Tretinoin does not improve laser therapy results in facial hyperpigmentation, photodamage

The combination of 1927 nm fiber laser therapy and tretinoin 0.05% lotion showed significant improvements in patients with facial hyperpigmentation and photodamage, according to a study.

However, laser therapy with tretinoin failed to show improvement over laser therapy without tretinoin.

“Dyspigmentation and photodamage are common concerns in patients who seek aesthetic consultation,” Rawaa Almukhtar, MD, MPH, of Cosmetic Laser Dermatology in San Diego, and colleagues wrote. “A number of treatment modalities have been utilized to address this issue.”

One of those modalities is a 1927 nm thulium fractionated non-ablative fiber laser, which has demonstrated safety and efficacy in the management of photoaging. Another is topical retinoids, which can promote epidermal hyperplasia and collagen synthesis and reduce the production of melanin production.

Few data sets have explored how the combination of these two approaches could benefit these patients, according to the researchers.

In the single-center, prospective, double-blind, evaluator-blind, non-randomized, vehicle-controlled study, a cohort of 41 women underwent one session of 1927 nm thulium fiber laser treatment. One month prior to the treatment, subjects started topical 0.05% tretinoin lotion (n = 21; mean age, 55.7 years) or vehicle (n = 20; mean age, 55.4 years), which ceased 3 days prior to and 7 days after laser treatment. On day 8 after laser treatment, subjects restarted the 0.05% tretinoin lotion or vehicle for the duration of the study. All subjects also used a gentle facial cleanser and a sunscreen with zinc oxide and SPF 50.

Results showed that laser treatment with or without 0.05% tretinoin lotion yielded a comparable change in Investigator Assessed Overall Hyperpigmentation and Investigator Assessed Overall Photodamage (P < .001).

The researchers also assessed patients based on the Investigator Global Aesthetic Improvement Scale and the Subject Global Aesthetic Improvement Scale (SGAIS). They observed no statistically significant differences between the two treatment groups in efficacy as assessed by these scales at most points during follow-up.

However, there were two exceptions. At 30 days after laser therapy, patients treated with 0.05% tretinoin lotion reported a lower SGAIS level of improvement (2.8 ± 0.86 in the treatment group vs. 2 ± 0.85 in the vehicle group; P = .009). Also at 30 days, patients in the 0.05% tretinoin group reported lower patient satisfaction than controls (2.87 ± 1.55 in the treatment group vs 1.53 ± 0.64 in the vehicle group; P = .001).

“In our study, patients tolerated the combination of 1927 nm thulium fiber laser and 0.05% tretinoin lotion well and had a significant improvement in hyperpigmentation and photodamage,” the researchers concluded. “However, combining 0.05% tretinoin lotion with 1927 nm [thulium fiber laser] didn’t result in statistically significant increased efficacy when compared to the 1927 nm [thulium fiber laser]. Future studies are needed to investigate the impact on efficacy when combining laser procedures with a longer duration of use or a higher concentration of topical tretinoin.”