Tretinoin serum and retinol - what are the side effects?

Q:I was using tretinoin serum for the beneficial effect it is claimed to have on aging skin. However, I have stopped using it since being told that it is a drug and has other side effects beside that of improving a wrinkled skin. Would you please tell me what these other side effects are? Also, what about retinol. Is this safe to use? P.D. B., South Yorkshire.

A:Good for you for being suspicious of tretinoin and retinol. Medicine has yet to find a fountain of youth that works with impunity.Tretinoin is a synthetic high dose variation of vitamin A, which goes by the brand name of Retin A and is produced by Ortho Pharmaceuticals in the States and by Cilag in the UK. Retin A is not yet licensed as a wrinkle cream. It was developed as a drug to treat acne. At the moment, no British or American authority recognizes Retin A's effectiveness in reversing the ravages of time or the sun. It is one example of drug which is licensed for one use being misused because of the accidental discovery of an unintended benefit. (The other is minoxidil, the heart drug which is now being used to treat baldness!).

In a January 1988 edition of the Journal of American Medical Association, a study of 30 patients suggested that it could improve or reverse the wrinkling process in some people. After these results Ortho launched a serious of "educational" press conferences and symposiums, peopled by researchers paid by the drug company to show studies sponsored by you guessed it! Ortho themselves. They quoted studies like the JAMA one mentioned above and put on an elaborate slide show of before and after shots of patients treated with Retin A.

These before and after shots were challenged in an issue of Money magazine in 1989, which reported that many of the photos had inconsistent lighting and facial expressions, so that comparisons were meaningless.

And what Ortho hasn't told you is that nine out of the 10 research subjects experienced some form of skin inflammation. Three of the participants withdrew from the study because of severe skin irritation; 11 others had to be given steroid drugs just to undo the scaling, swelling, redness and drying periodically caused by the test drug.

As if this isn't enough, the drug also may increase the skin cancer causing effects of ultraviolet light. In the Data Sheet Compendium, Cilag warns that tests with animals treated with Retin A and exposed to artificial sunlight suggest that tretinoin may speed up the appearance of sunlight induced skin tumours. Therefore, if you use the drug you must avoid the sun.

For those of child bearing age, tretinoin has been shown to cause abnormal skull formation in animal babies. The drug company recommends that anyone pregnant or likely to become pregnant avoids this drug.

Finally, the drug causes irritation and side effects when taken with sulphur containing drugs, salicylic acid, benzoyl peroxide, resorcinol, cosmetics, cleansers, abrasive soaps or skin cleansers, with a drying effect or products with a high alcohol content.

And with all these potential risks, the the actual benefits are, at best, questionable. Of the 15 patients treated with Retin A, only one was rated "improved" on fine facial wrinkling. Thirteen were rated only slightly improved and one "no change or worse". Ortho has sponsored eight studies in hopes of getting FDA approval.

Dr George Thorne, Ortho's director of clinical research, himself has described the physical changes in test patients as "all pretty mild". In at least one instance he himself had difficulty in distinguishing the "after" photos of a set of new test subjects with those of "before."

As for retinol, it is a megadose version of vitamin A used to treat deficiencies. At the doses needed to treat wrinkles it would be highly toxic.

So far, the best way to minimize the effects of aging are to avoid direct exposure to the sun, use protective sun lotions, keep your skin well moisturized and drink plenty of liquids. An excellent diet will probably do far more than anything that chemistry has yet come up with to keep you looking young.