Summer is ending, but concerns about protection from the sun should continue after beach season is a memory, skin-care experts now say. "You accumulate far more damage in 50 weeks going to and from work than in two weeks in Hawaii," says Dr. Vera H. Price, clinical professor of dermatology at the University of California, San Francisco.
Dermatologists generally agree that changes in the skin--wrinkling, dryness and irregular pigmentation--are a result of heredity and aging, as well as sun exposure. But now many are saying that sunlight accelerates the aging of the skin. Dr. Albert Kligman, professor of dermatology at the University of Pennsylvania, says significant sun damage may have already taken place by age 20, though it may not show up until age 40 or 50.
Kligman and Price were among the panelists at a recent seminar in New York called "Cosmaceuticals: The Science of Beauty and Aging," which described new research on skin and its aging. The newly coined term cosmaceuticals refers to products that have both cosmetic and pharmaceutical effects. (The session was sponsored by Boston University under a grant from Ortho Pharmaceuticals, marketers of Retin-A, a topical drug used to treat acne. Kligman holds a patent for Retin-A, but says all proceeds from the patent go to the department of dermatology at the University of Pennsylvania.)
Although sunscreens and moisturizers can help preserve the skin, they are little help once it has become dry, lined and less elastic, most dermatologists say. But early research by Kligman indicates that there may be new hope for sun-damaged skin. He says he can improve it by using Retin-A, a synthetic derivative of Vitamin A known generically as Vitamin-A acid, retinoic acid or tretinoin. Kligman was the first to report on the medication's effectiveness in treating acne, in the late '60s. Since the early 1970s, it has been prescribed for those plagued by oily, blemished skin. The Food and Drug Administration has approved it only for acne treatment.
Recently, Vitamin-A acid has also been used experimentally in healing wounds and treating psoriasis, warts, scars and cervical dysplasia--cell changes in the cervix that may lead to cancer.
In Kligman's latest study, 16 people with sun-damaged skin used the medication on their forearms for three months. The product was found to normalize activity in cells that had been damaged by ultraviolet light, as well as to increase cell turnover and improve skin circulation, color, texture and elasticity. The medication causes the skin to peel, working much like exfoliation, but at a deeper level.
Kligman says that while he has performed only two controlled studies of the product applied to the face, he has used it to treat hundreds of patients. "It's not a substitute for a face lift or dermabrasion or a chemical peel," he cautions. "You can't take old people and make them look like young people." But, he adds, "Retin-A can retard some of the changes that are going to happen to all of us."
He predicts that the drug may someday play a role in preventing skin cancer.
Vitamin-A acid is a potent drug that can cause redness, scaling and irritation. Kligman advises patients to apply it at night, to use moisturizers during the day and to avoid harsh cleansers. Since Vitamin-A acid thins the top layers of skin, a strong sunscreen is necessary during exposure to the sun.
He typically prescribes daily application of .05%-strength Retin-A cream for a year followed by maintenance treatments once or twice a week. If use is discontinued, he says, the effects are lost in six to 12 months.
Many dermatologists say it is too early to judge the efficacy of Vitamin-A acid in reversing sun damage.
"I'm telling my patients to hold off," says Dr. John H. Epstein, clinical professor of dermatology at UC San Francisco. "We have one group of people saying it's quite effective, and I think that information should be confirmed."
Dr. Arnold W. Klein, a Beverly Hills dermatologist and assistant clinical professor of dermatology at UCLA Medical Center and assistant professor of dermatology at Stanford University School of Medicine, says Kligman's tests are "encouraging" but warns that the results are "very preliminary" and that it would be extremely premature to view Vitamin-A acid as a breakthrough in restoring aging skin. Says Klein: "There is no fountain of youth."