An anti-aging cream with a new wrinkle: it may work
Penny Ward Moser
An old dermatologist once told me there are two groups of peoplethat never get wrinkles: Buddhist monks and schizophrenics. That’s because people who’ve been secluded in temples or institutions seldom see the sun. Their skin, therefore, ages very little. But for us 76 million baby boomers who’ve bagged a lot of rays en route to middle age, the horrible truth now greets us each morning in the mirror: wrinkles. We’re a little rich and a little spoiled. We’re smarter than our parents. We’ve seen men walk on the moon, so we’ve got to be technologically sophisticated. And we’re not going to wrinkle up without a good bio-tech fight.
This is how I came to be sitting at home one night with a quarter of an inch of green mud from the hills of Tuscany on my face. I’d gotten a free sample. The accompanying advertisement explained that for more than 2,400 years prophets and princesses have traveled to these hills to avail themselves of their legendary restorative powers. And here was a little sample poking out of a magazine at me. It was a gift from a princess herself, the ad explained, whose fascination with such therapies led her to establish a laboratory where ”minerals” and ”the latest advances in scientific skin care” offered ”primitive solutions that virtually reverse the effects of age on surface skin.”
For a couple of years I’d noticed anti-ageing treatments advertised in what I’d call the better publications. I don’t mean ads with some over-the-hill actress/model photographed through a Vaseline-coated filter. This stuff appeared to me to be non-science if I’d ever seen it. One ad promised younger-looking skin ”as a result of the discovery of a molecule called a glycosphingolipid.” Another said its system of ”lipidic microspheres” called Niosomes would mimic the skin’s intercellular organization and structure. These Niosomes would penetrate the skin and target ”the ageing areas, restructuring them and releasing anti-ageing ingredients.” A military-sounding potion, Cellular Defense Complex, promised to help prevent and ”reverse the visible signs of ageing.” And then there was the pretty Hungarian woman who vowed to help me ”restore youth and beauty” around the eyes with a ”secret formula created from the fertilized egg of the quail.”
This year Americans will buy about half a billion dollars’ worth of these kinds of pr oducts. So the question is: How come we don’t look younger? Some of us think these things work. Some of us think they don’t. The truth is hard to find, because there’s no authority validating anti-ageing claims. And while we’ve been wondering if skin nostrums are effective, we’ve rarely thought about whether they’re safe.
I’ve always assumed there was a ”they” out there, probably in Washington, making sure that whatever we rub on our skin is safe. Not the case. Of the 4,000 ingredients that can be used in cosmetics, only a handful is banned by the federal government.
But federal action against cosmetics firms isn’t unknown. In the1970s the Food and Drug Administration (FDA) clamped down on hair sprays and attempted to stop the use of dyes thought to be releasing carcinogens into the body. In 1974 its action led to a court decision that halted the sale of a fingernail lengthener that sometimes made the nails fall off.
The FDA says that the industry has generally done a good job atpolicing itself, and that, besides, the FDA has bigger fish to fry. ”For the most part the cosmetics business was one of puffery and embellishment,” says Heinz Eiermann, director of the colors and cosmetics division. ”There was a lot we could live with.”
The anti-ageing industry is fast changing that. The FDA recently sent letters to 20 cosmetics manufacturers stating that because of claims they’ve made in their advertising their cosmetics are also drugs. The crux of the matter for the FDA is that, in making anti-ageing and other claims, many manufacturers have been implying that whatever miracle ointment they’ve developed was penetrating the epidermis and affecting the function and structure of the body. Any such claim makes the product a drug under federal regulations.
In the U.S. all drugs must undergo extensive tests proving they’re safe and effective. While some companies in the cosmetics industry shouted in their own defense that their products contained only ”all natural ingredients,” the FDA raised an eyebrow and said it didn’t care if the firms were marketing cucumber juice. ”If you say it goes into the skin and does something, anything, tha t modifies the function or structure of the body, it’s considered a drug,” says Eiermann. The FDA letters, which were sent to industry leaders Avon, Christian Dior, Estee Lauder, Alfin (Glycel), and Shiseido, as well as 15 other firms, landed like a rock in a bowl of cold cream.
What the FDA isn’t saying, at least to the manufacturers, is that their tonics are bogus; rather, the message is: prove that they work as claimed. Since I’d just decided to try to put that 16-year-old glow back on my 37-year-old skin, I thought, well, maybe I can see for myself. I set out for New York, a mecca of unwrinkling. In just three days I would be wrapped in algae, scrubbed with salt from the Dead Sea, slathered with salmon egg oil, and hooked to electrodes that sent electric current — and pain — pulsing through my skin. Guilt would be heaped upon me. ”How long has it been since your last full skin treatment series?” a young woman asked me at one posh salon. ”About thirty-seven years,” I answered. She looked at my hide under a bright light and magnifying glass and then turned a steam gun on my face, uttering a lament I would hear repeatedly over the course of my treatments: ”Your poor pores!” She added that I should have started this regimen, ”when you started to get old, at eighteen or nineteen.”
Old at 18 or 19? This heaped guilt upon the guilt I had just gotten from a television show on skin care that had urged me to ”listen to your skin and love it.”
I’ll concede one thing to these zealots: I’d been taking my skin for granted. There it is, the biggest organ of my body — most of us have about ten pounds of it. Taken together, all the layers of the skin are only about an eighth of an inch thick at the thickest part. Apart from the soles of the feet and the palms of the hands, the upper back has the thickest skin. The eyelids, eardrums, and foreskin have the thinnest (one twenty-fifth of an inch). Skin is the first line of defense against disease. Its three million sweat glands regulate body temperature, excrete some waste products, and give off scents that are sexual attractants — or, at least, are supposed to be. The skin holds the body together in a nice package, and is loosely connected to the muscles, so that when we spin around real fast it comes with us.
Without skin, we would leak. The body’s cells are immersed in an internal sea of dilute salts essential to life. The skin is what allows us land-dwelling creatures to face our dry environment. But we couldn’t just take off our skin and swim happily off in the ocean. Sea water is hypertonic to the body. Without our skin, a dip in the ocean would make us shrivel like so many salted slugs.
The skin is a terrific sensor, alerting us to hot, cold, pain, and pressure. And it’s cleverly designed with the most nerve sensors packed together where you need them most — the lips, fingertips, and eyelids. The skin on the back is much less sensitive. Try this: Tell a friend you’re going to poke him in the back with one, two, three, or four fingers. Ask him to tell you how many he feels each time you poke. Chances are he’ll guess wrong — two may feel like three, four like one. The skin on the back, while it does a good job of keeping out the wind, just doesn’t have the sensory ability of that on the fingertips.
Certainly the skin seems worth taking care of. The question is:How? The young women working in the salons I visited in New York all had suggestions and all had nice skin. They talked to me about the composition of the dermis. This basement area of the skin contains collagen, a fibrous protein that provides the structural support and framework of the skin, and elastin, a stretchy fiber that sort of holds it all together. They talked about exfoliating my face, and clucked and tsked over the number of dead skin cells I was sporting on the top layer of my epidermis — the upstairs of the skin — and about the plight of my poor pores, which were either too open or too closed. It soon became apparent to me that neither I nor my skin was doing anything right.
The culmination of my embarrassment came at high noon at Saks Fifth Avenue with most of the good- looking world walking by. I had stopped at a skin care island. A lovely young woman with a perfect epidermis offered me a free skin analysis. I had just spent two days and about $300 learning to lov e my skin. I perched on a stool. The woman mixed a silicone substance with a hardener and puttied my left cheek. She peeled off the putty and put the specimen of my skin that was stuck to it under a microscope. To my horror, a picture of my skin sample was now beaming out from a Hitachi color monitor right there in the middle of Saks for all the world to see. And what was being seen? ”Your poor pores,” the woman said with a sigh. ”Oil is coming out of them.”
Hey, wait a minute. This is where I get defensive. Oil is supposed to come out of them. Furthermore, I’m supposed to have some dead cells on the surface of my skin. They protect the living cells below. With my specimen still displayed on the Hitachi, the woman handed me a catalogue of skin care products in her line. There were 29 products to be used in almost an equal number of steps in a good skin care routine. Not only would I have to quit my job so that I’d have enough time to maintain my skin, I thought, I’d have to shell out a couple of hundred bucks.
”Gee, I don’t think I can afford all of these right now,” I said, since I had just heard someone else down the counter utter the same thing. ”What do I really need to start out?” The woman suggested a cleanser, which, of course, would be more effective if I had exactly the right brush to put it on with. Then there was a peel-off mask, which had the consistency of rubber cement, and was to be smeared on the face and tugged off, bringing all those offensive dead cells with it. But the mask might cling to some of the wrong cells if I didn’t first use the moisturizer the woman was offering. Since by this point I had three bags full of pricy skin care products back in my hotel room, I suggested I might use some moisturizer I’d already bought. The woman looked at me as though I’d suggested lathering up with lye.
Could it be, this skeptical baby boomer thought, that these people are just trying to sell me stuff? When I told my skin story to Eiermann, he laughed a big laugh and said, ”You know, you’re now talking about an industry filled with dragons. It’s cutthroat. They’d all kill each other if they could.”
So maybe I should just leave my skin alone. There are those who say that when it comes to skin care, less is more. Or at least just a little is enough. ”The skin serves us better than any other organ. It has enormous reserves, it never wears out. Nobody ever died of skin failure. The truth is, at least as far as your skin is concerned, that if you never bathed again it wouldn’t make a damn bit of difference.” This is the opinion of Albert Kligman, a University of Pennsylvania dermatologist who heads the skin ageing clinic there. Kligman has been studying skin ageing longer than just about anyone, in part because he’s 71. And he has enormous compassion for all of us who fear ageing.
”You may think you’re talking to a maniac,” Kligman says, ”but I’m a serious student of wrinkles. I’ve listened to thousands of women. I know right well that wrinkles strike more fear in their hearts than heart attacks or cancer. So skin care is important.”
Care of the skin, in Kligman’s opinion, consists of one thing: protecting it from the sun from the minute you’re born. ”Take a look at the skin under your breasts,” Kligman told me, a somewhat surprising command during an interview, even a telephone interview. ”It’s going to look the same when you’re ninety.”
Almost all ageing is photo-ageing, changes in the skin caused by exposure to sunlight or just bright daylight. This results in an array of microscopic and clinical deviations termed dermatoheliosis. In other words, we look old before our time. Our skin appears slack, yellowish, mottled, wrinkled, leathery, and rough. Only a small part of ageing has to do with plain wear and tear of the elastin in our skin, through frowning and smiling and just living on a planet with gravity.
”Be conscious of how your skin is draped over your face,” oneskin salon worker had told me. She said I could avoid creasing my skin if I ”didn’t think unpleasant thoughts or feel distressed.” This doesn’t come naturally to me. Furthermore, I can’t undo the damage the sun has wrought. Or can I?
At least one respected drug company believes it has a product thatcan make skin look and act younger. The Ortho Pharmaceutical Corporation, a New Jersey-based subsidiary of Johnson & Johnson that’s best known for battling conception, is conducting phase three FDA trials on Retin-A, a patented vitamin A derivative that has long been used as an acne medicine. Ortho’s decision to take their cream through lengthy (approximately three years) clinical trials indicates that it’s confident Retin-A is safe and effective in combatting the ageing effects of the sun. (Industry rumors have it that one other drug company has been getting good results from an anti- ageing product it’s privately, and quietly, testing abroad.)
Retin-A appears to stimulate the skin to increase cell production in the epidermis. In a three-month trial conducted several years ago by the University of Pennsylvania and Philadelphia’s Skin Study Center, 16 fair-skinned, elderly volunteers allowed one of their forearms to be rubbed twice a day with a .05 per cent Retin-A cream. The other forearm was treated with a high-quality moisturizer. Changes in the skin’s condition were tracked histologically (on the cellular level) and biometrically (with dermatological measuring instruments). According to the researchers who conducted the study, the Retin-A forearms underwent a number of changes: the epide rmis thickened by an average of 40 per cent, a significant fact because skin thins as it ages; the top layer of the epidermis, the one with all the dead cells, thinned; the clumping together of epidermal cells, which in ageing skin shows up as scaly blotches, decreased; blood flow and blood vessel formation increased markedly, giving the skin a rosier color; and the clustering of melanin (dark pigment) granules in the bottommost cells of the epidermis decreased, lessening or elimi nating the mottling typical of ageing skin. Other Retin-A studies, conducted by Kligman and others, indicate that it increases collagen production and effaces fine lines in the skin.
What’s more, Retin-A appears to diminish actinic keratosis, a precancerous condition. D’Anne Kleinsmith, a research dermatologist at the Henry Ford Hospital in Detroit, has been conducting studies on Retin-A for nearly two years. Though her research isn’t finished, Kleinsmith says she’s ”optimistic that the drug is proving effective” both in reducing actinic keratosis and in reversing some effects of sun-ageing. And she gives it a ringing personal endorsement. ”I use it myself,” she says. ”I can see the difference in my skin. The Retin-A peels away the accumulation of dead cells, increases the number of fine blood vessels near the surface of the skin, and causes a slight smoothing of the skin. My skin just looks fresher.”
Reba Nyen, a mother of four from Atlanta, is another Retin-A user. She got it as a prescription from her dermatologist. She says, ”All my friends began asking me what I’d done. I myself really noticed the difference around my eyes. The general texture of my skin is livelier, moister. People say it kind of glows. And people I meet for the first time can’t believe I’m forty- nine.”
Retin-A’s ability to rejuvenate skin was discovered as a by-product of its use as a prescription treatment for acne. ”Dermatologists are excited about this,” says Thomas Nigra, chairman of the department of dermatology at the Washington (D.C.) Hospital Center. ”Regardless of the results of the trials, this has shaken up the cosmetics industry.
”Ortho and the Retin-A trials have done to the skin game what Upjohn and Minoxidil did to the hair growers. Suddenly, there’s someone legitimate saying ‘We’re a big company. We’ve got something that we’re confident works. We’re going to put it through the required FDA trials.’ The research is public, the patent is public. And it makes everybody else in this area look like a phony.”
Nigra and many of his colleagues are skeptical of the claims madefor cosmetic anti-ageing creams. In part because of professional conservatism, they stop short of saying that nothing out there works. Besides, they’ve no way of really knowing. Research by the cosmetics companies selling anti-ageing creams is often done in Europe, is almost always proprietary, and isn’t put up for peer review before the dermatological community.
Kenneth Arndt, dermatologist-in-chief at Beth Israel Hospital in Boston, says that he’s ”not aware of any data, articles, studies, or decent information” about the safety and efficacy o f ageing creams. Arndt should know. He’s the editor of the Archives of Dermatology, the profession’s most prestigious journal. Barbara Gilchrist, chairman of the dermatology department at Boston University’s school of medicine and senior scientist at the USDA Human Nutrition Research Center on Ageing at Tufts University, says she hasn’t seen serious scientific evidence that any compound now available as a cosmetic is an effective anti-ageing agent. ”The smokescreen is often ‘We can’t tell you about it. It’s a secret,’ ” she says. ”What they frequently do is refer to experiments done in vitro. They can put some cells in a dish and add something and show that the cells are somehow stimulated. But this differs from showing results in the body.”
What’s more, Gilchrist says, even the most sophisticated research hasn’t completely unraveled the mystery of skin ageing. Scientists know that skin cell production slows as the body ages, and therefore we replace our cells more slowly. The cells we produce as we get older aren’t as plump and bouncy as those of our youth. But no one’s sure why this is so. ”We know there are many differences between young skin cells and old skin cells,” Gilchrist says. ”What we don’t know is, if you took that old cell, which generally doesn’t work well, and changed its membrane composition so it was like that of a young cell, or changed the number of hormone receptors to match the number on a young cell, or changed the level of enzymes so it was like that of a young cell — would that cell be ready to go again? I’m not aware that any of the materials at present promulgated as useful in cosmetics have met that criterion of effectiveness.”
Arthur Bertolino, a dermatologist and molecular biologist at New York University’s school of medicine, says, ”Unless product research is showing some kind of tagging that proves the product penetrates the skin, I’d wonder if it was going in at all.”
Many cosmetics companies use altered forms of proteins — from animal placentas to the commoner collagen — or liposomes (small fatty envelopes containing biological materials) in their concoctions. They say these ingredients soak into the epidermis to produce remarkable results.
”I can say almost with certainty that these claims are phony, and that they’re hype,” Kligman says. ”In my opinion these liposomes, this collagen, and other proteins simply aren’t wiggling into the skin.” Says Gilchrist, ”Even if they are, so what? Who knows what they do if they get there?”
This leaves me with a nagging question: Are all of us consumers really stupid? The truth is that my skin looked great after my treatments. Unlike the woman I saw in a TV ad, I didn’t hear my skin care products ”calling out to me from the bathroom in the morning.” I did, however, enjoy scrubbing my face with the little brush I’d got at Saks. I decided I wasn’t up for the twelve-or-so- step rituals often suggested by cosmetics experts. Nor did I think I would combat the arid environment of an aircraft cabin by hydrating my face with an expensive mist while airborne, as someone had recommended. But I did feel I was on to something when one night, shortly after I’d washed some magic mud off my face, a man from the neighborhood who had dropped by to watch a Baltimore Orioles game looked away from the television screen and said, ”Your face looks nice.” It did.
Though I thought my skin looked just a little bit better, a little bit younger, I didn’t feel that one product was better than another. I can attest that my cat enjoyed licking my face when I applied a product that contained an extract from the desert plant jojoba and reacted not at all to the salmon egg oil. I knew nothing I smeared on my face would remove those big creases I’ve got from thinking unpleasant thoughts and feeling stress, but I thought maybe the little fine lines wer e going away. I also thought I’d got the same effect from Vaseline.
Dermatologists say two things are at work here. First, if you putsome kind of moisture barrier on the skin, the little tiny wrinkles flatten out as an increasing amount of the skin’s moisture is trapped beneath the barrier. Second, the skin can be puffed up by anything that irritates it. A sunburn is a good example. As the skin reddens, it swells a little, and the lines in the epidermis flatten out. However, products that work on this principle may be robbing Peter to pay Paul. ”These cosmetics, like the sun, may cause a low-level inflammation of the skin,” Kligman says. ”You could enjoy the immediate effects repeatedly for a number of years. But the delayed effects could be terrible. You could be much worse off. I worry that if you kick your skin in the ass too many times, it might just give up. This is what I think could happen with these cosmetics.”
Kligman is also dismayed with some of his fellow physicians who he believes endorse insufficiently tested cosmetics ”for a fast kill. But I think they’re going to have to pay for this with their reputations, because they’re practicing a form of quackery. Scientific hypotheses aren’t worth a goddamn unless validated by many other people.”
It now falls to the FDA to figure out what the truth is. As of June 1, eleven of the companies receiving FDA notices had responded by requesting a clarification meeting, in the hope that the FDA might relent. But the agency doesn’t plan to budge from its position that anything claimed to alter the function and structure of the body is a drug. Says FDA spokesman Roger Woodworth, ”We’re going to stick to our guns.”
Bernadette Mansur of Avon, which sells an anti-ageing compound that uses a vitamin A derivative as its active ingredient, says, ”We’ve done extensive testing, and wouldn’t market products that aren’t safe and effective. We’re saying to the FDA, ‘We’ll work with you. We’re willing to do what we have to do.’ ” Does that mean that Avon would be willing to conduct the full FDA trials? ”I don’t know,” Mansur says. ”I just can’t say.”
The controversy over anti-ageing creams doesn’t involve just the FDA and the cosmetics industry. For some time the industry had been squabbling within itself. Says Mansur, ”Avon and others have been advocating publicly that we as a group police ourselves better. A lot of us have seen the numerous claims made in advertising, and we saw the FDA issue coming.
We appreciate that it’s anindustry issue, and we have to get it resolved.”
The FDA would have been glad to let someone else police anti-ageing products. The agency is one of Washington’s most overworked and underfunded, and it generally turns its attention to more life- threatening matters. But it couldn’t ignore what it considered a flagrant disregard of the law. ”This time the industry started the ball rolling and couldn’t stop it,” says Eiermann. ”One mildly exaggerated claim was piled upon another mildly exaggerated claim. Each time, a new plateau was reached. Finally, consumers and even some of the companies were actually leaning on us to help sort it out.”
Still, Eiermann doesn’t think the FDA will immediately be seen as a knight in shining armor. ”We may not make the average consumer very happy — those that want to be fooled will look at the FDA and say ‘Why do you get involved in that?’ ” he says. ”When surveyed, ninety per cent of consumers indicated they wanted the FDA to hold a tight rein on the cosmetics industry. Until it hits home. I’m convinced that if it came to having to seek injunctions and seize warehouses full of someone’s product, users of that product would flock to the stores and strip the shelves, whether the FDA thought the product was safe or not.”
His comment made me think back to a television ad for skin care that presented endorsements from happy consumers who were nothing short of fanatics. One woman beamed at the camera and said, ”I’ve got a stressful week ahead of me, and I’m glad I’ve got my skin care products to see me through it.”
The only place all this leaves us baby boomers is confused. I’d like to believe that one of these products works. Of course, I’d also like to believe in Santa Claus. And I can’t think of any place where this can be sorted out except at the FDA. If something is going to go from the outside of my skin to inside my body, I want it tested by standardized protocols, and I want that testing to be a matter of public record.
I’m not alone in my thinking. ”In the end this issue is going to be decided in the marketplace,” says Nigra. ”People today are smart, they’re sophisticated, and they’ve grown up seeing amazing things in science. But they’ve also grown up with the consumer movement, and are perhaps the most health-conscious generation in history. Nobody is going to fool them, once all the cards are on the table.”
I, for one boomer, hope the FDA finds Santa Claus.
COPYRIGHT 1987 Discover
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