WAIKOLOA, HAWAII – Have topical retinoids fallen by the wayside for treatment of facial wrinkles in this era of cosmeceuticals, spa facilities, lasers, and injectables?
Not by a long shot, a panel of experts in aesthetic dermatology agreed at the Hawaii Dermatology Seminar provided by Global Academy for Medical Education/Skin Disease Education Foundation.
Dr. Christopher B. Zachary
“I think there’s an ethical issue here. When my patients come in for an assessment, I feel bound to say, ‘Look, we can do all these fancy procedures, lasers, and so forth, but if you use Retin-A for 6 months you’re going to see a nice improvement, so maybe you should try that first.’ It’s quite common that I’ll do that, although I prefer Tazorac [tazarotene] for a number of reasons,” said Dr. Christopher B. Zachary, professor and chair of the department of dermatology at the University of California, Irvine.
That being said, he added a caveat: “I couldn’t use a topical because I just don’t have it in me to put something on my face every night, but there are people who want that. I prefer a quick fix, like a laser.”
Dr. Suzanne L. Kilmer, director of the Laser and Skin Surgery Center of Northern California, Sacramento, declared, “I tell everybody, ‘Number one, I want you to block the sun. I believe only in the zinc oxide sunscreens because I want to block all the way up to 400 nm.’ ” And number two, she says that tretinoin and tazarotene are by far the most studied, and that “ ‘there are lots of great data that it helps not only with acne and wrinkles, but dysplastic nevi, actinic keratoses – it’s definitely a normalizer for your skin. You’ll get great results. And if you’re using that you’re probably going to get better results with any treatments I do.’ ”
Dr. Michael S. Kaminer, a partner in SkinCare Physicians in Chestnut Hill, Ma., said one thing that hasn’t changed over the years is that quite a few patients – especially those who are fair-skinned – can’t tolerate a topical retinoid on the face. They find it too irritating.
Dr. Michael S. Kaminer
“I think it’s a lot of people. They just have a hard time with it,” observed Dr. Kaminer, also of Yale University in New Haven, Conn.
Asked if patients can get results comparable to Retin-A using OTC topical cosmeceuticals, Dr. Brooke C. Sikora, a dermatologist who also practices at SkinCare Physicians, said it’s tough to say because the studies that have been done were cosmeceutical-industry sponsored.
“Some of the industry-sponsored studies claim and show evidence that with some of the retinol products they can get near-tretinoin results. But you have to take that with a grain of salt,” she advised.
All of the speakers reported receiving grant support from and serving as consultants to various pharmaceutical companies. SDEF and this news organization are owned by the same parent company.