant or sensitising just as a synthetic molecule can.

I have sensitive skin — can I use actives?

Generally yes, but the how changes: lower concentrations, less often and priority on repairing the barrier before asking anything of the skin. If the sensitivity is constant and comes with persistent redness, it is worth first ruling out rosacea, which is a diagnosis and not a skin type.

Sources

• Regulation (EC) No 1223/2009 of the European Parliament and of the Council of 30 November 2009 on cosmetic products. Text in the BOE · consolidated text on EUR-Lex. — Article 2(a): legal definition of a cosmetic product and its six purposes. Article 20(1): in labelling, marketing and advertising, text, names, trade marks or symbols shall not be used “to imply that these products have characteristics or functions which they do not have”. Annex II: list of substances prohibited in cosmetics — among them hydroquinone, entry 1339. Annex III: list of restricted substances, with the conditions of use for each. It is the framework regulation applicable throughout the European Union. The annexes verified against the consolidated text on 28-08-2026; the BOE page resolves the articles but does not display the annexes.
• Spanish Agency of Medicines and Medical Devices (AEMPS). Frequently asked questions on Regulation (EC) No 1223/2009. aemps.gob.es. — It sets out the definition in article 2(a) and refers to Regulation (EU) 655/2013 for claims. Verified on 27-08-2026: it nowhere uses the terms “cosmeceutical” or “dermocosmetic”, which supports the statement that they are not regulated categories.
• Royal Decree 1487/2009 of 26 September on food supplements (amended by Royal Decree 130/2018). Text in the BOE. — The Spanish regime for food supplements, distinct from that for medicines and that for cosmetics. Its article 9 requires the product to be notified to the Spanish Agency for Food Safety and Nutrition before marketing; the notification is not an authorisation to sell, but the mechanism by which the authority knows what product is in circulation.
• Commission Regulation (EU) No 432/2012 of 16 May 2012 establishing a list of permitted health claims made on foods. Text in the BOE. — A closed list of what a food supplement may claim. Among those authorised: “biotin contributes to the maintenance of normal hair”, “biotin and zinc contribute to the maintenance of normal skin and hair” and “vitamin C contributes to normal collagen formation for the normal function of skin”. It complements Regulation (EC) 1924/2006 on nutrition and health claims. Verified on 27-08-2026.
• Commission Regulation (EU) No 655/2013 of 10 July 2013 laying down common criteria for the justification of claims used in relation to cosmetic products. Text in the BOE. — The six common criteria: legal compliance, truthfulness, evidential support, honesty, fairness and informed decision-making. It includes the rule that mere compliance with legal minimums cannot be presented as a benefit, and the exception for hyperbole.
• AEMPS — CIMA. Summary of product characteristics for Retirides 0.5 mg/g cream (tretinoin). cima.aemps.es. — A prescription-only medicine. Authorised indications: mild to moderate acne vulgaris and adjuvant topical treatment for the reduction of fine wrinkles, mottled hyperpigmentation and roughness of facial skin. Contraindicated in pregnancy.
• Hughes MC, Williams GM, Baker P, Green AC. Sunscreen and prevention of skin aging: a randomized trial. Annals of Internal Medicine, 2013;158(11). PMID 23732711. — Randomised community trial in 903 adults under 55 followed for 4.5 years. The daily sunscreen group showed 24% less skin ageing than the discretionary-use group (odds ratio 0.76). Beta-carotene had no effect.
• Kafi R, Kwak HS, Schumacher WE, et al. Improvement of naturally aged skin with vitamin A (retinol). Archives of Dermatology, 2007;143(5). PMID 17515510. — Randomised, double-blind, vehicle-controlled trial comparing right and left arm. Retinol 0.4% up to three times a week for 24 weeks in 36 elderly subjects (mean age 87). Significant improvement in fine wrinkles and increased glycosaminoglycans and procollagen I.
• Humbert PG, Haftek M, Creidi P, et al. Topical ascorbic acid on photoaged skin. Clinical, topographical and ultrastructural evaluation: double-blind study vs. placebo. Experimental Dermatology, 2003;12(3). PMID 12823436. — Randomised double-blind trial with 5% vitamin C cream against excipient, applied to the neck and arms for six months. Significant improvement in the global score, increased microrelief density, a decrease in deep furrows and ultrastructural evidence of repair of the elastic tissue.
• Bissett DL, Oblong JE, Berge CA. Niacinamide: a B vitamin that improves aging facial skin appearance. Dermatologic Surgery, 2005;31(7 Pt 2). PMID 16029679. — Double-blind trial with half-face application and vehicle control on the other half, twice daily for 12 weeks, in 50 women with clinical signs of facial photoageing. It reduced fine lines and wrinkles, hyperpigmented spots, redness and yellowing, and improved elasticity measured by cutometry.

Book your consultation

If you have spent a while buying products without knowing whether you are doing the right thing — or if you have just had a treatment and want to preserve it — what settles the question is an in-person assessment: the skin type is looked at, what you already use is reviewed and it is decided what is really needed, which is often less than what is in the washbag.

Clinical confirmation by the surgeon

Last reviewed: 17 September 2026. This content is for information only and does not replace an individual assessment by a healthcare professional.