Retinoids in the treatment of skin aging: an overview of clinical efficacy and safety

Figures & data

Table 1 Comparison of chronological aging and photoaging

Ageing types	Identification characteristics
	Epidermis	Dermis	Clinical
Chronological aging	Thinner than normal with lower cell growth, minor abnormalities in keratinocyte regularity Normal stratum corneum There is loss of rete pegs here as well	Elastin fibers appear irregular in their arrangement, whereas collagen fibers begin to lower in number and thickness	Skin is smooth, unblemished, but shows saggy appearance
Photoaging	Thick skin, with acanthosis followed by atrophy of the cells High basal keratinocyte irregularity Stratum corneum appears compact There is loss of rete pegs here as well	Excessive production of elastin fibers in an improper orientation, collagen fibres appear to thicken and then wear out soon Appearance of grenzzone	Smooth, leathery, reddened appearance with initially light wrinkles, which later deepen, thus showing loss of collagen fibers

Figure 1 Chemical structures of retinoids.

Table 2 Overview of short-term studies on tretinoin

Reference	Study design	No. of patients	Duration	Observations in tretinoin group
Weiss et al (1988)	Randomized, Double-blind 0.1% tretinoin cream vs vehicle	30	4 months	Compaction of stratum corneum Increase in glycosamine glycans (GAGs) Improvement in fine wrinkles, coarse wrinkles, tactile roughness, sallownessa
Lever et al (1990)	Double-blind 0.05% tretinoin cream vs placebo control	20	3 months	Epidermal thickening Improvement in fine wrinklesa
Shukuwa et al (1993)	Open-label 0.05% tretinoin cream	5	1 month	Compaction of stratum corneum, Disappearance of atypia, dysplasia No significant dermal changes

Note: ^aAll observations were statistically significant compared with control group.

Table 3 Overview of studies involving 6 months’ tretinoin treatment

Reference	Study design	Duration	No. of patients	Observations and Inferences
Leyden et al (1989)	Randomized, double-blind 0.05% tretinoin cream vs vehicle control	6 months	30	Improvement in fine wrinkling, coarse wrinkling, sallowness and hyperpigmentation
Caputo et al (1990)	Dose escalating study tretinoin cream 0.01% in the 1st month, 0.025% in the 2nd month, 0.05% for next 4 months	6 months	89	Improvement in fine and coarse wrinkling, mottled hyperpigmentation, skin texture and laxity
Weinstein et al (1991)	Double-blind tretinoin emollient cream 0.05% and 0.01% vs vehicle	6 months	251	Significant improvement in fine wrinkling, mottled hyperpigmentation, roughness, laxity, epidermal thickness, in group treated with 0.05% tretinoin as compared with 0.01% and vehicle group Dose-dependant responses were observed No effect was seen in dermal thickness, collagen regeneration, reversal of keratinocytic atypia
Bhawan et al (1991)	Randomized, Double-blind tretinoin emollient cream 0.001%, 0.01% and 0.05% vs vehicle	6 months	533	Significant improvement in fine wrinkling, mottled hyperpigmentation, roughness, epidermal thickness, in group treated with 0.05% tretinoin as compared with 0.01%, 0.001% and vehicle group Dose-dependant responses were observed Vehicle-treated group showed some improvement
Olsen et al (1992)	Same as in case of Bhawan et al (1991)	6 months	296	Same as in case of Bhawan et al (1991)

Figure 2 N-formyl aspartame derivative of retinol.

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