As the world population ages, the search for treatments for sun damaged, also known as photo-damaged, skin has become the holy grail for cosmeceutical, pharmacologic and device research. In both medical literature and the media, there is daily mention of the newest and best treatments for our aging population, particularly treatments that purport to “turn back the clock” on aging or photo-damaged skin. The target population for such products is generally women 30-70 years of age. However, men are increasingly requesting treatment for the stigma of photo-aging. Clinically, photo-aging comprises the well-known visible signs of wrinkles, skin laxity or looseness, dyspigmentation or freckling (also referred to as liver spots by some), roughness, dilated blood vessels, rough precancerous spots and skin cancers.*
It is a Herculean task sorting through the vast array of treatments that are promoted as offering safe, efficacious and cost-effective management of sun damaged skin. The task is daunting because patients are bombarded by the cosmeceutical industry with vast amounts of unsubstantiated claims. The cosmeceutical industry uses apparently compelling in vitro results from small, frequently uncontrolled studies which are often bolstered by the claims of “experts”.
Yet, compelling clinical data do exist for the utility of one class of topicals in treating the visible and invisible changes caused by sun damage. These are the FDA-approved retinoids and their analogues. At present, only three retinoids or synthetic retinoid analogues have FDA approval for the mitigation of photo-aging.* They are tazarotene cream 0.1% and tretinoin emollient cream 0.05% and 0.02%.
Tazarotene 0.1% is approved as an adjunctive agent for the reduction of signs of facial sun damage, including fine wrinkling, mottled hyperpigmentation and benign freckles.* Tretinoin 0.05% emollient cream has a moisturizing base that is useful for the treatment of fine wrinkles, mottled hyperpigmentation and facial roughness in patients who do not achieve palliation of symptoms using a comprehensive program of skin care and sun avoidance.* Tretinoin 0.02% is only approved as an adjunctive agent for the mitigation of fine wrinkles but not hyperpigmentation or tactile roughness. The efficacy of all three agents in the management of photo-damage is supported by numerous well done clinical trials.*
The reversal and prevention of structural changes accounts for the majority of the visible benefits of retinoid therapy. Even more important changes can be demonstrated by microscopic examination which demonstrates repair of sun damage and the deposition of new collagen*. An additional important benefit of retinoids in treating photo-damaged skin is their ability to restore normal immune function and correct precancerous changes.*
Retinoids are an ideal choice for reversing and preventing many of the changes in sun damaged skin.* Nevertheless, concerns are frequently voiced regarding the so-called retinoid dermatitis or the irritation seen especially at the initiation of this class of drug. We have special expertise in preventing and treating this problem.* In our clinical studies we have demonstrated that the use of non-soap cleansers and high quality moisturizers help treat and prevent this type of irritation.* Our staff are eager to help educate you about the proper use of these products and supporting agents to develop a program that is ideally suited to your individual needs
While retinoids have been shown to help with abnormal pigmentation, hydroquinones also have a special place in the treatment of freckling from sun damage, hyperpigmentation of melasma , and the pigmentation from acne that develops in persons of color.* We conducted a study using a topical retinoid, tazarotene 0.1% cream, and an 8-week course of hydroquinone 4% cream. This combination resulted in dramatic improvement in mottled hyperpigmentation and freckling in our study patients.*
Increasingly, recent studies demonstrate that in addition to their efficacy in the treatment of sun-damaged skin, retinoids also play a role as adjuncts to cosmetic procedures.* We conducted a well-controlled study using a topical retinoid in conjunction with a pulsed dye laser. Patients treated their entire face with a topical retinoid and one side only was treated with the laser in the low dose mode to treat sun damage. Most patients showed significant improvement and comparable results were seen on both sides indicating that the topical retinoid was responsible for most of the improvement.*
Retinoid pretreatment prior to procedures, such as chemical peels and ablative, non-ablative and fractional laser resurfacing, can accelerate healing which results in less down time and more comfort.*
Retinoids clearly show great promise with very few drawbacks in the prevention and treatment of sun damaged skin.* The most common drawback, irritation early in the course of treatment, can be minimized by the use of a non-soap cleanser, high quality moisturizers, and adjustments in dosing regimens early in the treatment course. Topical retinoids are the treatment of choice for visible and invisible signs of photodamage.*