Search

Acne is a chronic, self-limiting inflammatory disease of pilosebaceous unit. It is multifactorial, of which Propioniobacterium acne and Sebum play an important role in etiopathogenesis.The aim of the study is to compare efficacy of Tretinoin and Adapalene in Acne Vulgaris and to compare the side effects of topical tretinoin and adapalene.Randomized prospective comparative clinical trial with sample size of 50 patients who are recruited from department of dermatology of MMCH&RI.Adapalene 0. 1% produced numerically greater lesion reduction than tretinoin 0. 04% for all lesion types. Thus, Adapalene was found superior to Tretinoin in reducing average number of lesions. Highest reduction in number of lesions with both topical retinoids was for comedones (p< 0. 001) followed by papules (pIn Patients who applied adapalene, most of them were reduced to grade 0 and grade I and only few were in grade II. Whereas in patients who applied tretinoin only few were reduced to grade 0 and many were in grade I and grade II. Side effects were more commonly seen in patient treated with topical Tretinoin than with topical Adapalene. Adapalene was better tolerated than tretinoin. Hence adapalene is a safe and effective in treatment of acne.

Narrowband UV-B (NBUVB) phototherapy is the mainstay of vitiligo treatment, but hyperpigmentation is one of the limitations. Meanwhile, topical tretinoin is effective against pigmentary disorders.To determine whether tretinoin 0.05% cream would prevent hyperpigmentation when patients with facial vitiligo underwent phototherapy.A randomized, controlled, split-face trial was conducted. Adult patients with stable, non-segmental facial vitiligo were enrolled. The left/right sides of the face were randomly allocated to receive either topical tretinoin 0.05% cream or moisturizer twice daily. The entire face was subjected to NBUVB phototherapy twice weekly for 12 weeks. The degree of hyperpigmentation was assessed as the delta L* (brightness) value of the darkest spot in each side of the face at baseline and every 4 weeks. The degree of repigmentation was assessed.Twenty-five patients were enrolled; 21 completed the study. The delta L* value was significantly different between the two groups: -0.5% in the tretinoin group and -8.7% in the control group at 12 weeks (Tretinoin 0.05% cream prevented hyperpigmentation during NBUVB phototherapy in patients with facial vitiligo, and did not compromise the overall treatment response.ClinicalTrials.gov NCT03933774.

Treatment of verruca plana is often challenging, and multiple treatment modalities, both pharmacologic and destructive, are frequently necessary to clear lesions. We report a case of a 16-year-old girl with a 2-year history of extensive verruca plana of the forehead, temples, and upper periorbital skin, recalcitrant to monotherapy with topical tretinoin cream, that completely resolved following first dose of nonavalent human papillomavirus (HPV) immunization.

Purpose To report cross-reactivity between topical vitamin A derivatives and tetracycline-class antibiotics. Observations A 19-year old woman with a remote history of resolved secondary intracranial hypertension due to minocycline use developed intracranial hypertension while using topical tretinoin alone. Examination demonstrated bilateral optic nerve edema, a right sixth cranial nerve palsy, along with characteristic features of markedly elevated intracranial pressure on imaging. Lumbar puncture opening pressure was 60 cmH2O. Cessation of topical tretinoin use ensued complete resolution of symptoms and optic nerve swelling in both eyes. Conclusions and importance Our findings substantiate the need to avoid topical vitamin A derivatives and alternate drug classes known to be associated with drug-induced intracranial hypertension.

Nodulocystic acne is prone to scarring and difficult to treat with treatments other than oral isotretinoin. The aim of this article is to discuss the role of a single session of a fractional carbon dioxide (CO2) laser combined with a topical treatment with a tretinoin and antibiotic gel for a month as a successful treatment to improve nodulocystic acne and chronic microcystic acne. Two cases were involved: the first with nodulocystic acne lesions that persisted after oral retinoids and the second with chronic microcystic acne resistant to topical treatments. After only one session of treatment with the CO2 laser and the topical treatment, a complete healing of the nodulocystic acne lesions was observed with minimal secondary effects. The microcystic acne showed great improvement. No other topical or oral treatment was needed. This treatment could be a safe and effective treatment for nodulocystic acne lesions and microcystic acne when other treatments fail. More studies should be performed to confirm our results.

Striae gravidarum is a common skin condition resulting after pregnancy, caused by fibroblast dysfunction. Although not considered a disease, it may be considered cosmetically unpleasant to sufferers and remains as a therapeutic challenge to date.To evaluate the efficacy and safety of a sublative bipolar fractional radiofrequency (FRF) system, associated with 0.1% topical tretinoin, in treating striae gravidarum.Eighteen Chinese women with striae gravidarum on the abdomen were enrolled in the study. The target area of each patient was divided into 4 sites randomly: control, tretinoin, FRF, and tretinoin and FRF. Fractional RF was used 3 times, with 3-month intervals. Changes to striae gravidarum were evaluated through subjective scaling and objective measures, using both high-frequency ultrasound and histological study.Both subjective assessment and skin thickness differences demonstrated significant improvement in the combination site (p.001). Average optical density and density percentage of neocollagen and elastic fibers were also markedly increased in the combination site (p.05). The adverse effects of FRF were limited to mild pain and transient erythema, edema, and microcrusts.The combined therapy of FRF and topical tretinoin may be a potential method in treating striae gravidarum, with satisfactory efficacy and limited side effects.

Background: Striae are linear atrophic depressions that form in areas of dermal damage in the skin. As on date, no consensus or protocol exists for the treatment of stria rubra. Topical retinoids, chemical peels, microdermabrasion, radiofrequency, photothermolysis, intense pulsed light and lasers are some of the modalities used. Aims and Objective: To compare the efficacy of various therapeutic modalities in striae rubra. Methods: This prospective cohort study comprised of a total of fifty patients from August-2012 to October-2013 in a tertiary care center in Western India, Gujarat having striae rubra. They were randomly divided into five groups of ten patients each. Patients were evaluated on the basis of visual assessment, both by doctor as well as the patient. Group I was given topical tretinoin (0.1% w/w) gel applied once at night, Group II-microdermabrasion (MDA) combined with trichloroacetic acid (TCA) (30%) peel, Group III-mesotherapy, Group IV-Q-switched Nd: YAG laser, and Group V-combination treatment of microdermabrasion, salicylic acid peel and retinol (yellow) peel. Patients were treated at an interval of 15 days for 2 months and then at monthly intervals. Objective assessment was done at 2nd month, 6th month, and at the end of 1st year. Results: Patients in Group I treated with topical tretinoin showed the least response with 80% (8) of them showing minimal clinical improvement (0–25%) as compared to patients in Group V in which 60% (6) patients showed moderate clinical improvement (50–75%). While majority of the patients in Group II, III, and IV showed mild clinical improvement (25–50%). Conclusions: Striae rubra is a common cause of concern for adolescent population. Combination treatment with microdermabrasion, salicylic acid and retinol yellow peel gave superior results as compared to other therapeutic options. Mild to moderate improvement was seen with Nd: YAG laser, mesotherapy and MDA + TCA whereas minimal improvement were seen with topical tretinoin.

Summary Background Milia are small, hard, white superficial epidermal cysts measuring a few millimetres that can occur during skin healing due to occlusion of pilosebaceous units. Milia rarely occur on tattoos. However, cases of allergic reactions with hyperkeratosis and open comedones have been described in the literature, sometimes under the term “epidermal cysts”. Patients and methods We saw three patients who developed milia, including a 32-year-old man with eruptive milia 10 weeks after getting a black, red and green tattoo on his upper arm. Topical tretinoin was applied. We encountered two further cases of eruptive milia on black/grey tattoos. A fourth patient presented a massive hyperkeratotic reaction with retention comedones on the red/pink area of a tattoo. Discussion The occurrence of milia and acneiform allergic reactions after tattooing is rare. We collated a total of 13 cases from the literature, of which 8 involved milia. This condition occurred within 3 months following tattooing, with no particular correlation with any given colour, and generally without any allergic reaction (except in one case). Reactions comprising excessive acneiform hyperkeratosis and open comedones were noted with pink and red inks and were a complication in a setting of allergic inflammatory reaction. However, the histopathology of these reactions is poorly described in the literature. It seems inappropriate to diagnose the condition as “epidermal cysts” since the lesions are not in fact simple cysts but rather retention lesions occurring during an inflammatory reaction and are thus different from post-traumatic milia.

To assess the effectiveness and safety of a 24-week application of tretinoin 0.025% cream, with an alternate-day regimen, in achieving control of VLS signs and symptoms.17 patients affected with VLS were included. The main efficacy parameters were the response rate, as defined by protocol parameters, the rate of patients achieving an improvement from baseline of ≥75% in the subjective and objective scores, and the mean reduction in subjective and objective scores throughout the treatment. The safety of the treatment was also assessed.By the end of the 24-week treatment, 12 patients (70.6%) experienced a response; 35.3% and 17.6% of patients achieved an improvement of at least 75% in subjective and objective scores, respectively. Mean scores of itching, leukoderma (pallor) and hyperkeratosis decreased significantly in the study patients, and none presented itching-related excoriations. Erythema increased compared with baseline. Six patients (35.29%) experienced some side effects related to tretinoin, mainly mild erythema and burning. None of the subjects discontinued the treatment because of side effects.Tretinoin 0.025% cream applied for 24 weeks may represent a useful alternative option to corticosteroids in the treatment of active VLS, acting particularly on hyperkeratosis and pallor.

Abstrract Purpose: To assess efficacy and safety profile of combining a potent corticosteroid with a retinoid in the treatment of vulvar lichen sclerosus (VLS).We retrospectively compared 21 VLS patients treated with tretinoin (T) in short-contact therapy and mometasone furoate (MMF) (group A) and 20 treated with cold cream (CC) and MMF (group B) for 5 consecutive days/week for 12 weeks. The efficacy parameters were the response rate, the percentage of patients achieving an improvement from baseline of ≥75% in subjective and objective scores and the mean reduction in subjective and objective scores.Thirteen patients (75.2%) were considered as responders in group A and 15 (78.9%) in group B; 50% and 61.1% of patients in group A and 100% and 63.1% in group B achieved an improvement of at least 75% in subjective and objective scores, respectively. The scheme combining MMF and CC was better tolerated than the combination of MMF and T.The combination with a topical retinoid did not enhance the effectiveness of a potent corticosteroid in the treatment of VLS. Either the scarce efficacy of the short-contact therapy regimen or a less favorable safety profile of such combination may account for these findings.

BACKGROUND Striae distensae (SD) is a common skin condition, with a prevalence ranging from 40% to 90%, depending on the population studied. OBJECTIVES To evaluate the efficacy of superficial dermabrasion and compare it with that of topical tretinoin cream in the treatment of narrow and early SD. MATERIALS AND METHODS Prospective, single-center, randomized, open-label study. Thirty-two women presenting with early, untreated SD (striae rubra) were included in this study. One group received 16 weekly sessions of superficial and localized dermabrasion, and the other used 0.05% tretinoin cream daily. Striae width and length were measured and compared between groups and over time. Global Aesthetic Improvement Scale scores and subject satisfaction were also assessed. Biopsies were performed for subjects who agreed to undergo this procedure, followed by histologic analyses of the skin samples. RESULTS Both treatments were efficacious, with significant improvement in early SD from baseline, but there was no significant difference between the two treatments. Histologic assessment showed improvement in epidermal and dermal layers for the dermabrasion treatment group. CONCLUSION Both treatments had similar efficacy, but superficial dermabrasion had a lower frequency of side effects and better adherence of the patients. The authors have indicated no significant interest with commercial supporters.

BIBLIOGRAPHY Ando K, Hattori H, Yamauchi Y. Histopathological differences between early and old lesions of hyperkeratosis Lenticularis Perstans (Flegel’s disease). Am J Dermatopathol 2006;28:122-6. Bean SF. The genetics of hyperkeratosis lenticularis perstans. Arch Dermatol 1972;106:72. Flegel H. Hyperkeratosis lenticularis perstans. Hautarzt 1958;9: 363-4. Jang KA, Choi JH, Sung KJ, Moon KC, Koh JK. Hyperkeratosis lenticularis perstans (Flegel’s disease): histologic, immunohistochemical, and ultrastructural features in a case. Am J Dermatopathol 1999;21:395-8. Langer K, Zonzits E, Konrad K. Hyperkeratosis lenticularis perstans (Flegel’s disease). Ultrastructural study of lesional and perilesional skin and therapeutic trial of topical tretinoin versus 5-fluorouracil. J Am Acad Dermatol 1992;27(5 pt 2):812-6. Pearson LH, Smith JG Jr, Chalker DK. Hyperkeratosis lenticularis perstans (Flegel’s disease). Case report and literature review. J Am Acad Dermatol 1987;16(1 pt 2):190-5. Price ML, Wilson JE, MacDonald DM. A clinicopathological study of Flegel’s disease (hyperkeratosis lenticularis perstans). Br J Dermatol 1987;116:681-91. Cunha Filh o R, Almeida HL Jr. Hyperkeratosis lenticularis perstans. An Bras Dermatol 2011;86(4 suppl 1):S76-7. Sterneberg-Vos H, van Marion AM, Frank J, Poblete-Gutierrez P. Hyperkeratosis lenticularis perstans (Flegel’s disease) successful treatment with topical corticosteroids. Int J Dermatol 2008;47(suppl 1):38-41.

Background Numerous modalities have been used to treat keloids and hypertrophic scars; however, optimal treatment has not yet been established. Therefore, prevention is the mainstay. Recently, silicone gel and tretinoin cream have been shown to be useful for the prevention of hypertrophic scars and keloids. However, there has been no comparative study of the two topical agents thus far. Objective To determine and compare the effectiveness of silicone gel and tretinoin cream for the prevention of hypertrophic scars and keloids resulting from postoperative wounds and for scar improvement. Method This study included 26 patients with 44 different wounds. The postoperative wounds were divided into two treatment groups and one control group. The patients in the first and second treatment group applied silicone gel and tretinoin cream, respectively, twice a day on their wounds after their stitches were removed. In contrast, the control group patients did not apply anything. We used the Modified Vancouver Scar Scale to quantitatively examine the effectiveness of silicone gel and tretinoin cream just after stitches removal, and at 4, 8, 12 and 24 weeks after removal of the stitches. Results The silicone gel and tretinoin cream effectively prevented hypertrophic scars and keloids and improved scar effects in the two treatment groups compared with those in the control group. However, no significant difference was noted between the two treatment groups. Conclusion To prevent hypertrophic scars and keloids and improve scars after surgery, application of a silicone gel or a tretinoin cream to the wounds is needed.

Porokeratotic Eccrine Ostial and Dermal Duct Nevus (PEODDN) is a rare disorder of keratinization characterized by the presence of cornoid lamellae and association with eccrine sweat ducts. These lesions are usually benign and asymptomatic, so treatment is often for cosmetic purposes. Current therapies for PEODDN are either insufficient or impractical. We present a case of PEODDN treated with topical tretinoin 0.05% cream and 5-fluorouracil 5% cream with the hopes of providing an efficacious, financially relevant, and well-tolerated treatment regime for PEODDN. The combination of topical tretinoin and 5-fluorouracil did not provide substantial improvement in the lesions of a patient treated with this therapy for 6 weeks, and further studies are needed to identify an efficacious treatment for PEODDN that is both well-tolerated and economically feasible for patients with this condition.

Fibroelastolytic papulosis (FEP) is an acquired elastic tissue disorder that presents as white-to-yellow papules and plaques usually occurring on the neck. Although the lesions are often asymptomatic, their appearance may be distressing to patients. FEP has been treated with topical tretinoin in one case report (1). Other reports have not mentioned treatment for this rare disorder (1–6). We present a case of FEP successfully treated with a fractionated carbon dioxide (CO2) laser.

We have investigated the effects of short-contact topical application of tretinoin using 16 male db/db mice by creating two full-thickness wounds on the skin of the back. A 0.1% tretinoin aqueous gel was applied to one wound for five minutes daily for five successive days while only aqueous gel was applied to the other (control). The mean (SD) percentage surface area unhealed before and after treatment were 0.88 (0.3) and 0.64 (0.15). In tretinoin-treated mice and non-treated mice (controls), the mean (SD) thicknesses of granulation were 1.383 (697) micro m and 683 (413) micro m, the density of capillary vessels in granulation was 12.2 (5.5)% and 5.7 (3.9)%, respectively. Differences between the two groups were significant for each variable. Wound healing was accelerated with short-contact topical application of tretinoin in db/db mice.

Extramammary Paget's disease is a rare neoplasm of apocrine gland-bearing areas of the skin. The most common site of presentation is the vulva. Surgery is the most frequently reported therapy so far; however, it is invasive and it is complicated by a high rate of recurrence. For this reason, several less-invasive treatments have been recently proposed, including photodynamic therapy. We describe in this article the case of an 84-year-old patient with a noninvasive vulvar extramammary Paget's disease successfully treated with methyl-aminolevulinic acid photodynamic therapy associated with topical tretinoin.

Background: A new dermatopharmacokinetic (DPK) approach has been proposed for bioequivalence determination of topical drug products by comparing the drug content kinetics in stratum corneum. Objective: We sought to establish any correlation between clinical safety/efficacy and DPK approach in bioequivalence determination of tretinoin gel 0.025%. Methods: Tretinoin and isotretinoin were quantified in human volar forearm stratum corneum as a function of time with 3 tretinoin gel 0.025% products in 49 patients. Stratum corneum layers were harvested using multiple adhesive disks, which were subsequently extracted and quantified for both isomers by high-performance liquid chromatography. Results: Products with similar composition and therapeutic equivalence were found bioequivalent, and products with different composition and clinical profiles were found bioinequivalent by DPK methodology. Conclusions: There is a direct correlation between DPK parameters in healthy patients and clinical safety/efficacy of tretinoin gel products in patients with acne. Data support the use of DPK parameters and methodology in the bioequivalence assessment of topical tretinoin gel products. (J Am Acad Dermatol 2003;48:740-51.)

Dyer et al. (this issue) assess the risk of new basal cell carcinoma (BCC) in the Veterans Affairs topical tretinoin chemoprevention trial, which included individuals with a history of at least two prior keratinocyte carcinomas. In addition to known risk factors for a future BCC, such as number of prior BCCs, a history of eczema and lower education levels were also associated with greater risk.

Large-cell acanthoma is an asymptomatic, slightly keratotic, usually hyperpigmented epidermal lesion that is mostly seen in the sun-exposed skin of middle-aged or elderly people. It is characterized by extraordinarily large keratinocytes that can reach up to twice their normal size without a change in the nucleus/cytoplasm ratio. Here, we describe a chronic case of large-cell acanthoma that involved the whole upper eyelid of a 67-year-old man for at least 15 years. The lesion was almost depigmented and demonstrated altered consistency of the eyelid, causing lax and folded skin. The lesion responded to treatment with topical tretinoin and urea. This case verifies the benign character of large-cell acanthoma and demonstrates how it may have atypical presentations. Copyright (C) 2012, Taiwanese Dermatological Association. Published by Elsevier Taiwan LLC. All rights reserved.

First described in 1968 by Hitch and Lund. Disseminated and Recurrent infundibulofolliculitis (DRIF) is an uncommon eruption characterized by recurrent, pruritic follicular papules commonly seen on the trunk and proximal extremities. Rarely limited to the neck. It is much more common in black population but has also been reported in other ethnicities including Caucasians. Its etiology has constantly been debated with a few authors describing it as a variant of atopic dermatitis while others have refuted the same as a family history of atopy is not present. Various others have classified DRIF as variants of follicular eczema, along with lichen spinulosus and juxtaclavicular beaded lines. Its treatment also varies with different authors claiming response to steroids, isotretinoin, UVA therapy, keratolytics and tetracyclines. We describe a case of localized infundibulofolliculitis of the neck diagnosed in a 21 year old female who was successfully treated with a course of topical tretinoin 0.025%. The presenting history, clinical findings, biopsy results and available literature are reviewed.

A 46 year old black male presented with a complaint of multiple growths on his penis. He was previously diagnosed with condylomata acuminata, HIV infection and diabetes. He admits to having numerous sexual partners, and rarely uses barrier contraception.

Treatment of a linear verrucous epidermal nevus using topical 0.1% tretinoin cream and 5% 5-fluorouracil in a young patient is described. In 1994, successful topical therapy using this combination was described in the management of an inflammatory linear verrucous epidermal nevus. We report another case in which treatment of a noninflamed epidermal verrucous nevus with 0.1% tretinoin and 5% 5-fluorouracil resulted in significant improvement. An updated summary of the literature discussing management of epidermal nevi is presented.

This study was done in the outpatient department of Rajshahi Medical College Hospital from January 2004 to December 2005. In this study the efficacy of topical tretinoin, benzoyl peroxide and oral tetracycline was studied in 50 patients. Forty five patients completed the course of treatment and 5 patients were defaulter. Complete remission was seen in 32 (71.11%), marked improvement in 08 (17.78%) and good response in 05 (11.11%) patients. Application of topical tretinoin cream (0.05%) in the evening, benzoyl peroxide cream (5%) in the morning and oral tetracycline (500 mg bd) before meal was found very effective, safe and cheap in the treatment of comedonal, pustular and pustulo-nodular acne vulgaris. doi: 10.3329/taj.v19i1.3161 TAJ 2006; 19(1): 10-12

Background. Tretinoin induces neovascularization and the formation of collagen when applied topically. Objective. The goal was to determine whether preoperative and postoperative treatment with tretinoin enhances the healing of high-tension, full-thickness excisional wounds and the survival of full-thickness skin grafts. Methods. A blinded, randomized, placebo-controlled pilot study involved high-tension excisional wounds and full-thickness skin grafts treated perioperatively with tretinoin in a porcine model. Results. Perioperative treatment of high-tension excisional surgery sites with tretinoin appeared to have no consistent beneficial or adverse effects on wound healing or scar spreading. In the full-thickness skin graft model, a trend toward impaired wound healing was noted. Conclusion. The collagen-inducing effects of topical tretinoin do not appear to enhance the healing of high-tension excisional surgery wounds in a porcine model. Tretinoin does not appear to improve the survival of full-thickness skin grafts and, in fact, a detrimental effect was apparent in our model.

Hypopigmented macules are frequently observed in the photodamaged skin of elderly people. We undertook to study and treat 2 types of hypomelanosis of photoaged skin. These lesions were: 1) idiopathic guttate hypomelanosis; and 2) macular hypomelanosis. Comparative studies included: 1) high-resolution photography using parallel polarized light, ultra-violet (UVA) and epiluminescence; 2) Silflo replicas for microtopography; and 3) suction device (Cutometer) for elasticity. Macular hypomelanosis was distinguishable from idiopathic guttate hypomelanosis because the macules were less white and less well demarcated. Glyphic markings were essentially absent in macular hypomelanosis, but variably effaced in idiopathic guttate hypomelanosis. Distensibility of the macules was characteristically low in proportion to the loss of glyphic markings. The chief histologic finding was the absence of melanin in basal keratinocytes. Macular hypomelanosis and idiopathic guttate hypomelanosis are probably related disorders along a spectrum of depigmentation. Treatment with tretinoin for 4 months restored the elasticity, the glyphic markings, with a partial restoration of pigmentation.

Acne conglobata is an uncommon disorder characterized by the presence of nodulocystic lesions. Conservative therapy with oral and topical antibiotics is of limited efficacy in many cases, and surgical excision is often needed for removal of the cystic lesions. Treatment is particularly difficult in cases with lesions located in aesthetically sensitive areas, such as the face. We successfully treated a case of acne conglobata by CO(2) laser ablation to remove the top of the sinuses and their tracts. In addition, topical tretinoin therapy was also initiated simultaneously to prevent the appearance of new acne lesions. Based on the results, we propose that the use of CO(2) laser for opening the cysts, combined with topical tretinoin therapy to prevent the appearance of new lesions, is a powerful treatment option for acne conglobata.

Topical tretinoin is established as an effective treatment for photoaging. Yet some confusion still exists about the proper way to use this medication, confusion that can misguide physicians in their clinical approaches and patients in their treatment regimens. Most of the misinformation about tretinoin has been perpetuated from the early days of the drug, when its efficacy for treating the effects of photoaging was still in dispute. Significant advances in clinical and basic research in this area have dispelled much of the confusion, clearing the way for an evidence-based medical approach to tretinoin therapy for photoaging. This review summarizes recent relevant advances in tretinoin therapy to guide physicians in treating patients with this safe and effective hormone. To date, tretinoin remains the only therapeutic agent proved to repair photodamage.

Premature skin aging caused by repeated exposure to solar radiation is called photoaging. Although once considered an irreversible process, it is now established that photoaging can be treated by topical tretinoin. Both from carefully designed controlled clinical studies; and basic investigations into the mechanism by which tretinoin improves photoaged skin, our understanding of photoaging has been enhanced. This article highlights some of these studies which have contributed to our knowledge.

Background: Topical tretinoin is effective treatment for both acne and photoaging. This creates a problem for insurers that cover medication costs, because treatment of acne is often covered but treatment of photoaging is not. The age distributions of patients with acne or photoaging are likely to be very different. Therefore, one approach insurers can use is an age cutoff for covering the cost of topical tretinoin therapy. Objective: Our purpose was to determine at what age patients are more likely to receive tretinoin for treatment of acne vulgaris versus other conditions to provide a rational basis for insurers to set coverage cutoffs. Methods: National Ambulatory Medical Care Survey data for the years 1990 to 1994 were analyzed to ascertain the age distribution of acne vulgaris office visits and treatment with topical acne agents including tretinoin. These data were compared to office visits and tretinoin treatment of wrinkles, solar elastosis, and other conditions. Results: The mean age (± standard deviation) of patients seen for acne vulgaris was 24.3 ± 11.5 years old. The age distribution of topical tretinoin treatment paralleled the age distribution of acne. Tretinoin treatment of acne and of nonacne conditions were equal at an age of 44. Conclusion: The distribution of outpatient visits for acne treatment is skewed toward older patients and persists beyond age 40. A rational age cut-off for coverage of topical tretinoin treatment is 40 years.(J Am Acad Dermatol 1998;38:221-6.)

Combination of procedures is necessary to obtain better results in facial rejuvenation. We have combined resorcinol chemical peel, topical tretinoin, oral isotretinoin, fat transplantation, GORE-TEX® implants, and Botox injections with good results and optimal patient acceptance.

Colloid milium is a degenerative process that is characterized clinically by the development of translucent, yellow, 1-2 mm papules located in photoexposed areas. Histologically, deposits of a colloid substance are seen in the papillary dermis. We present two cases of this infrequent pathology in two male patients, who had been subjected to intense sun exposure because of their work. We initiated treatment with photoprotective creams and topical tretinoin, with little clinical improvement.

Background: Actinic keratoses (AK) are premalignant lesions occurring mainly in sun-damaged skin. Current topical treatment options for AK and photo-damaged skin such as liquid nitrogen and electrosurgery are not suitable for field treatment. Otherwise, therapies suitable for field treatment bring along considerable patient discomfort. Non-ablative fractional resurfacing has emerged as a logical treatment option especially for field treatment of AK. Objectives: To evaluate the clinical efficacy of fractional laser therapy for clearing AK and improving skin quality. To compare patient friendliness of the "fractional" therapy with those reported for other field treatment modalities. Materials & methods: Ten patients with Fitzpatrick skin type I to III with multiple AK and extensive sun-damaged skin, received 5-10 sessions with a 4-week interval using a 1550 nm Erbium-Glass Fractionated laser (Sellas, Korea). Four weeks and 24 weeks after the last treatment the clinical results were evaluated by an independent physician. Results: The mean degree of improvement, in terms of reduction in the number of AK and improvement of skin texture, was 54% on a 4 point PGA scale, and persisted for approximately 6 months. The biggest advantage of fractional laser treatment, besides the eradication of AK and a clear rejuvenation effect, is the absence of "downtime". Conclusion: Fractional non-ablative resurfacing induces significant reduction in the number of AK and improves the skin quality. Also all patients preferred fractional laser therapy above other AK treatment modalities.

Background: Photodamaged skin typically displays lentigines, actinic keratoses, wrinkles, and textural alteration. Chemical peeling has been used to treat these, but few controlled studies have been performed to determine its efficacy. Objective: Our purpose was to compare the efficacy of a medium-depth chemical peel with and without tretinoin before and after treatment. Methods: Sixteen men with actinic damage including actinic keratoses were treated with a 40% trichloroacetic acid (TCA) chemical peel. Half were pretreated for 6 weeks with topical tretinoin; they also used tretinoin after the peel. Photographs were obtained at baseline and at 6 weeks and 6 months after treatment. Changes in specific features were rated by a panel of three examiners. Results: Some improvement was noted in all patients. More rapid and even frosting was observed in the patients pretreated with tretinoin. Solar lentigines, actinic keratoses, and skin texture were the features of photoaging most affected; wrinkles were least affected. No statistically significant difference was found between patients treated with TCA and tretinoin (before and after peel) and those with TCA alone. Conclusion: A medium-depth chemical peel with 40% TCA alone produced moderate improvement in some manifestations of actinic damage but had little effect on wrinkles. Treatment with tretinoin before and after TCA did not significantly enhance the efficacy of the peel.

Some of the clinical sequelae of cutaneous photodamage include wrinkling, pigmentary changes, roughness, laxity and telangiectasia, which can result in the aging of the appearance. This in turn can have a negative impact on certain aspects of quality of life including: (1) social interactions, most commonly manifesting as uneasiness and anxiety during interpersonal interactions; (2) occupational functioning, in that an attractive and youthful appearance may be associated with better employment opportunities; and (3) the psychological state of the individual, resulting in decreased self-esteem and an adjustment disorder. Among some individuals, concerns about an aging appearance can culminate in an excessive preoccupation with dieting, exercise and thinness. Studies have shown that a reduction in the cutaneous stigmata of photodamage with topical tretinoin is associated with an improvement in these dimensions of quality of life. The possible geographic and sociocultural differences in the impact of photoda...

Photodamaged skin shows striking alterations in both epidermis and dermis. Epidermal dysplasia is a frequent finding even in the absence of clinical changes. Solar elastotic degenerative change app...

Laser resurfacing is a proven method for countering unwanted changes in skin tone and texture. The fi rst widely available devices were fully ablative, but these carried substantial risks, particularly for scarring and hypopigmentation. Fully nonablative alternatives, which were safer, offered a welcome alternative but were less effective. In 2004, the seminal concept of fractional photothermolysis was introduced, delivering meaningful clinical results while maintaining an improved safety pro fi le [ 28 ] . In this chapter, we aim to review complications and management strategies of fractional laser systems. Although complication rates will be cited and may serve as a reference, it should be noted that rates in any clinician’s practice depends on training, experience, choice of device, settings, and prophylactic regimens, among other variables. The discussion that follows derives from an extensive literature search of the MEDLINE database. Representative studies of common complications will be discussed along with the few reports of unusual complications.

A multicentre clinical trial has been conducted to assess the efficacy and safety of tretinoin 0.05% cream (Retin-A) in the treatment of photo-damaged Australian skin. Subjects with cutaneous facial photodamage were randomised to treatment with tretinoin (62) or vehicle (63) cream. After an initial two week run-in, all subjects applied the cream to the face, neck and left forearm/hand, once nightly for 24 weeks. Changes in clinical signs of photodamage and parameters of cutaneous irritation were assessed by investigators using a 7 point scale, whilst changes in signs of photodamage were rated by subjects using a 5 point scale. Changes in skin biopsies and silicone skin surface replicas were also assessed. Significant improvements in skin wrinkles, mottled hyperpigmentation, laxity, lentigines and roughness of tretinoin treated subjects were noted by investigators. Subjects receiving tretinoin noted significant improvements in skin wrinkles, tightness, colour and pores. Improvement in overall severity of photodamage was significantly greater for tretinoin treated subjects and was progressive over the study period. Histological findings included a significant increase in mean epidermal thickness. Significant topographical changes were not detected in skin surface replica sets. Cutaneous irritation, the most common side effect, was usually mild and transient. We conclude that tretinoin 0.05% cream significantly improved the appearance of photo-damaged skin.