Prescription retinoids, OTC products positively impact photoaged skin
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Key takeaways:
- Over-the-counter niacinamide, co-enzyme Q10 and vitamins C, E and A may improve photoaged skin.
- Tazarotene and tretinoin are among the most effective treatments for photoaged skin.
Prescription retinoids are the most potent treatment option for photoaging while over-the-counter products may induce positive outcomes as well, according to a study.
Photoaging due to a lifetime of ultraviolet light exposure is the No. 1 external factor for facial aging. The current market is saturated with products that claim to treat signs and symptoms of aging with approximately $400 million being spent in direct and indirect costs due to photoaging in the U.S. alone.
In this comprehensive review, Neil Sadick, MD, of Weill Cornell Medical College and Sadick Dermatology, both in New York, and colleagues evaluated the best treatment options for photoaged skin.
OTC and cosmeceutical products
“OTC and cosmeceutical products comprise the majority of treatment options for photoaging, possessing a variety of mechanisms of action and effects on photoaged skin,” Sadick and colleagues wrote.
Because these products do not follow the same regulatory rules as prescription drugs, there are few studies evaluating their effectiveness, according to the researchers.
Nevertheless, antioxidants such as niacinamide, vitamins C and E and co-enzyme Q10 scavenge reactive oxygen species which increases collagen production and reduces inflammation. These cosmeceutical products also improve skin barrier function, pigmentation and wrinkling.
While there are some clinical studies that support the outcomes of niacinamide and vitamin C, data are lacking for vitamin E.
“Vitamin A in its endogenous biologically active form, all-trans retinoic acid, is perhaps the most efficacious topical agent for the treatment of photoaged skin,” the researchers wrote.
Because all-trans retinoic acid is classified as a drug, it cannot be included in OTC drugs in the U.S. However, vitamin A derivatives presumably undergo a transformation to all-trans retinoic acid in the skin and has demonstrated the ability to increase epidermal thickness, improve the extracellular matrix, increase collagen and decrease matric metalloproteinases.
Tazarotene
Tazarotene 0.1% cream is one of two FDA-approved treatments for signs of photoaging. To mitigate wrinkles, patients can use tazarotene as an adjunctive agent with a comprehensive skin care routine and sunlight avoidance program.
Tazarotene is also indicated in the treatment of mottled hypo- and hyperpigmentation and benign lentigines, according to the study.
Two double-blind, randomized, vehicle-controlled trials have found that tazarotene 0.1% cream improves signs of aging after 24 weeks of usage.
In the first study, 63% of patients using tazarotene experienced improvement in fine wrinkling compared with 24% of those using vehicle.
Tretinoin
Tretinoin 0.02% was the first FDA-approved topical retinoid to be developed for signs of photoaging and, according to the researchers, is likely the most widely studied.
Two double-blind, randomized, 24-week, vehicle-controlled trials showed that those who used tretinoin had significantly better outcomes in aging than those who used vehicle.
Compared with those using vehicle, those using tretinoin saw improvements in fine wrinkling, coarse wrinkling and sallowness.
Additionally, a greater proportion of patients treated with tretinoin vs. vehicle exhibited overall improvement compared with vehicle, according to the study.
Adapalene
“Adapalene is approved for the treatment of acne and is among the best-tolerated topical retinoids,” the researchers wrote. “Two studies have demonstrated its efficacy in the treatment of photoaged skin.”
In a head-to-head 6-month study comparing adapalene 0.3% to tretinoin 0.5% cream, both treatments demonstrated significant reductions in aging symptoms, although the differences between the treatments did not reach statistical significance.
Conclusion
“Although there is no cure for photoaged skin, a host of OTC and prescription topical treatment options are available to reduce signs and symptoms,” Sadick and colleagues wrote, adding that while retinoids are the most potent, they may cause cutaneous irritation.
Communication with patients concerning the efficacy and safety of each treatment option is always encouraged, the researchers concluded.
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