Combination Superficial Peels With Salicylic Acid and Post-Peel Retinoids.

BACKGROUND: Salicylic acid (SA) and retinoids, tretinoin (all-trans retinoic acid [ATRA]), and retinol (all-trans retinol) are widely used as topical agents for the improvement of photodamage and acne vulgaris. They can be used in daily take-home products or as part of an in-office procedure, combining the benefits of a keratolytic (SA) and a retinoid. OBJECTIVE: The objective of this research was to compare the efficacy for ameliorating photodamage of topical tretinoin (0.25%) and retinol (0.25%) to baseline and with each other when applied after a 30% salicylic acid peel on human facial skin. METHODS: Twenty female subjects received a full face 30% SA peel followed by the overnight application of tretinoin to a 1 randomized half-face and retinol to the opposite side (split-face study). The identical procedure was repeated at week 2. Double-blinded subject and investigator assessments of the results were captured at weeks 2 and 4. RESULTS: By investigator evaluation, both peeling regimens were effective in improving photodamage parameters compared to baseline. (ATRA P-values at week 4 were: P=.00008 texture, P=.00013 roughness, P=.00221 pores, P=.00098 dryness, P=.02770 erythema, and P=.00008 overall appearance. Retinol P-values at week 4 were: P=.00019 texture, P=.00053 roughness, P=.00221 pores, P=.00147 dryness, P=.02770 erythema, and P=.0043 overall appearance.) By subject self-assessment compared with baseline, both tretinoin and retinol were effective in improving overall appearance (ATRA P=.0229 and retinol P=.0190). By investigator evaluation comparing tretinoin with retinol, tretinoin was slightly better than retinol at week 4 in improving texture P=.00506, roughness P=.01171, and overall appearance P=.00506. By subject self-assessment comparing tretinoin with retinol, there was no difference in overall appearance (ATRA P=.2367 and retinol P=.3613). CONCLUSION: Either topical tretinoin (0.25%) or retinol (0.25%) can be used safely and effectively when applied in office immediately after SA peeling to ameliorate signs of photoaging.

High-strength tretinoin for rapid retinization of photoaged facial skin.

BACKGROUND: Emollient creams of 0.02% and 0.05% tretinoin are currently used for improving the appearance of photoaged skin. At these concentrations, using this vehicle, the clinical results take many months. OBJECTIVE: The objective was to formulate and test a higher strength tretinoin that enhances penetration of the active molecule through the stratum corneum so that the clinical result is achieved after 1 month of treatment. METHODS: Thirty-two female subjects underwent treatment with 0.25% tretinoin solution applied nightly for 1 month. Subjects were evaluated clinically at baseline and 1, 2, and 4 weeks. Clinical grading was performed by comparing digital photographs before and after treatment. RESULTS: Almost all subjects improved on all measures of clinical grading (fine lines, mottled pigmentation, surface texture/roughness) by the end of the study. CONCLUSION: Tretinoin solution at a concentration of 0.25% is an effective and tolerable treatment for photodamaged facial skin and greatly shortens the time required for clinical response.

Intense pulsed light treatment of photoaged facial skin.

BACKGROUND: It has been reported that intense pulsed light is efficacious for rejuvenation of photoaged skin, specifically the improvement of appearance of telangiectases and solar lentigines. OBJECTIVE: The objective was to define the treatment variables for photodamaged facial skin using a newer intense pulsed light system. METHODS: Twenty-three female subjects received three treatments using double-stacked pulses with fluences of 24 and 30 J/cm2. Response to treatment was evaluated using digital photography. Three signs of photoaging were evaluated: surface texture/roughness, mottled hyperpigmentation, and erythema/telangiectases. RESULTS: There was a shift in clinical grading from more to less severe on all three measures of photoaging. CONCLUSION: Intense pulsed light therapy was efficacious in ameliorating the clinical signs of photoaging. The device was well tolerated with minimal side effects.