Clinics in Dermatology (2008) 26, 633–635
Cosmeceuticals: focus on topical retinoids in photoaging
Riccarda Serri, MD a,⁎, Matilde Iorizzo, MD b
a
Department of Dermatology, University of Milan, Milan, Italy
b
Department of Dermatology, University of Bologna, Bologna, Italy
Abstract Evidence from a randomized clinical trial showed that, in spite of the many surgical procedures
effective in ameliorating the clinical appearance of photoaged skin, the only medical therapy with
proven benefits in photoaged skin are topical retinoids, in particular tretinoin, isotretinoin, and
tazarotene. The application of retinoids might not only clinically and biochemically repair photoaged
skin, but their use might also prevent photoaging. Furthermore, new evidence suggests a beneficial role
of topical retinoids in the treatment of intrinsically aged skin.
© 2008 Elsevier Inc. All rights reserved.
Introduction Tretinoin, isotretinoin, alitretinoin, tazarotene, and ada-
palene are registered as drugs; the others are cosmeceuticals
Vitamin A and its derivatives, both natural and synthetic, (medicinally active cosmetics).
have been popular additives in topicals for years and are Vitamin A and its derivatives exert their action by binding to
recognized as the gold standard for the prevention and specific nuclear receptors. The ligand-receptor complex
treatment of photoaging. modulates the expression of the genes involved in cellular
The following topical retinoids are recognized as being differentiation and proliferation, normalizing cell keratinization.
useful: Retinoids might also act independently from the binding
to nuclear receptors. Each of them exerts its own activity,
Natural retinoids offering a further choice to the dermatologists who deal with
• Retinol (vitamin A alcohol) topical retinoids.
• Retinyl-palmitate (vitamin A ester) Although there are several studies proving the efficacy of
• Retinyl-acetate (vitamin A ester) tretinoin as topical treatment of photoaging, few studies are
• Retinaldehyde (vitamin A aldehyde) available for the other retinoids.
• Tretinoin (all-trans-retinoic acid)
• Isotretinoin (13-cis-retinoic acid)
• Alitretinoin (9-cis-retinoic acid) Tretinoin
Synthetic retinoids
• Tazarotene Kligman and Willis1 first introduced retinoids for use as
• Adapalene photoaging agents. After its application, the author noticed
improvement of skin depigmentation and rejuvenation.2,3
⁎ Corresponding author. 46-7 Via della Moscova, Milan 20121, Italy. When used on photodamaged skin, tretinoin's clinical
Tel.: +39 02 6575245. effects include improvement of wrinkles, roughness, mottled
E-mail address:
[email protected] (R. Serri). pigmentation, and skin appearance as a whole.
0738-081X/$ – see front matter © 2008 Elsevier Inc. All rights reserved.
doi:10.1016/j.clindermatol.2007.09.016
634 R. Serri, M. Iorizzo
The histologic changes observed are decreased corneo- Isotretinoin
cyte adhesion (loss of desmosomes, decreased tonofila-
ments, increased autolysis of keratinocytes, intracellular Topical isotretinoin is available as a 0.05% cream or
glycogen deposition), epidermal hyperplasia, increased gel. It appears to be less irritating, yet less effective, than
number of Langerhans cells, increased synthesis of collagen tretinoin.10
and elastin, and angiogenesis. Tretinoin enhances epidermal
cell turnover, decreasing contact time between keratinocytes
and melanocytes and promoting a rapid loss of pigment
through epidermopoesis. Alitretinoin
Tretinoin is available in different concentrations (0.01%,
0.25%, 0.5%, and 0.1%) and as different formulations
The theoretic benefit of alitretinoin 0.1% gel in the
(cream, gel, solution). Creams are generally prescribed for
treatment of photoaging originates from the binding and
sensitive skins, whereas gels are prescribed for oily skins.
activation of all nuclear retinoid receptors, but larger,
Continuous once-daily application is mandatory to
blind, and controlled trials are necessary to better
achieve maximum results, in any case not occurring before
investigate its role.11
a 3-month period.4 The only clinical improvement that
appears after only 1 month is skin smoothness. To maintain
the results, long-term treatment is necessary. There are no
limits to the duration of tretinoin topical use. Tazarotene
Moderate cutaneous side effects, especially erythema and
desquamation, are observed in most patients even if after 2 to Tazarotene is an analogue of tretinoin that belongs to the
4 weeks these side effects decrease without discontinuing the family of acetylenic retinoids. It has a specific binding profile
treatment. It may be necessary to interrupt the treatment for 2 for beta and gamma retinoid receptors. Tazarotene improves
to 3 days, to apply a calming and moisturizing cream, and skin roughness, fine wrinkling, and epidermal atrophy.12 It is
then to restart treatment once every 2 days. available at 0.05% and 0.1% gel and cream.
Whenever tretinoin is prescribed, the use of sunscreen is
very important to avoid sunburns (the treated skin is thinner)
and worsening of photodamage (UV radiations decrease the
expression of retinoid receptors in skin cells, thus limiting Adapalene
the effects of retinoids).
Even if usually indicated for acne, adapalene has also
been tested for the treatment of photoaging.13 Once-daily
Retinol application of adapalene 0.1% gel for 4 weeks, followed by a
twice-daily application for up to 9 months, significantly
reduced actinic keratoses and lentigines.
There are no studies comparing its effectiveness with that
of tretinoin, although retinol does not appear to be as
effective. In photoaging, it is used as a cream in different
concentrations, ranging from 0.075% to 1%. It can be References
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