A medical milestone almost as eagerly sought as the fountain of youth appears to have been reached with a Michigan research report today on the promising results from a prescription drug treatment for wrinkles.
The report that the anti-wrinkle salve called tretinoin, which is sold under the brand name Retin-A, is effective in causing sun-induced wrinkles to disappear appears in the Journal of the American Medical Assn.
The apparent major advance, in a study conducted by a prominent University of Michigan dermatologist whose work was financed by the drug company that makes the compound, comes after years of promises by cosmetic makers promoting wrinkle-elimination products that turn out to have no quantifiable medical effect.
A researcher not involved in the new study said in an editorial published in the journal and in a telephone interview with The Times that tretinoin can appropriately be called the first effective medical treatment for skin aging.
"Up until the advent of (this use of) tretinoin, there wasn't anything out there. Nothing," said Dr. Barbara Gilchrest of Boston and Tufts universities. "To me, this is clearly a major, major breakthrough clinically and research-wise. This is truly a very dramatic event."
Used in Acne Treatment
The development is probably not yet enough to bring Ponce de Leon back from the grave because the drug involved--a long-established acne treatment--does not appear potent enough to produce truly dramatic changes in facial lines and other lines caused by chronic exposure to the sun.
The new research found that quantifiable improvement in facial wrinkles was observed in 14 of 15 patients who used tretinoin on their faces and in all 30 patients who used it on their forearms. The researchers speculated that tretinoin will eventually prove effective on age wrinkles, as well as those induced by sun-exposure, which the study proposes should be reclassified because cigarette smoke, heat, wind and chemical exposure may also play a role in creating them.
The wrinkle improvement was far from dramatic, however. The majority of changes in sun-caused wrinkles were classified by researchers as only "slight" and the therapy produced less-pronounced improvement on facial wrinkles than on those on the forearms of the patients, who ranged in age from 35 to 70. Moreover, 92% of the patients who used tretinoin experienced some sort of side effects from it--usually skin irritation or reddening--that caused them to temporarily discontinue use of the drug.
The drug would probably have to be used between three times a week and daily, which would mean an annual cost of about $175 based on the price of $19 a tube widely charged at Los Angeles- area drugstores.
Researchers who have tested tretinoin say they expect that tinkering with its chemistry could, within the next few years, produce more specific molecules that would allow the erasure or near-erasure of not only sun-caused wrinkles but also skin lines that result from the natural aging process. The new study concludes the tretinoin treatment does not now affect deeper, age-induced, wrinkles. The Michigan researchers did not include data on long-term maintenance therapy with tretinoin, but the head of the research said ongoing, long-term use would be necessary to maintain the improvement.
Dr. John Voorhees, who headed the study, said most cosmetics touted as wrinkle treatments have temporarily increased the water content of the outer layer of the skin and caused it to reflect light differently so there was an illusion of improvement in the wrinkles. But to truly repair wrinkle damage, Voorhees said, a product must penetrate to the deeper levels of the skin--called the stratum corneum.
Looking 20, 30 at 50 or 60
"I think it's a shame that we all feel that we have to look 20 or 30 when we're 50 or 60, but the fact of the matter is that whether I like it or not, that is the way it is," Voorhees said of the intense public interest in the new findings. "I guess I don't see any harm in this as long as it makes people happier, as long as they have the money to pay for a tube of it (tretinoin)."
Microscopic evaluation of changes induced by tretinoin, Voorhees said, made it clear skin cells themselves are changed and improved by the drug. Official approval of the use of Retin-A to combat wrinkles won't be sought from the U.S. Food and Drug Administration for at least a year, according to Ortho Pharmaceutical Corp., the drug's maker, to allow further work on at least 16 other research studies currently under way. But Ortho, a subsidiary of Johnson & Johnson, and government officials noted that there is no legal bar to doctors prescribing Retin-A for the new use now.
The long-term safety of the chemistry involved may also require additional verification, researchers say, because tretinoin is a derivative of Vitamin A--itself a known cause of birth defects when used in extremely high dosages.