Can gene tests determine the best, customized treatments for your skin-care regimen?

Mapping the human genome was completed in 2003, and researchers, drug makers and biotechnologists have been racing to develop ways to treat disease more precisely, based on individual patients’ genetic information. In the past few years, at-home DNA tests like 23andMe and Ancestry.com have become readily available, aimed at helping consumers discover all or part of their genome and its variations.

Enter the skin-care-industrial complex, a $121 billion global industry in 2016, projected to reach $11 billion in the U.S. alone by 2018, according to MarketResearch.com.

Walking into Tracey Cleantis’ home office in Pasadena’s San Rafael district, one encounters all the elements of a relaxing spa — soft lighting; the aroma of a scented candle in the air; plush, inviting couches and chairs. It’s an appropriately welcoming, stress-free place. As a licensed marriage and family ther, C If eer If there ever        More than a dozen skin-care-specific at-home DNA-test kits, ranging in price from $12.95 to $299, are available for purchase on the Internet, and some, in brick-and-mortar stores, like London’s Gene U skin-care clinic. The DNA tests for skin care 

More than a dozen skin-care-specific at-home DNA-test kits, ranging in price from $12.95 to $299, are available for purchase on the Internet, and some, in brick-and-mortar stores, like London’s Gene U skin-care clinic. The DNA tests for skin care are marketed with tantalizing claims that genetic sequencing technology can be applied to customized skincare concoctions that will moisturize, plump, dewrinkle and rejuvenate, making up for genetic failings writ large on our skin.

The manufacturers — with names like Orig3n (orig3n.com), SkinShift (skinshift.com) and Skinome (skinome.com) — send a kit that instructs you to swab your cheek for saliva, slip the swab into a tube, seal it and mail it back. Later, you receive advice pinpointing your skin’s shortcomings, based on your DNA results. The company also directs you to a regimen of specially formulated skin-care products that, the theory goes, will meet your skin’s greatest needs, determined by your genetic information. Think: rapidly degrading collagen, skin cancer susceptibility, lost elasticity, wrinkles, brown spots.

But dermatologists and geneticists say consumers should be cautious. The American Academy of Dermatologists does not have a position on the at-home DNA tests, and none of the dermatologists contacted for this story use them or know of any colleagues who do. The industry holds promise, but is still in the first stages of development. “This is a very infantile area and you have to treat this with a great deal of skepticism, especially since the company providing the testing [also] provides the necessary materials needed to fix it,” said Dr. Whitney A. High, associate professor of dermatology and pathology at University of Colorado School of Medicine in Denver and director of the school’s dermatology clinic. “I have been a clinical director here for 20 years and I don’t know anyone doing it.”

Though DNA tests are typically not employed by dermatologists, High said that perhaps in 30 years today’s skin-DNA test kits, or some version of them, will seem like a step in the right direction, and using DNA information to create personalized skin care will be common. After all, no one’s skin is exactly the same as anyone else’s. Different people have different skin structures, including various matrix matelloproteinases (MMPs), the group of enzymes responsible for most extracellular matrix proteins during growth and normal tissue turnover, High said. Among the many types of genetic variants within human DNA are the so-called single nucleotide polymorphisms (SNPs). There are roughly 10 million SNPs in the human genome; some SNPs predict disease risk and others bear a regulatory effect on how a gene functions. A company called SkinShift, based in Austin, Texas, examines 16 SNPs that SkinShift claims are linked to collagen formation, sun protection, glycation protection (against harmful sugar-protein bonding), antioxidant protection and inflammation control. Based on the results, the company claims, SkinShift can tell you what specific ingredients and products to use. But High indicated that such claims may be premature. “We really don’t know enough to fully employ what we know,” he said.

GeneU (geneu.com), a London-based company founded by Christofer Toumazou, an electrical engineer, does “skin genetic tests” in its store, looking for genetic variations in how fast collagen degrades in an individual’s skin and for genes involved in the skin’s antioxidant protection. DNA-test results and answers to a brief lifestyle questionnaire are run through an algorithm, after which two concoctions are recommended. SkinShift, founded by an internist and based in Austin, also uses a fixed number of serums; based on individual DNA tests, the company suggests a combination of purchasable serums and nutritional supplements.  In other words, DNA results are not taken into the lab, where a concoction is made to order.

“It is not like you spit into a tube and they make a skin-care product based on your DNA or genetic results…truly personalized skin care,” said Dr. Ava Shamban, a dermatologist in Santa Monica and Beverly Hills. “Here is the hundred-billion-dollar question: What is the actual expression of genes in your skin? Certain genes turn on and off based on the environment. There are people who are prone to rosacea, but they don’t develop it in certain exposures, and do in other exposures. So a lot depends on environment and ultraviolet light.”

Exposure to ultraviolet light ages skin and degrades collagen, the primary protein responsible for maintaining elasticity and skin’s structural support, according to a 2015 article on molecular health in the journal Nature. Collagen-producing skin cells called “dermal fibroblasts” become less productive over time, resulting in wrinkles, sagging and irregular pigmentation. Tretinoin, the prescription vitamin-A-derived cream marketed as Retin-A, is the first substance recognized by dermatologists as an effective wrinkle treatment. It was co-invented by Dr. Albert Kligman, who was also the first dermatologist to show that ultraviolet light caused skin to wrinkle. It was approved to treat acne in 1971, but off-label use proved to diminish wrinkles, so dermatologists began prescribing it for that purpose. Thus began the research field on the reversal of skin aging. Tretinoin counters some destructive effects of ultraviolet light by stimulating procollagen (collagen’s precursor) and supporting the skin’s structure, according to the Nature article. But how this happens is not understood and whether it actually reverses the degradation that happens with skin aging is not known.

“What is happening appears to some to be a premature translation of new technologies into the marketplace, and it is confusing to people,” said Dr. Robert C. Green, professor of medicine (genetics) at Harvard University Medical School and director of Genome2People Research Program at Brigham and Women’s Hospital in Boston. “There is a lot of good science behind linking genetics to collagen, skin color, eye color and predisposition to sun damage, but companies’ claims that by measuring this genetic marker, you can do something about it with this product” are unsubstantiated.

“To my knowledge, there is no pharmocogenetic [regarding gene variations that affect one’s response to drugs] or dermatologic application that can be used to personalize skin care,” said Green. “There are clearly skin-related medical conditions and there are a lot of genetic diseases that affect the skin in horrible ways, and there is an opportunity to look at those diseases using genetic information. But there are no genetic biomarkers that would influence skin and beauty care. And the kinds of claims being made of individual improvement based on a product that is somehow supported by DNA information is completely unsupported by science.”

Green added that genetic markers aren’t necessarily expressed; that is, having the genetic marker for a physical trait, or a disease, does not necessarily mean a person will develop it. Genetic biomarkers only increase the probability that a person will develop a trait, such as freckles. A gene variation can mean you have a lower risk for a disease such as melanoma, for example, but estimating risk based on genetic variants is likely to confuse consumers, cautions Green. But most consumers understand that wearing sunscreen is an important tool for protecting skin from ultraviolet light -— no DNA test required. Though the idea of individualized skin care routines gleaned from at-home DNA testing is exciting, the validity of using genetic testing this way is questionable. “It should make people nervous that these ‘skin DNA tests’ are not offered by skin-care companies on every corner,” High said “It has not permeated the industry to the degree that medical associations have taken a position on it, which is another reason for caution.”