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Enhancing Diabetic skin outcomes with Dermocosmetics
Published on 10 October 2023
Over half a billion of adults live with Diabetes Mellitus worldwide, and up to 50% of these can develop skin side effects from their condition, as high glucose levels can damage blood vessels and reduce nutrient supply. Diabetes-related skin complications range from mild conditions such as dryness and itchiness or hyperpigmentation, to more severe conditions such as infections and ulcers. Although the use of moisturising creams and lotions could effectively manage these complications in their early stages, awareness and willingness to address skin-related issues remain low among both patients and healthcare professionals (HCPs). Unless patients can consult a Dermatologist, they are unlikely to receive adequate advice and tend to use generic moisturisers as they do not perceive the benefits of specialised products.
Currently, a few solutions specially formulated and explicitly indicated for dry, Diabetic skin are on the market, as some dermocosmetic brands have recognised the needs of patients living with Diabetes. Brands such as Cerave, Gold Bond and Bioderma have incorporated at least one moisturiser for Diabetic skin into their offerings, carefully crafted with science-backed and Dermatologist-approved ingredients such as urea and ceramides.
We estimate the dermocosmetics market for Diabetic skin, especially moisturising solutions for Diabetes-related skin Xerosis, at 7.6 billion USD and project it to grow, reaching 8.4 bn USD by 2030 and 8.9 bn USD by 2045 in North America and Europe. The absence of a prominent leader in Diabetic skincare, combined with current low levels of patient awareness, leaves an opportunity to capture the market.
As a result, Diabetes represents a growing avenue for dermocosmetic brands, which could establish themselves as valuable partners for patients. To seize this opportunity effectively, companies must first ensure that their solutions are tailored to these patients’ specific needs and address key barriers to adoption through, for instance, educational campaigns and collaboration with HCPs.
The role of skincare in Diabetes
Diabetes Mellitus, or Diabetes for short, is a chronic condition that affects the body’s ability to produce or use insulin effectively, resulting in high glucose levels. In 2021, approximately 537 million adults (20-79 years old) were living with Diabetes worldwide, including 112 million in North America and Europe 1. If poorly controlled, hyperglycaemia (high glucose levels) can cause changes in blood vessels and nerves, impacting the healthy functioning of various organs, including the skin.
High glucose levels in the bloodstream typically prompt the body to extract fluid from its cells to produce more urine to eliminate this excess. This commonly results in xerosis (abnormally dry skin) and sometimes pruritus (severe itching of the skin). As the skin becomes dryer, it loses flexibility and its ability to withstand trauma, which may result in skin breakdown.
Additionally, high blood glucose can cause fatty deposits to form inside blood vessels, leading over time to a narrowing of these vessels and lower blood flow. The reduced blood supply can lead to skin hyperpigmentation, such as Diabetic Dermopathy (reddish-brown spots located on the shins) and Acanthosis Nigricans (dry, dark patches of skin).
In more serious cases, skin damage can take longer to heal as high glucose levels prevent white blood cells from reaching the infected site quickly. This also increases exposure to bacterial and fungal infections as well as ulcers. If left untreated, the infection may ultimately spread to muscle and bone. A notorious example of these more extreme complications is Diabetic Foot Ulcers, which can require amputation of a toe, foot, or part of a leg if left untreated for too long 2.
The cascading effect of hyperglycaemia on the skin can be prevented with better glucose control, regular exercise to improve blood circulation and appropriate skincare to strengthen skin resilience. The medical community recommends various behavioural changes such as taking shorter showers, using mild soaps, and moisturising the skin daily to manage early-stage skin complications, namely xerosis and pruritus. Moisturisers can play an important role in healing dry skin and preventing skin breakage. By relieving itching, they prevent patients from scratching their skin, which could cause the skin to tear and allow an infection to set in. Moisturising is particularly important to prevent chapping in cold or windy weather.
Although estimates vary across studies, it seems that at least 50% of people living with type 1 and type 2 Diabetes experience skin issues ranging from Xerosis to Diabetic Foot Ulcers 3, making these a highly prevalent side effect. This means that ~268.5 million adults worldwide are concerned, with 56 million in North America and Europe. Xerosis stands out as an especially prevalent skin condition among patients living with Diabetes, with reported occurrence rates reaching up to 40% 4. These patients are also more likely to develop Pruritus than the general population, particularly if they have dry skin or Diabetic Neuropathy 5. Global evidence suggests that the occurrence of Diabetes associated Pruritus ranges between 18.4% to 27.5% 6. As illustrated below, we can therefore estimate that ~214.8 million adults living with Diabetes also have Xerosis, and 123.2 million have Pruritus worldwide. This translates to ~44.8 million with Xerosis, and 25.7 million with Pruritus in North America and Europe.
Skin health is a missing piece in Diabetes care
Unfortunately, early-stage Diabetes-related skin conditions often go unnoticed by patients and HCPs. When they do notice complications such as dry skin, they tend to dismiss or downplay their symptoms due to their commonality. Moreover, if patients decide to address these symptoms, their approach is usually suboptimal as they opt for generic moisturisers not specifically formulated for Diabetic skin.
Awareness regarding Diabetes-related skin conditions is still relatively low. Even with more well-known Diabetes complications such as Diabetic Foot Ulcers, patients generally have a decent knowledge of foot care but poor practice 7. Suspected factors explaining this knowledge-practice gap include socioeconomic status, unwillingness to comply with health behaviours, lack of time and poor quality of foot care education. As a result, education remains a key lever to improve patient behaviour towards better self-care.
Furthermore, Diabetes-related skin conditions are currently underdiagnosed as many HCPs lack the time and/or knowledge regarding the link between Diabetes and skin health. Indeed, they typically prefer focusing on their specialities and tend to prioritise general Diabetes management, that is blood glucose control and prevention of severe risks, such as heart disease and nerve damage. Unless they specialise in Dermatology, HCPs are more likely to be aware of serious skin complications, such as Diabetic Foot Ulcers, than of more minor conditions, such as Xerosis. The high prevalence of such skin problems among the general population further complicates the matter, as HCPs may struggle to distinguish between routine dermatological concerns and those directly related to Diabetes. As a result, patients are unlikely to receive comprehensive skin guidance unless they consult a Dermatologist. This can also be a challenge, as most are unable to do so for various reasons ranging from a lack of perceived benefit, difficulty of access and lack of HCP awareness for referrals.
Currently, patients living with Diabetes who engage in skincare behaviour often opt for generic moisturising products and are unaware of the benefits of skincare solutions specially formulated for Diabetic skin. Based on discussions on online forums and social media, patients living with Diabetes prefer to use generic moisturisers out of habit, convenience, accessibility, price differences and lack of perceived benefit from moisturisers for Diabetic skin. Patients are oriented to mainstream moisturising products found in their local grocery store or seen on social media for younger generations. Typical products used include generic creams from Vaseline, Nivea, Dove, Olay, Cerave, La Roche-Posay, Eucerin and Lubriderm. Overall, patients appear to remain unaware of the ingredients and product properties that would cater to their specific needs, as seen below in discussion posts from the Diabetes.co.uk forum.
Current players capture a small portion of the market
From a medical perspective, patients could benefit from medical-grade skincare with strong moisturising properties that are specially formulated for sensitive skin. This translates to products composed of active ingredients with benefits backed by clinical studies, such as urea, ceramides, and ammonium lactate 8. These products also should not contain skin irritants such as fragrances. Although patients increasingly look for products with natural ingredients, these should not compromise the efficacy of the moisturiser. Additionally, products backed by Dermatologists add legitimacy.
Currently, 3 brands offer products with these characteristics that are explicitly indicated for Diabetic skin: Cerave, Gold Bond and Bioderma. Each has created at least one moisturiser specially formulated for Diabetic skin, i.e., with moisturising agents backed by science (Ceramides, urea and Antalgicine®) and without ingredients that could irritate sensitive skin. All 3 include at least one natural ingredient: bilberry, aloe vera and jojoba respectively. Each product has a varying degree of scientific evidence and HCP approval. Cerave’s cream was developed with Dermatologists and was recognised by the American Diabetes Association but does not refer to any studies. Gold Bond has the least amount of evidence, only mentioning having their product tested by Dermatologists. And Bioderma has the highest amount of evidence, citing numerous usage tests and a clinical study but only in oncology (chemotherapy-induced dryness) to back up their claims. When comparing the prices of these three products to the average price of basic moisturisers in the US (3.99 USD 9), we find a price premium of 69.75%.
Other prominent dermocosmetic brands do not have a Diabetes range and instead promote their moisturiser for dryness and itchiness. For example, Eucerin, recommends its UreaRepair PLUS range as it is specially formulated for “dry, rough and irritated body skin” (cf. fig.3). This includes its 10% Urea Body Lotion, which contains synthetically made urea, ceramides, and other moisturising factors. Similarly to Bioderma, Eucerin refers to clinical and dermatological studies to demonstrate their products’ efficacy and tolerability. Although these products are not explicitly indicated for Diabetes, they have been tested and are deemed suitable for patients with a range of conditions including Diabetes.
Another example would be Vaseline, which recommends its Intensive Care Advanced Repair Unscented Lotion, designed for very dry and sensitive skin, for patients living with Diabetes to help soothe and relieve itchiness (cf. fig.4). Its active ingredients are lipids and Vaseline Jelly. Like Eucerin, it does not contain any natural ingredients. Vaseline mentions that this body lotion was tested by Dermatologists and that clinical results show it to provide 90% more moisture compared to untreated skin.
Considering that ~112 million adults lived with Diabetes in North America and Europe in 2021, we can estimate the total market size potential for moisturisers targeted at Diabetes patients living with Xerosis to be 7.6 billion USD. However, only a small proportion of this opportunity is currently captured due to low awareness among patients and low attention from HCPs.
Increased interest from a growing patient demographic will fuel market expansion
This market potential is expected to grow in the near future as the prevalence of Diabetes steadily rises. The diabetic adult population in North America and Europe is expected to reach ~124 million by 2030 as risk factors such as genetic predisposition, sedentary lifestyles and poor diets persist. This number is predicted to further increase to 132 million by 2045 10. This would translate to approximately 49.6 million adult patients also developing Xerosis by 2030 and 52.8 million by 2045. As a result, the market size for dermocosmetics targeted at Diabetes could grow to 8.4 billion USD by 2030 and 8.9 billion by 2045 .
Additionally, the market of dermocosmetic solutions for patients living with Diabetes is likely to grow because more skincare companies appear to be interested in this space. Even companies that currently do not offer any moisturiser formulated for Diabetic skin are investing in research focused on this area. La Roche-Posay, for instance, regularly sponsors studies on the importance of dermocosmetic management, particularly the treatment of skin Xerosis in Diabetes patients 11. Similarly, ISDIN is actively re-evaluating the properties of urea and its potential role in enhancing the skin barrier for patients living with Xerosis, including those with Diabetes 12. Another example is Aquaphor, which has been investigating the relationship between their moisturising products and wound healing in Diabetic mice 13. These activities could hint that more players will enter the dermocosmetics for Diabetic skin space by launching new moisturisers and other skincare products indicated for patients living with Diabetes.
Thirdly, patient interest in dermocosmetics is also growing. The importance of maintaining a dedicated skincare routine is becoming increasingly evident, especially among younger individuals (<40 years old). This heightened interest is driven by a desire for healthier, radiant skin and a proactive approach to overall well-being. Patients are recognising the value of a consistent skincare regimen to address a range of concerns, from protection against environmental stressors to anti-ageing. This rising trend of valuing skincare is anchored in a broader cultural shift towards embracing wellness practices that extend beyond mere aesthetics, encompassing a holistic approach to personal health and confidence.
Becoming patients’ trusted partners
Diabetes presents a growing opportunity for dermocosmetics. These companies have the potential to cater to patients’ unique needs by introducing moisturisers specially formulated for Diabetic skin. The absence of a prominent leader in Diabetic skincare, combined with low levels of patient uptake, leaves an opportunity to capture the market. In this endeavour, dermocosmetic brands can establish themselves as partners for the patients, providing comprehensive support beyond simple product offerings. Launching educational and awareness campaigns is a key strategy to elevate the role of Dermatologists in Diabetes and emphasise the significance of skincare in enhancing patients’ quality of life. These campaigns might involve sharing informative and engaging content such as social media videos, podcasts, live Q&As, and self-diagnostic tools.
To truly distinguish themselves, dermocosmetic firms could take an additional step by directly engaging with key opinion leaders and key online influencers (HCPs, patients, caregivers, advocacy and support groups influencing public health through online channels). Such collaborations could involve creating diagnostic tools tailored to HCPs, offering training sessions and hosting live events to improve patient care. Through these proactive efforts, these companies can actively shape the healthcare landscape to better accommodate patients living with Diabetes, thereby solidifying their brands as compassionate industry leaders.
Sector & Segment can help you identify patient needs to build a differentiation strategy and win in the Diabetes dermocosmetics market
Sector & Segment has extensive experience deep diving into a market to identify patients’ unmet needs and the challenges they may encounter. Our experts can help shape and customise your go-to-market strategy.
We can leverage our experience to help you:
Create patient profiles and segment patient behaviour
Size and quantify the market opportunity
Leverage customer insights to enhance product development, strategic planning and market positioning
Formulate comprehensive strategies for HCP engagement to enhance their awareness of dermatological concerns and optimise patient outreach
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