Doi:10.1016/j.clindermatol.2007.09.016

Clinics in Dermatology (2008) 26, 633–635 Cosmeceuticals: focus on topical retinoids in photoaging Riccarda Serri, MDa,⁎, Matilde Iorizzo, MDb aDepartment of Dermatology, University of Milan, Milan, ItalybDepartment of Dermatology, University of Bologna, Bologna, Italy Abstract Evidence from a randomized clinical trial showed that, in spite of the many surgical procedureseffective in ameliorating the clinical appearance of photoaged skin, the only medical therapy withproven benefits in photoaged skin are topical retinoids, in particular tretinoin, isotretinoin, andtazarotene. The application of retinoids might not only clinically and biochemically repair photoagedskin, but their use might also prevent photoaging. Furthermore, new evidence suggests a beneficial roleof topical retinoids in the treatment of intrinsically aged skin.
2008 Elsevier Inc. All rights reserved.
Tretinoin, isotretinoin, alitretinoin, tazarotene, and ada- palene are registered as drugs; the others are cosmeceuticals Vitamin A and its derivatives, both natural and synthetic, have been popular additives in topicals for years and are Vitamin A and its derivatives exert their action by binding to recognized as the gold standard for the prevention and specific nuclear receptors. The ligand-receptor complex modulates the expression of the genes involved in cellular The following topical retinoids are recognized as being differentiation and proliferation, normalizing cell keratinization.
Retinoids might also act independently from the binding to nuclear receptors. Each of them exerts its own activity, offering a further choice to the dermatologists who deal with Although there are several studies proving the efficacy of tretinoin as topical treatment of photoaging, few studies are Kligman and Willisfirst introduced retinoids for use as photoaging agents. After its application, the author noticedimprovement of skin depigmentation and rejuvenation.
When used on photodamaged skin, tretinoin's clinical ⁎ Corresponding author. 46-7 Via della Moscova, Milan 20121, Italy.
effects include improvement of wrinkles, roughness, mottled pigmentation, and skin appearance as a whole.
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The histologic changes observed are decreased corneo- cyte adhesion (loss of desmosomes, decreased tonofila-ments, increased autolysis of keratinocytes, intracellular Topical isotretinoin is available as a 0.05% cream or glycogen deposition), epidermal hyperplasia, increased gel. It appears to be less irritating, yet less effective, than number of Langerhans cells, increased synthesis of collagen and elastin, and angiogenesis. Tretinoin enhances epidermalcell turnover, decreasing contact time between keratinocytesand melanocytes and promoting a rapid loss of pigmentthrough epidermopoesis.
Tretinoin is available in different concentrations (0.01%, 0.25%, 0.5%, and 0.1%) and as different formulations The theoretic benefit of alitretinoin 0.1% gel in the (cream, gel, solution). Creams are generally prescribed for treatment of photoaging originates from the binding and sensitive skins, whereas gels are prescribed for oily skins.
activation of all nuclear retinoid receptors, but larger, Continuous once-daily application is mandatory to blind, and controlled trials are necessary to better achieve maximum results, in any case not occurring before a 3-month period.The only clinical improvement thatappears after only 1 month is skin smoothness. To maintainthe results, long-term treatment is necessary. There are nolimits to the duration of tretinoin topical use.
Moderate cutaneous side effects, especially erythema and desquamation, are observed in most patients even if after 2 to Tazarotene is an analogue of tretinoin that belongs to the 4 weeks these side effects decrease without discontinuing the family of acetylenic retinoids. It has a specific binding profile treatment. It may be necessary to interrupt the treatment for 2 for beta and gamma retinoid receptors. Tazarotene improves to 3 days, to apply a calming and moisturizing cream, and skin roughness, fine wrinkling, and epidermal atrophyIt is then to restart treatment once every 2 days.
available at 0.05% and 0.1% gel and cream.
Whenever tretinoin is prescribed, the use of sunscreen is very important to avoid sunburns (the treated skin is thinner)and worsening of photodamage (UV radiations decrease theexpression of retinoid receptors in skin cells, thus limiting Even if usually indicated for acne, adapalene has also been tested for the treatment of Once-daily application of adapalene 0.1% gel for 4 weeks, followed by atwice-daily application for up to 9 months, significantlyreduced actinic keratoses and lentigines.
There are no studies comparing its effectiveness with that of tretinoin, although retinol does not appear to be aseffective. In photoaging, it is used as a cream in differentconcentrations, ranging from 0.075% to 1%. It can be considered a “light” alternative to tretinoin in case ofsensitive 1. Kligman AM, Willis I. A new formula for depigmenting human skin.
2. Kligman LH, Do CH, Kligman AM. Topical retinoic acid enhances the repair of ultraviolet damaged dermal connective tissue. Connect Tissue 3. Kligman AM, Grove GL, Hirose R, et al. Topical tretinoin for Esters are not considered effective against photoaging if photoaged skin. J Am Acad Dermatol 1986;15:838-59.
4. Kligman AM. Guidelines for the use of topical tretinoin (Retin-A) for used Most of the products available are, in fact, a photoaged skin. J Am Acad Dermatol 1989;21:650-4.
combination of esters and hydroxy acids.
5. Kang S, Duell EA, Fisher GJ, et al. Application of retinol to human skin in vivo induces epidermal hyperplasia and cellular retinoidbinding proteins characteristic of retinoic acid but without measur-able retinoic acid levels or irritation. J Invest Dermatol 1995;105: 6. Green C, Orchard G, Cerio R, et al. A clinicopathological study of the effects of topical retinyl propionate cream in skin photoageing. Clin Exp Retinaldehyde is formulated as cream or gel and in concentrations varying from 0.015% to 0.1%. Its efficacy is 7. Lupo M. Antioxidants and vitamins in cosmetics. Clin Dermatol 2001; similar to that of tretinoin, but it is much less irritating.
Cosmeceuticals: focus on topical retinoids in photoaging 8. Saurat JH, Didierjena L, Masgruve E, et al. Topical retinaldehyde on 11. Baumann L, Vujevich J, Halem M, et al. Open-label pilot study of human skin: biologic effects and tolerance. J Invest Dermatol 1994;103: alitretinoin gel 0.1% in the treatment of photoaging. Cutis 2005;76: 9. Creidi P, Vienne MP, Ochonisky S, et al. Profilometric evaluation of 12. Kang S, Krueger GG, Tanghetti EA, et al. A multicenter, photodamage after topical retinaldehyde and retinoic acid treatment.
randomized, double-blind trial of tazarotene 0.1% cream in the 10. Maddin S, Lauharanta J, Agache P, et al. Isotretinoin improves the appearance of photodamaged skin: results of a 36-week, multicenter, 13. Kang S, Goldfarb MT, Weiss JS, et al. Assessment of adapalene gel for double-blind, placebo-controlled trial. J Am Acad Dermatol 2000; the treatment of actinic keratoses and lentigines: a randomized trial.

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