Lines Form for Wrinkle Treatment

Times Staff Writer

Skin specialists and drugstores said Monday they had been overrun with inquiries and orders for Retin-A, an acne medication identified late last week as possibly the first medically legitimate treatment for sun-induced skin wrinkles.

But local dermatologists cautioned that patients flooding their offices with calls about what they hope is an anti-aging miracle drug should prepare for possible disappointment because the wrinkle-reducing effects are far less dramatic than they had hoped and the incidence of side effects greater than they expect.

"I tried it myself," said Dr. Jack McCleary, a Sherman Oaks dermatologist and former president of the Los Angeles County Medical Assn., "and I really didn't feel I was ready to go to some young teen-agers' nightclub."

Consumers Still Eager

Despite such cautions, eager Southern California consumers appeared to have seized on a medical journal report of anti-wrinkle effects of Retin-A. Although it is available only by prescription, drugstores said they had been flooded with calls from people who wanted to know how to get the product.

Druggists said patients apparently had little trouble finding physicians willing to prescribe the drug, even though the U.S. Food and Drug Administration has not even received an application for official market clearance for Retin-A for anti-wrinkle use.

Stores reported they quickly sold out over the weekend and a spokesman for the Horton & Converse chain said three different wholesalers had run out, too. Bergen Brunswig Corp., a wholesaler, reported its Anaheim warehouse, which normally receives orders for 20 tubes of Retin-A on the average Saturday, received orders for 484 on Saturday.

Gene Manabe, Horton & Converse senior vice president for operations, said he was coincidentally visiting five of the chain's stores Friday when news of the wrinkle use for Retin-A broke. "Patients were calling about it and then, a little while later (after pharmacists told them a prescription was required), they were getting their doctors to write the prescriptions.

"Other than some diet fads, I haven't seen anything like this before," he said.

The Southern California response appeared to mirror other parts of the country. In Florida on Monday, druggists reported they had been inundated with inquiries. "It's a bombshell," one Miami pharmacist told reporters.

Company's Stock Affected

Stock in Johnson & Johnson, the parent company of the maker of Retin-A, showed the effects of profit-taking Monday. Shares were down 1 3/8 after running up 6 points last week as word of the impending medical journal announcement spread. Monday, the stock closed at $78.50

Jack Paige, a druggist at the Egyptian Pharmacy in Long Beach, said demand for Retin-A was so brisk he ordered three times the amount he normally stocks. The store ran out over the weekend and three customers were on a waiting list Monday to have their prescriptions filled, Paige said.

Media coverage late last week focused on a research study in Michigan that found patients who used Retin-A on their forearms and faces showed slight to significant improvement in wrinkles. An accompanying editorial written by a medical expert in skin aging heralded the study as the first legitimate medical treatment for the effects of aging.

Bergen Brunswig said it had been notified by Ortho Pharmaceutical Corp., Retin-A's manufacturer, that demand nationally was so great that supplies would be temporarily rationed, with wholesalers limited to one-month supplies at a time, predicated on the quantities they sold in an average month in 1987. An Ortho spokeswoman, however, said the precise effect of demand would not be clear from wholesale orders for another four to six weeks.

"This doesn't make much sense," said Jack Fay, Bergen Brunswig's vice president for corporate affairs. "This is an unapproved use, with just one four-month study on 30 patients."

Physicians seemed to share Fay's caution, warning that enthusiasm of media accounts did not coincide with real world results many physicians have experienced in limited use of Retin-A. Some doctors have been cautiously prescribing the drug for more than a year since initial reports in medical journals tentatively identified Retin-A, whose generic name is tretinoin, as possibly of use in wrinkle treatment. The drug is a derivative of Vitamin A.

"There have been dermatologists appearing on talk shows pushing this item for some period of time," McCleary said, "and it's been written up in publications that you buy at the checkout stand in supermarkets."

Side Effects Noted

McCleary said he has been using Retin-A with caution since most patients--like 92% of the subjects in the Michigan research study published last week--report skin inflammation, scaling and redness as side effects of tretinoin use. McCleary said he prescribes Retin-A to be diluted, 2-to-1, with an inert skin cream and he advises patients to try small test areas on their faces until they see what actual effects the drug has for their own wrinkling.

"I frankly find that there are not that many (patients) who are willing to continue with it," McCleary said. "I have not been impressed with the numbers."

The actual degree of improvement, McCleary said, is generally less than patients expect and the degree of side effects more than they had hoped. Some critics contend that Retin-A's anti-wrinkle effect is achieved simply because the skin smoothes as a result of swelling caused by the drug. Laboratory experts say that isn't the case, but McCleary said he remains unconvinced that simple swelling isn't largely responsible.

He said many patients become so enthused about Retin-A that they smear it indiscriminately all over their faces, only to have large areas of the skin redden and peel. "All of a sudden, they look end up looking like a prune," McCleary said.

Dr. Stanley Bierman, a Century City skin specialist and president of the Los Angeles Dermatological Assn., said he recently distributed a patient newsletter urging lowered expectations for Retin-A as a wrinkle cure, even though it has been used successfully as an acne treatment for 17 years.

"The response has been overwhelming," Bierman said. "If it's the aging skin of a 60-year-old woman with drooping eyelids that you are treating and the patient expects to restore it to the look of a 30-year-old, that's unrealistic.

"But a 40-year-old woman with sun-damaged skin, with an irregularity of texture, that is the type of problem that can be corrected to some extent. The time span in order for the response (to Retin-A to occur) is three to six months. A lot of people will use it and almost all of them develop a mild redness, which is a reflection of overzealous use. They use half the tube and they burn their skin and they say, 'My God, this is terrible stuff!' "

Both McCleary and Bierman noted that since Retin-A so far appears to work only on sun-damaged skin, patients interested in using it should be sure to also use an effective sun block product to prevent further damage. "People who avoid sun exposure will, in three to six months, see some appreciable changes," Bierman said.

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