Rx Care

New hope for aging skin:
From OTCs to Rx drugs

Patients seeking ways to improve the look of aging or photodamaged skin have a wide variety of new options. From OTC cosmetics to new Rx products and dermatologic procedures, skin rejuvenation choices have never been broader.

On the OTC side, Procter & Gamble unveiled a new line of cosmeceuticals at the American Academy of Dermatology (AAD) annual meeting in San Francisco last month. A trio of Olay Regenerist products uses an amino acid pentapeptide, KTTKS, which is active in collagen repair during wound healing. The peptide was identified at the National Institutes of Health. P&G researchers added palmitic acid, a fatty acid, to form Pal-KTTKS, a molecule that easily penetrates the epidermis. The combination stimulates skin-cell production to thicken the epidermis and increase production of collagen.

KTTKS also downregulates production of dermal glycosaminoglycan (GAG), which binds water in the dermis and interferes with collagen to produce wrinkles. Reducing dermal GAG reduces wrinkles.

Researchers also added niacinimide, a vitamin B₃ precursor that Donald Bissett, P&G research fellow, claims has been shown to reduce the size of facial pores, reduce pigmentation spots, and increase skin resistance to environmental damage.

Double-blinded studies have shown Pal-KTTKS to be as effective as retinol in reducing the visual effects of aging without irritating the skin barrier. Both retinol and Pal-KTTKS stimulate pathways associated with wound healing, but Pal-KTTKS does not stimulate inflammatory pathways as powerfully as retinol.

"We wanted to present consumers with an alternative to surgical procedures and topical use of Rx-strength trans-retinoic acids," Bissett explained. "Pal-KTTKS can provide similar cosmetic benefits without the irritation and skin barrier damage associated with these medical procedures."

The Regenerist line was introduced in conjunction with the AAD. In marketing terms, said Lauren Hodges, associate director of skin and hair science for P&G, Regenerist is designed for people who want to reverse the effects of aging skin. The Olay Total Effect product line targets younger consumers who want to stop aging but do not yet see the need to reverse the years.

"We're not trying to compete with dermatologic procedures," Hodges explained. "But a lot of women want to take anti-aging treatment into their own hands. We want to close that gap with better science that women can take into their own homes."

On the Rx side, the Food & Drug Administration recently approved 0.1% tazarotene cream (Avage, Allergan) as a palliative for facial wrinkling, mottled pigmentation, and benign facial lentigines (Drug Topics, March 17). The retinoid prodrug hit pharmacy shelves in January.

For patients who need more than topical products, the FDA has approved CosmoDerm and CosmoPlast, tissue-engineered human collagen from Advanced Tissue Sciences and marketed by Inamed Aesthetics. The products are derived from human collagen, so dermatologists can bypass the four-week allergic-reaction waiting period required for other dermal fillers.

Both products have been approved to correct facial wrinkles, acne scars, and other soft-tissue contour defects as well as to restore the lip border. CosmoDerm is a non-cross-linked formulation used to treat superficial lines. CosmoPlast is cross-linked and used to fill more pronounced wrinkles. Both products are distributed directly to physicians.

Still in the pipeline are injectable silicone and hyaluronic acid gel. Rhoda Nairns, M.D., clinical professor of dermatology at New York University Medical Center, predicted that once approved by FDA, the two would become the fillers of choice for soft tissue defects. "Both fillers provide unique benefits over other fillers currently being used to treat aging skin," Nairns said. "Based on the study results that we've seen, I expect the demand will be overwhelming."

Liquid injectable silicone was approved by the FDA in the late 1990s to treat chronic retinal detachment. Trials are under way in dermal filling. Tiny amounts are injected at four- to eight-week intervals until the desired result is achieved.

Unlike other fillers, Nairns said, silicone injections are permanent. No further treatments are needed unless the underlying tissue changes.

Hyaluronic acid forms part of the framework in which skin cells grow. In gel form, it binds to water, creating enough volume to fill wrinkles left by tissue loss. Nairns said the gel is particularly useful for filling large folds of skin around the mouth and cheeks.

A non-animal form of hyaluronic acid gel has already been approved for use as a filler in Australia, Canada, and Europe. In U.S. trials, the gel works better than bovine collagen to fill nasolabial folds (the deep lines from the nostrils to the corners of the mouth), lasts longer, and requires less filler volume. It is also non-allergenic, Nairns said, and it has no potential for transmission of bovine-borne diseases.

Fred Gebhart

 

Fred Gebhart. New hope for aging skin: From OTCs to Rx drugs. Drug Topics Apr. 21, 2003;147:27.