Antidote To All Those Wrinkles?

By Anastasia Toufexis

"People think I've had a face-lift," beams Carole Herman, 42, of Penn Valley, Pa. "It's astounding what a difference it makes." It is Retin-A, the nation's hottest new anti-aging potion, and despite the misgivings of some dermatologists about the perpetual parade of glops and goos that promise a more youthful complexion, many doctors cautiously agree that the mounting clamor may be justified. "People have gone absolutely crazy about it," declares Duane Tucker, a Manhattan Beach, Calif., skin doctor. "When it comes to sun damage, it's the closest thing we have to a youth cream."

Actually, Retin-A is a synthetic derivative of vitamin A called retinoic acid that was introduced in 1971 as a prescription medication for acne. Older patients began reporting an unexpected benefit: not only did their pimples disappear, but fine age lines, freckles and blotches faded or vanished as well. What is more, their skin took on a rosy, youthful glow. The drug's developer, Dermatologist Albert Kligman of the University of Pennsylvania, was at first skeptical of the claims. But about a decade ago, he began studies to determine the effects of Retin-A on sun-damaged skin. With a team of researchers, Kligman took skin biopsies and examined the tissue microscopically. "To our surprise, there were changes that were quite dramatic, even startling," says Kligman, who published his findings last year in the Journal of the American Academy of Dermatology. Retin-A accelerated skin-cell turnover, stimulated blood-vessel growth and boosted production of collagen and elastin fibers. His conclusion: retinoic acid can help ease and even correct some of the effects of prolonged exposure to the sun.

Intrigued by Kligman's early results, the drug's manufacturer, Ortho Pharmaceutical Corp. of Raritan, N.J., began sponsoring clinical trials around the country. One method used to assess the drug: researchers make molds of facial skin with dental modeling plastic, then scrutinize the impressions with an imaging analyzer of the kind used by NASA to examine the moon's surface. The company claims that results so far have been positive and plans to submit its findings next year to the Food and Drug Administration. Although it is already approved for treating acne, Retin-A cannot be promoted as an anti- aging cream without FDA clearance.

Alerted by word of mouth, however, consumers and doctors have not been waiting. "Ladies come in asking for it because their friends are using it," says Tucker. "Or they steal it from their children who are using it for acne." Prescribing Retin-A is perfectly legal. Observes FDA Spokesman Herman Janiger: "If a physician wants to use an approved drug for unapproved purposes, that's what's called 'accepted medical practice.' " Notes Stephen Kurtin, a New York City dermatologist: "It is the single most popular prescription I'm giving out now."

Doctors generally advise patients to use the medicated cream (cost: $15 to $25 a tube) as often as every day for about six months, then less frequently after that. Side effects, which usually last two to six weeks, include skin irritation, scaling and peeling. Dermatologists caution against overdoing it. One woman, convinced that more is better, began slathering it on six times a day. Says Kurtin: "When she came in after a week, she was a mess."

Those who believe they have license to bask in the sun after using Retin-A are also in for a surprise. The drug leaves the skin more sensitive to sunlight. "I went skiing last winter, and even though I used a strong sun block, I still got a killer sunburn," reports Monica Gutierrez, 32, of Manhattan Beach, Calif., who has used Retin-A for about 18 months. Declares James Leyden, a professor of dermatology at the University of Pennsylvania: "Retin-A is not an antidote to sun worshiping."

It is no fountain of youth either, doctors agree. "It doesn't make old people into young," warns Kligman. "It does not help very deep wrinkles. It does not help sags or bags or very loose skin. People who need a face-lift are not going to get any benefit." Dermatologist Jerome Shupack of New York University School of Medicine puts it more bluntly: "Retin-A won't do much for a prune." Indeed, some physicians wonder about the popularity of the drug at all. "The only thing I see Retin-A doing is irritating the skin and increasing the susceptibility to sun damage and thus to skin cancer," says Dr. Carl Korn of the University of Southern California Medical School. "To my eye, using four-times magnification, the effect is less than dramatic," notes Dermatologist Gabe Mirkin of Silver Spring, Md. "And on patients over 55, because the deep wrinkles so predominate, it's just not worthwhile."

Still, desperate people are unlikely to pay heed to such nitpicking equivocations. One 76-year-old woman, volunteering to be a subject in a study of Retin-A, told the researchers that she planned to donate her body to the center at her death and plaintively asked, "Wouldn't you like me to look my best?" Her offer was politely turned down.

With reporting by Georgia Harbison/New York and Nancy Seufert/Los Angeles