Topical Retinoids in the Management of Photodamaged Skin: From Theory to Evidence-based Practical Approach

R. Darlenski; C. Surber; J.W. Fluhr

Disclosures

The British Journal of Dermatology. 2010;163(6):1157-1165. 

In This Article

Abstract and Introduction

Abstract

Skin, being exposed directly to the environment, represents a unique model for demonstrating the synergistic effects of intrinsic and extrinsic factors on the ageing process. Ultraviolet radiation (UVR) is the major factor among exogenous stressors responsible for premature skin ageing. The problem of skin ageing has captured public attention and has an important social impact. Different therapeutic approaches have been developed to treat cutaneous ageing and to diminish or prevent the negative effects of UVR. Topical retinoids represent an important and powerful class of molecules in the dermatologist's hands for the treatment of photodamaged skin. Since their introduction more than 20 years ago, topical retinoids have shown beneficial efficacy and good safety profiles in the management of photodamaged skin, and as therapeutic anti-ageing agents. This review provides a brief retrospective of the development of topical retinoids in the treatment of photodamaged skin, elucidates their mechanism of action, delineates their use and addresses clinical, pharmaceutical and regulatory issues in connection with their intended use.

Introduction

Like all other organs and systems in the human body skin is subject to the inevitable process of ageing – the generally irreversible and complex changes of growing older. Demographic data show a trend towards a relative and absolute increase of senescent individuals in the human population over the past decades.[1] The major factors for this demographic redistribution include the increase in life expectancy over the last 100 years, improvement of health care and living conditions, and decreasing fertility and infant mortality rates.[1,2] Although the 'growing' older population is obvious in industrialized countries, it is expected that the greatest increases in the elderly population in the 21st century will be in developing countries[3] and, in fact, an increase is already being observed in China. The problems of ageing are therefore getting more attention in all fields of health care, including the scientific community.

There is a high public and scientific interest in the numerous prophylactic and therapeutic modalities to decelerate, to stop or even to reverse the process of ageing. With pharmacological and physical means including the use of topical medications, cosmeceuticals, laser treatments and surgical procedures, respectively, health care professionals and consumers try to delay the process of senescence or cache signs of skin ageing. In the dermatologist's hands topical retinoids feature an important and powerful class of molecules to improve signs of skin ageing.

This review provides a brief retrospective of the development of topical retinoids in the treatment of photodamaged skin, elucidates their mechanism of action, delineates their use and addresses clinical, pharmaceutical and regulatory issues in connection with their intended use.

A systematic literature search using Pubmed, Medline and Google Scholar search engines was performed in December 2009. The search terms used were 'photodamage', 'photoaging', 'topical retinoids', 'tretinoin', 'isotretinoin', 'retinoic acid', 'tazarotene', 'adapalene', 'retinol' and 'retinaldehyde'. The databases were also explored by means of the 'related articles' function. No specific period of time was pre-selected and no case reports, letters, news or methodology articles were included in the reviewing phase. Recent publications, including the Cochrane database systematic reviews, offer comprehensive details on randomized, controlled studies on retinoids in skin ageing.[4,5]

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