Women on the hunt for Prevage

In this youth-obsessed culture, beauty junkies in search of the next miracle skin-care product are rushing to their dermatologists’ offices on a quest: Find Prevage.

Launched just this month by Allergan Inc., the Irvine, Calif.-based pharmaceutical company best known for its blockbuster Botox product, Prevage contains idebenone, an antioxidant the company claims reduces the appearance of fine lines and wrinkles.

At $115 an ounce, the cream is expensive. And there is a catch: Although Prevage is not a drug and does not require a prescription, it is available only through doctors’ offices. The exclusivity has given the product more cachet, and articles in beauty and fashion magazines have heightened the appeal.

In the fall, dermatologists around Los Angeles say, patients-in-the-know began calling and demanding the 1-ounce vials of the then impossible-to-find lotion. Last month, Allergan sent Prevage to a select group of about a dozen doctors around the country, who began selling it to patients.

Now, about 500 doctors carry the coveted cream, Allergan officials say.

“My patients are savvy,” says Dr. Joshua Wieder, a dermatologist in Los Angeles who is listed on Allergan’s Prevage Web site as a doctor who has the product. He has gone through two 50-vial cases in two weeks.

“They were asking, ‘Is that new stuff in your office yet?’ They were looking for it.”

Since the official launch, some doctors’ offices say they are getting calls from women in other states asking to have Prevage shipped to them, while others say they can’t keep the product on the shelves.

“It’s the greatest, hottest, supposedly new thing on the market,” says Dr. John Joseph, a Beverly Hills dermatologist. “I don’t have much experience (with Prevage), but I finally got some in my hot little hands.”

According to Allergan marketers, what sets Prevage apart from the raft of other anti-aging creams, lotions and potions in the massive “cosmeceutical” market is the science behind it.

Allergan’s Web site describes idebenone, the active ingredient in Prevage, as “scientifically proven to be the most potent antioxidant available in skin care today.”

Idebenone is a synthetic antioxidant. Sun, smog, cigarette smoke and even oxygen create byproducts, known as free radicals, which cause damage to the skin. Antioxidants scavenge these free radicals before they can cause that damage. Vitamin C, vitamin E, Kinetin, coenzyme Q10 and alpha lipoic acid are antioxidants found in various skin products.

Idebenone is a synthetic form of coenzyme Q10 but easier to absorb into the skin. But some scientists say how antioxidants react in a laboratory test does not mean they will have the same effects in preventing or repairing skin aging.

Allergan commissioned Pharma Cosmetix Research, a Richmond, Va., product development company that works with pharmaceutical and cosmetic companies, to conduct tests to compare idebenone with five other antioxidants used in skincare products.

The research, done by dermatologists at the University of California, San Francisco but not yet published in a peer-reviewed scientific journal, found that application of idebenone reduced the number of sun-damaged cells on five patients’ skin, ages 18 to 60, by more than 38 percent, outperforming other antioxidants tested.

Several other lab experiments also showed idebenone to be highly effective.

Pharma Cosmetix then did a small clinical study on Prevage. Twenty-one women between the ages of 18 and 65 with dry facial skin and fine lines and wrinkles used Prevage, which contains 1 percent idebenone, twice a day.

“After six weeks of product use, a 26 percent reduction in skin roughness/dryness was observed, a 29 percent reduction in fine lines and wrinkles was obtained, a 33 percent overall global improvement in the appearance of the skin and up to a 37 percent increase in skin hydration was observed,” according to Allergan marketers.

Neither study has been published in a scientific journal, a common yardstick that doctors use to weigh the validity of medical research.

Also, the clinical trial did not compare Prevage with any other product. Joseph A. Lewis II, Pharma Cosmetix’s president and chief executive, said the company planned further tests.

“We compared antioxidants,” said Lewis. “Now we will compare Prevage against other well-known products in the marketplace.”

Unlike with drugs such as Botox, the Food and Drug Administration is able to regulate cosmetics only after products are released into the marketplace. Neither cosmetic products nor cosmetic ingredients are reviewed or approved by the FDA before they are sold to the public.

“The big thing about this product,” says West Los Angeles dermatologist Heather Roberts, who appeared recently on a local television news segment about Prevage, “is that it does have some great basic science research behind it, showing it can clinically help decrease brown spots, refine lines and help hydrate skin.”

Other dermatologists are taking a more cautious approach, noting that the Allergan-funded studies involved very few patients.

“We will know in two to three years, when a bunch of doctors like me have used it with their patients, whether it really works,” says Joseph, the Beverly Hills dermatologist.

There are seemingly endless variations of anti-wrinkle creams. There are products such as Retin-A, Renova and Avage, which are approved by the FDA and sold by prescription; most of these have some side effects, such as redness, peeling or increased sensitivity to sunlight. Doctors say these products are generally effective.

Other products are sold over the counter or, in the case of Prevage, in doctors’ offices. These are nonirritating, nonprescription, antioxidant anti-wrinkle creams that have not been shown to stimulate new collagen.

Wieder, who was one of the first doctors in the country to begin carrying Prevage at his office, acknowledges that Prevage, while promising, lacks research showing how effective it is at diminishing lines and wrinkles.

He says studies to date have not demonstrated that any of the antioxidants are very effective at reducing lines and wrinkles. Idebenone is believed to be the most chemically potent of the antioxidant group, he says, but larger and more rigorous studies need to be done.

“It is not a face-lift in a jar, so to speak,” says Wieder. “If people use it, especially younger people, they will see a benefit in a reduction in fine lines and improved skin texture. But for older people with wrinkles, they are probably not going to see much benefit.”