Use of Topical Retinoids for the Treatment of Nonmalignant Photodamage in Clinical Practice, Part 2

Photodamage is primarily an aesthetic issue for patients but also can lead to malignant skin changes. Moreover, clinical and histologic evidence show that the skin changes attributable to photodamage are not necessarily irreversible, and there are now a number of nonsurgical approaches to this problem. Topical therapies are simple to use but require proper adherence to treatment for some months before measurable improvement is seen. Of all topical therapies available to date, the retinoids can be prescribed with most confidence, as the clinical evidence underpinning their use far outweighs that available for other compounds such as antioxidants and a-hydroxy acids. Retinoid therapy consistently has been shown to attenuate and reverse the signs of photodamage, including coarse wrinkling, in controlled trials. Tretinoin has been the most extensively studied retinoid in trials of up to 4 years’ duration, and a systematic analysis demonstrated that the evidence of benefit for tretinoin at concentrations of at least 0.02% is greater than for other agents. Moreover, the clinical changes achieved with tretinoin are accompanied by histologic