To the Editor.
—The report by Weiss et al1 as well as the accompanying editorial2 engender vast medical, economic, and social considerations. Pronouncements such as these should be founded on extensive and scientifically sound data and conclusions, which we found lacking in this study.The conclusions of the study are based on a combination of clinical and histopathologic findings in 30 patients (only 15 patients were treated on their faces) after only four months of treatment with topical tretinoin cream. All clinical findings are based on the subjective observations of a single observer. Clearly, any conclusions suggesting "reversal" of 35 to 70 years (range of patient ages) of photoaging are tenuous and premature.The main difficulty, however, is that the study is not, as stated in the subtitle, double-blind. Fully 92% of patients treated with tretinoin experienced an irritant dermatitis. This required administration of potent topical steroids to
Tavelli BG, Storrs FJ. Topical Tretinoin for Photoaged Skin. JAMA. 1988;259(22):3272–3274. doi:10.1001/jama.1988.03720220019016