To say Dr. Zoe Diana Draelos is accomplished is an understatement. A research and clinical board-certified dermatologist with over thirty years of expertise in aesthetics, over-the-counter (OTC), and pharmaceutical treatments, her contributions to the field of cosmetic dermatology are unmatched. Once the Vice President of the American Academy of Dermatology as well as the editor-in-chief of the Journal of Cosmetic Dermatology, Dr. Draelos has authored over 500 scientific papers as well as 14 textbooks on topics ranging from skin physiology to cosmeceuticals and sunscreens.
In 1988 she founded the North Carolina-based research organization, Dermatology Consulting Services, where she and her team of doctors, scientists, and technicians study and develop the next big skincare and OTC innovations for major beauty and personal care companies like L’Oreal and Johnson & Johnson. In 2019 she was recognized as the most influential woman in cosmetic science by the Society of Cosmetic Chemists when she received the inaugural Florence Wall Award.
IBA recently caught up with Dr. Draelos to discuss her career path, groundbreaking moments in cosmetic dermatology, and what “dermatologist tested” really means.
IBA: What lead you to become a dermatologist?
ZD: My original degree is in mechanical engineering, although every aptitude test I took in high school told me I should be a doctor. But I was good in math and science, so I thought engineering was my calling. When I got to my junior year of engineering school, I suddenly had this thought, this may not be for me after all. I like the technical side of things, but I really love people.
I decided to go to medical school instead, but I had no chemistry, no biology, none of that on my record. But regardless I applied and got in. I got a job in a pediatric cardiology lab after studying fluid mechanics; this is when they were developing the first ultrasound machines. We were looking at kids’ hearts, which combined my study of engineering with my love of people. I decided I’m going to be a pediatric cardiologist.
Now I’m a third-year medical student and instead of doing research, I had to go out and see patients. At that point, I had realized that all the kids ultimately died in pediatric cardiology. The study itself was fascinating, and the technology was great, but chances are if you were born with a heart defect in the ’70s your longevity wasn’t good. Did I want to spend my life telling parents that their child wasn’t going to leave the hospital?
I decided not to be a pediatric cardiologist and that year I had to rotate throughout all the specialties. After a few uninspired rotations in obstetrics and psychiatry, I just felt lost. I was supposed to be signing up for residencies and internships, and I thought medical school was a big mistake!
My next rotation was dermatology, in a private practitioner’s office. I show up for my first day and I see the doctor was happy! He saw kids, babies, males, females, and people in their 90’s. He was able to fix most things; he could cut it off, sew it up, he could diagnose it, he could look under the microscope, he could do medicine, he could do surgery, he was looking at hair and nails. I finally figured out what I wanted to do. It was a revelation! Since that day I’ve loved every day of my work.
IBA: What made you specialize in cosmetic dermatology?
ZD: I was so late in declaring my specialty that I had to get my residency and internship outside the traditional match. I had to oversee the research lab to secure my spot, so while everyone was out playing, I was working with the rats in the research lab. Little did I realize that I was training to become a research dermatologist, which is what I am now.
It was my last year of residency and my program director turned to me and said, you know a lot about hair and nails and skin and cosmetics. When I was in high school, I had finished all my requirements early so I did some cosmetology and really loved learning to do hair and nails. So he said, you should write a book. There’s nothing out there for dermatologists on the subject. He introduced me to his publisher and got me started writing my first book.
I left training, went into a group practice, and had my children, but I really had the research bug. Patients are great, but I love the research and engineering. I eventually went into practice on my own and set up my own research lab. I started working on improving skincare products. I wanted to understand how new developments in skin physiology could translate into meaningful products for people. I also do drug research as well, half are OTC-type products, and the other half are prescription products.
I have a 28,000 square foot lab with analytical chemistry capabilities to analyze drug and cosmetic ingredient products in the skin. We have high-pressure liquid chromatography, and mass spectrometry. We have a full medical office for surgery, and we have spaces dedicated to cosmetic research and we have biomechanics lab.
There’s my engineering, my cosmetology, my dermatology, and I just put it all together. Part of dermatology is, you have a skin disease, let’s diagnose it and treat it. But the other part of it is, you need the right cleanser and the right moisturizer. We need to optimize what this drug can do for you by providing OTC products and skincare. Then once the disease is cleared, we need to prevent it from coming back. In many ways, skincare goes hand and hand with medicine. A lot of medical needs drive needs in skincare, but prevention and maintenance are really where it’s at. That’s the OTC realm in which I work.
IBA: How do you work with brands on developing topical products?
ZD: Sometimes I come in as a consultant. Sometimes I come in testing already developed products for a claim. Sometimes I come in at the formulation stage. Sometimes I even come in at the product conception stage when the brand is trying to figure out where there’s an unmet need in the marketplace.
For example, I did the very first formulations for CeraVe, helping to decide what they were going to create, and what the product would look like. There was no mass-sensitive skin, ceramide-containing brand at that time, so it really represented an unmet need. Cetaphil was around, which is a good brand that I also worked on, but it didn’t have the ceramides and it was based on some older skin physiology. Now Cerave is part of the L’Oreal group and I often do work for them online extensions.
IBA: What is it about the research part that makes you more passionate than patient work?
ZD: I still see patients and I do love that, although I don’t do as much of it now. This is the scenario that happens to me every day. People will come in with a skin problem, and they’ll ask what I can do to help them. For example, people who pick holes in their skin and slowly turn their acne lesions into scars. Well, we don’t have anything to help. Or someone comes in with horribly dry skin to the point they want to claw their face. Well, we don’t have a cure for that either. We have medicines we can give them to make it better, but I don’t have anything that’s going to cure them in a week.
Every day when I see patients, I’m confronted with all these challenges for which I have either no treatment, a sub-optimal treatment, or a treatment that smells bad and is greasy. We still have a long way to go in skin science. So many people are out there suffering, and we really don’t help them much, but we could, and we should and that drives me into the research lab.
IBA: What have been the most groundbreaking innovations in the field of cosmetic dermatology since you’ve been in the industry?
ZD: A breakthrough moment in the drug realm was the development of what’s called the biologics, which are antibodies that attack substances that are elevated in the body, most notably psoriasis. You can now inject monoclonal antibodies that attack what’s making those with horrible psoriasis red and itchy, bind them and make them go away. The psoriasis is not cured but it just completely disappears. That whole category of injectable biologics has really revolutionized dermatology in many areas besides psoriasis, like atopic dermatitis and prurigo nodules.
In the cosmetics realm, the development of ingredients that mimic natural substances in the skin has been really groundbreaking. Hyaluronic acid is a great example. Hyaluronic acid is what the body uses to moisturize itself, and it used to be really expensive to make over twenty years ago. We can now build a bio-identical kind of molecule in the lab that’s cheap enough in its manufacturing process that it can go into a mass body lotion.
What’s also hugely changed in skincare is an overall better understanding of skin physiology. We understand now that aging is due to oxidative stress on the skin. The concept of antioxidants being used as a preventive, and that whole arena of inflammaging has been huge. For instance, why do people who smoke cigarettes age more quickly? Well, when the tobacco burns it creates nanoparticles as part of combustion which sits on the skin and generates reactive oxygen species. Those reactive oxygen species damage the collagen elastin, and you get wrinkled, saggy skin. Understanding that very complex sequence of events has made a big difference.
IBA: How does your research facility operate? Do you pursue your own research projects or do companies hire you for R&D?
ZD: Both. We publish about one paper a month. Some of them are based on research done in conjunction with the industry, and some of them are based on my own research topics. Lately one of my interests has been developing vehicles for drugs that are built more on a cosmetic chassis, paying more attention to aesthetics, spreadability, smell, and delivery. We’re exploring different vehicles and how their construction affects the delivery and penetration of topical agents like retinoids into the skin, for example.
We do work for bigger companies, but I’d say at least half of our cosmetic work is with smaller companies that don’t have an R&D facility. We write the protocols for them, get them through the institutional review board, run the study, write the report, and all that. Our own in-house statistician does the statistics. We have a full-time IT person developing all our databases so that companies who need to test products can come to us from start to finish.
We can be a for-hire R&D facility for many of the companies in the IBA, for example. We can do any part of the process. Some people just want the clinical tests. Some people need the repeat insult patchwork done. Some people need ideas on how to position their product and in that case, I just consult for them.
IBA: What does it mean when a brand works with a dermatologist on a skincare line, and what does that relationship often look like?
ZD: There are several ways of approaching it. The most common one is the dermatologist who comes in and functions as a spokesperson for a company with an already established brand. They’ll lend their name to the line, but they didn’t formulate it, nor were they in on it from the start. Maybe they gave their blessing on the end product; maybe they said their favorite ingredient was Vitamin C, so the brand made a Vitamin C-based line.
But a lot of that ‘dermatologist brand’ that you see in the market now is there more for marketing cache than for the science or the brand development. Usually, the dermatologist is approached towards the end or at the end, when the brand needs help flushing out the line and so on and so forth.
I work for so many companies across the board, doing testing, but I never put my name on a product. I’m happily in the background. I’m the “dermatologist-developed,” or the “dermatologist co-developed,” or the “dermatologist tested” that you often see on the final bottle. I stand up for all the work and research I’ve done but I don’t want this to be “Zoe’s Skin Cream.” That’s not my focus. I want to be the scientist, investigator, and skin physiologist helping to put products together that will serve consumers and meet marketing goals. If the brand wants a spokesperson/model they can find someone else to fill that role.
IBA: How much weight should a consumer put on “dermatologist tested”?
ZD: “Dermatologist tested” doesn’t have a rigid framework that defines what it means, but larger companies have a lot to lose so they certainly all test. They have standard operating procedures that incorporate specifics like how many uses there must be for each product, how many subjects must use each product, what’s the threshold for success, etc. They do repeat insult patch testing, phototoxicity testing, and clinical testing as well. We do all that type of testing for them here.
But there are some companies that will mail a questionnaire to 20 dermatologists asking what they think about a product, and if they say they like it, they’ll claim it’s “dermatologist tested.” Some tiny company with not much to lose maybe cavalier about the claim as well. One of my goals has been to raise the bar so that “dermatologist tested” really means something.
IBA: What’s been your most satisfying accomplishment so far?
ZD: I would have to say my family. I met my husband when I was 16 and he’s been the love of my life. He’s a gastroenterologist who works with me now. I have two sons, who are both MD-PhD’s. A lot of highly professional women don’t pursue having a family because it interferes with your career. But I think that if you plan carefully, you can make it all fit and work. As you get older you appreciate your kids more and more and that’s certainly where I am!
Erica La Sala is a beauty writer and reporter who specializes in covering the business behind beauty. Her work has been featured in several digital publications and newsletters serving both the professional and consumer communities, including Beauty Independent, Glossy, CEW Beauty News, BeautyMatter, and Allure Magazine. She graduated from Fordham University’s Gabelli School of Business with an MBA in Management Systems.