Topical retinoid treatment yields gradual results, but the modality can be effective for some wrinkles and depigmentation.
Baltimore - Patient selection and realistic expectations are key factors in successful retinoid treatment for anti-aging, according to Sewon Kang, M.D., Noxell Professor and chairman, department of dermatology, Johns Hopkins University School of Medicine.
"Dermatologists, in general, are well aware of the complexity of skin aging and that (treatment) is not one-size-fits-all. Successful treatment depends on what aspects of the skin aging features are targeted by the dermatologist," he says, noting that brown spots and fine wrinkling respond well to retinoid treatment over time.
For deeper, coarse wrinkling, however, better options may include treatment with a device, such as a fractionated laser.
Safety and effectiveness of topical retinoids for the treatment of photoaging have been well demonstrated. Furthermore, extensive research has elucidated the mechanism by which the improvement is achieved.
In addition to photoaging, Kafi et al reported that topical retinol improves fine wrinkles associated with natural aging. They also found that improved appearance was associated with enhanced pro-collagen formation in dermal fibroblasts.
Dr. Kang, who along with colleagues evaluated retinoids extensively while a professor of dermatology in the department of dermatology, University of Michigan, Ann Arbor, notes that, "Scientific evidence from both clinical and basic research that topical retinoids improve skin aging is substantial. For this reason, Renova (tretinoin, Ortho Neutrogena) and Avage (tazarotene, Allergan) have received Food and Drug Administration (FDA) approval to treat photodamaged skin. The situation is not the same for cosmeceutical products.
"In the cosmeceutical arena, there is more to do with claims than data generated from rigorous investigations."
This is due in part to the different manner in which drugs and cosmetics are currently regulated by the FDA.
When discussing anti-aging therapies with patients, optimal treatment depends on patient expectations and objectives, and timing, Dr. Kang says.
"Obviously, if the patient wishes a topical treatment approach, applying a retinoid cream to the face will not bring overnight changes. However, it is a relatively user-friendly approach that will bring improvement gradually over months.
"For patients who prefer more immediate improvement, a procedure like CO2 laser resurfacing, although it will require some downtime, would be more optimal," he says.
Dermatologists should discuss with patients what their goals are and whether those goals realistically could be achieved with topical retinoids.
"If that is not possible, the dermatologist should discuss other treatment options. The kinds of improvement the retinoids deliver are limited," Dr. Kang says.
For example, retinoids are not effective for coarse, deep-seated wrinkles. Instead, they are better suited to treat fine wrinkles and depigmentations, such as brown spots.
"Those brown spots will lighten, and there will be effacement of reasonable wrinkles over time, but not deep furrowed ones. If a patient comes in with frown lines on their forehead, no retinoid is going to get rid of them," Dr. Kang says.
With skin aging there is a certain degree of sagging skin, which probably would not be improved with topical retinoids, he says.
Instead, anti-aging treatments must be customized to individual patients and may include a variety of treatments, including retinoids, Botox (onabotulinumtoxinA, Allergan) and devices.
Disclosure: Dr. Kang reports that the University of Michigan has intellectual property related to retinoid treatment of skin aging and prevention of photoaging.