Tretinoin: lasting results, lingering doubts.Tretinoin tretinoin /tret·i·noin/ (tret´i-noin?) the all-trans stereoisomer of retinoic acid, used as a topical keratolytic in the treatment of acne vulgaris and disorders of keratinization and administered orally in the treatment of acute : Lasting results, lingering doubts
The latest study of tretinoin (Retin-A) shows the drug continues to reduce wrinkles wrinkles
See bells and whistles. , age spots and roughness for at least 22 months in patients with sun-damaged skin. Yet despite the good reviews, scientists still voice skepticism. Tretinoin "is somewhat controversial," says Edgar B. Smith, president-elect of the American Academy of Dermatology The American Academy of Dermatology (AAD) is the largest organization of dermatologists in the world.
The Academy grants Fellowships and Associate Memberships, as well as Fellowships for Nonresidents (of the United States of America or Canada). . He and others worry that doctors and patients are rushing to embrace the drug without waiting for the long-term research needed to prove its safety and efficacy.
In a follow-up study of 21 patients, John J. Voorhees and his colleagues at the University of Michigan (body, education) University of Michigan - A large cosmopolitan university in the Midwest USA. Over 50000 students are enrolled at the University of Michigan's three campuses. The students come from 50 states and over 100 foreign countries. Medical Center in Ann Arbor Ann Arbor, city (1990 pop. 109,592), seat of Washtenaw co., S Mich., on the Huron River; inc. 1851. It is a research and educational center, with a large number of government and industrial research and development firms, many in high-technology fields such as found sustained skin improvement when patients used the drug for 22 months. "I think the future of this particular agent is substantial," Voorhees said this week at the Academy's 47th annual meeting in Washington, D.C.
The 21 patients were among the original 30 participants in a study conducted by Voorhees, Jonathan S. Weiss and their colleagues, described earlier this year in the Jan. 22/29 JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION JAMA: The Journal of the American Medical Association is an international peer-reviewed general medical journal, published 48 times per year by the American Medical Association. JAMA is the most widely circulated medical journal in the world. . Patients treated with tretinoin in that study showed dramatic improvements that researchers documented with before-and-after photographs. But many doctors wondered whether these early effects would last (SN: 9/24/88, p.200). The new study suggests the drug continues to improve skin as long as it is used.
Smith, however, says the follow-up study is flawed because the 21 patients knew they were getting tretinoin treatment. He notes that the original study used a double-blind method of assigning patients to a control or treatment group. "If a study is not blinded," he asks, "can you really be objective about your results?"
In addition, some dermatologists have faulted the Michigan team for using photographs to measure tretinoin's efficacy. Many scientists regard pictures as a crude way to show skin improvement.
A new, coputerized method of measuring wrinkles may help dispel such criticism. "The system takes some of the subjectivity out of evaluation and gives us, for the first time, and objective method of measuring the drug's effect," says James J. Leyden of the University of Pennsylvania School of Medicine The University of Pennsylvania's School of Medicine, presently located in the University City section of Philadelphia, Pennsylvania, was the United States's first school of medicine, founded at the College of Philadelphia, as the University was then called. in Philadelphia, who helped develop the technique. Researchers make a rubbery cast of the skin, and a computer compares wrinkle dimensions before and after treatment. Leyden has used the system to analyze skin imprints from 40 people in a double-blind study double-blind study,
n experimental technique in clinical research in which neither the researcher nor the patient knows whether the treatment administered is considered inactive (placebo) or active (medicinal). . Those who received tretinoin for six months showed significant improvement compared with controls who were given a cream without the drug, he says.