The dark side of perfect skin

Nothing is free. Not the t-shirt we wear, not the skincare cream we apply every day, not the smartphone we never lose sight of, not the noodles we have for lunch or the painkillers that relieve our headaches. Everything comes at a price. And we’re not talking about money. Sometimes, we pay it ourselves; often, others have already paid it. From psychology to vaccine research, from genetics to engineering, from medicine to cosmetics, few fields of scientific progress are free from a history of unethical, immoral, or even illegal practices, exploiting unaware, marginalized, or vulnerable people. One of the most controversial examples involves Retin-A, also known as tretinoin, a revolutionary skincare ingredient used to treat acne, hyperpigmentation, and wrinkles, while also improving skin texture.

The Discovery of Retin-A and Its Impact

Retin-A is one of the most groundbreaking dermatological discoveries of the 20th century, still used by millions worldwide. Praised by skincare experts and enthusiasts, it has become a must-have acne treatment because it’s gentler on the skin compared to other retinoids and acts as a multi-tasking skincare solution by exfoliating, stimulating collagen production, reducing fine lines, and evening out skin tone. In 1971, the FDA approved it, and Johnson & Johnson started selling it. The drug was patented for commercial use in 1967 by Albert Kligman, a dermatologist and researcher at the University of Pennsylvania. However, the discovery of its anti-aging and acne-fighting benefits is deeply tied to decades of unethical medical abuse.

Albert Kligman and the prisoners of Holmesburg Prison

Between 1951 and 1974, Holmesburg Prison in Philadelphia became Kligman’s laboratory. Thousands of prisoners, many of them African American and in poverty, were subjected to dermatological testing without fully understanding the risks. Jobs inside the prison were scarce and poorly paid, and many inmates needed money for bail or legal aid. Desperate, they agreed to participate in cosmetic and pharmaceutical experiments for just a few dollars, unaware of the side effects, medical complications, and long-term health damage they would suffer for the rest of their lives. In a 1966 interview with the Philadelphia Inquirer, Kligman said: "All I saw before me were acres of skin. I was like a farmer seeing a fertile field for the first time." His words reflected a dehumanizing attitude toward the test subjects.

The experiments at Holmesburg Prison

As reported in Allen Hornblum's book Acres of Skin, Kligman conducted experiments regarding cosmetic and pharmaceutical products, including but not limited to perfumes, shampoos, baby products, and liquid diets. His clients also included major pharmaceutical manufacturers such as Pfizer and Johnson & Johnson, chemical companies such as Dow Chemical, and the U.S. Army, which commissioned Kligman to test hallucinogenic and psychotropic drugs. Throughout the 1950s, 1960s, and into the early 1970s, he subjected Holmesburg prisoners, both men and women (they were primarily involved in testing menstrual products, with devastating consequences), to diseases such as herpes and staph, to asbestos and radioactive isotopes, including dioxin, an extremely poisonous and carcinogenic component of Agent Orange. Survivors testified that they had undergone "patch tests" on their backs, faces and arms with untested creams and toxic chemicals, as well as biopsies, mysterious injections and several sets of other medical procedures. Dr. Kligman's testing program was shut down in 1974.

The Truth Behind Retin-A

Kligman’s research on Vitamin A led to the discovery of tretinoin. In his early trials, he used a 1% concentration on test subjects, disregarding severe side effects such as burning, peeling, redness, and irritation. Considering that today the most common Retin-A prescription contains only 0.025% retinoic acid, it’s no surprise that test subjects suffered serious medical complications. As Kligman admitted in a shocking statement to Philadelphia Magazine: "I almost killed people [before] I could see a real benefit." Despite the huge financial success of Retin-A, which earned Kligman hundreds of millions of dollars.

The hidden and unpaid price of beauty

Reactions to Kligman's abuse went little beyond dismay. Each time a survivor tried to hold him accountable by filing legal charges, the case was dismissed for lack of evidence. Until in 2022 the city of Philadelphia issued an apology and, in 2023, the Medical Board revoked the Society for Investigative Dermatology's lecture and travel award dedicated to Kligman and publicly apologized to survivors. Survivors and their families continue to demand justice without getting it.

Ethics sacrificed for progress?

Retin-A's origin story has helped strengthen regulations such as the Nuremberg Code and the Declaration of Helsinki, which set strict standards for the protection of human subjects in clinical trials, with guidelines prohibiting experimentation on non-consenting subjects. Crucial moral questions remain: is it right for millions of people today to benefit from a drug developed in such a questionable manner? On the one hand, Retin-A has improved the quality of life for millions of people, treating severe acne and contributing to the fight against skin aging. On the other, the human price paid by the Holmesburg inmates is an indelible stain on the history of medicine. Because scientific advances should never come at the expense of human dignity and rights, and the flawless skin we admire in the mirror today carries the invisible scars of all the men and women of Holmesburg.