Daily topical application of 0.05% tretinoin in a cream base was compared with its vehicle with regard to moderation of photoaging changes of the face and forearms. In comparison with the control tissue, tretinoin-treated tissue examined by light and electron microscopy showed the following effects: replacement of the atrophic epidermis by hyperplasia, elimination of dysplasia and atypia, eradication of microscopic actinic keratoses, uniform dispersion of melanin granules, new collagen formation in the papillary dermis, new vessel formation (angiogenesis), and exfoliation of retained horn in the follicles. Physiologic studies demonstrated: increased blood flow and dermal clearance, increased transepidermal water loss, and greater permeability and reactivity. It was concluded that topical tretinoin is capable of at least partly reversing the structural damages of excessive sunlight exposure and may be useful in decelerating the photoaging process.

Topical tretinoin for photoaged skin

In a 16-week randomized, double-blind, vehicle-controlled study of topical tretinoin in the treatment of photoaging, all patients applied topical tretinoin to one forearm and vehicle cream to the other. Half of the patients received tretinoin to the face, and half received vehicle cream. All 30 patients who completed the study showed statistically significant improvement in photoaging on the tretinoin-treated forearms, but not on the vehicle-treated forearms. Fourteen of the 15 patients who received tretinoin to the face had improvement in photoaging, whereas none of the vehicle-treated patients' faces improved, a statistically significant difference in response between the two groups. Statistically significant histologic changes were seen in forearm skin treated with tretinoin, but not with vehicle cream. Side effects were limited to irritation of tretinoin-exposed skin. ( JAMA 1988;259:527-532)

Topical tretinoin improves photoaged skin. A double-blind vehicle-controlled study.

These guidelines stemmed from a consensus meeting held by the British Photobiology Group (BPG) in 1999. Following this meeting one of the authors (J.M.M.) was invited to draw up guidelines for the management of actinic keratoses by the British Association of Dermatologists Therapy Guidelines and Audit Subcommittee. Relevant evidence was sought using the search terms 'solar keratosis' and 'actinic keratosis' in Medline from 1966 onwards. Additional and earlier literature was reviewed on the basis of references within post-1966 publications. All articles of apparent relevance were reviewed independently of the nature of the publication. The quality of the evidence elicited has been indicated. The National Ambulatory Medical Care Survey (U.S.A.) was used for further data on topical chemotherapy. Papers were reviewed and discussed by the contributors to the BPG Workshop (see Acknowledgments). Recommendations are evidence based where possible. Strength of recommendation is coupled with quality of evidence. Strength of recommendation includes consideration of apparent cost-benefit and practical considerations. Quality of evidence reflects the nature of the trial structure that provides data of efficacy.

https://www.bad.org.uk/shared/get-file.ashx?id=40&itemtype=document

Guidelines for the management of actinic keratoses.

• Vitamin A and its newly developed synthetic analogues recently have been demonstrated to have profound effects on disorders of keratinization, sebaceous gland function, and cancer. In separate sections of this article, we review the history, chemistry, metabolism, mechanism of action, toxicity, and clinical applications of both the naturally occurring and synthetic retinoids. ( Arch Dermatol 1981;117:160-180)

Retinoids, cancer, and the skin.

Background. The hyperpigmented lesions commonly called liver spots distress patients, in part because such lesions are associated with aging. We investigated their treatment with topical 0.1 percent tretinoin (retinoic acid). Methods. Fifty-eight patients completed a 10-month randomized, double-blind study in which they applied either 0.1 percent tretinoin (n = 28) or vehicle (n = 30) cream daily to the face, upper extremities, or both. Fifteen patients who responded well were then randomly assigned to continue tretinoin therapy or use vehicle alone for six more months. Patients were evaluated by physical examination every month and by analysis of biopsy specimens of lesions obtained at base line and at the end of the 10-month trial. Results. After one month of treatment the patients treated with tretinoin had significant lightening of hyperpigmented lesions as compared with the patients who received vehicle (P<0.002). After 10 months, 20 (83 percent) of the 24 patients with facial lesions who we...

Topical Tretinoin (Retinoic Acid) Treatment for Liver Spots Associated with Photodamage

Topically applied retinoic acid induces partial or complete clinical regressions of senile or actinic keratoses as well as of basal cell carcinomas of the skin. 15 out of 16 treated basal cell carcinomas regressed by more than 50%, regressions being complete in 5 cases. The mode of action of retinoic acid on premalignant and malignant lesions is discussed.

F. Ott

Papers

Retinoic acid: Topical treatment of senile or actinic keratoses and basal cell carcinomas