Tretinoin (0.05% cream vs. 5% peel) for photoaging and field cancerization of the forearms: randomized, evaluator‐blinded, clinical trial

Abstract

Background Topical tretinoin cream is the gold standard treatment for skin ageing, particularly photoaging. The purpose of tretinoin peel was to obtain similar results, but in a shorter time, however, there have been few controlled trials on its effectiveness. Objective To compare efficacy and safety of tretinoin 0.05% cream and 5% as a peeling agent on photoaging and field cancerization of the forearms. Methods Clinical trial with therapeutic intervention, prospective, randomized (computer‐generated randomization list), parallel, comparative (intrasubject) and evaluator‐blinded (except for histology and immunohistochemistry), including 24 women (48 forearms) aged over 60 years who have not undergone hormone replacement and categorized as Fitzpatrick skin phototype II or III. The forearms of the participants were randomized for treatment with 0.05% tretinoin cream three nights a week, or 5% tretinoin peel every 2 weeks. The opinion of the participant, severity of photoaging, corneometry, profilometry, high‐frequency ultrasound, histology (haematoxylin–eosin and Verhoeff stainings) and immunohistochemistry (p53, bcl‐2, Ki67 and collagen I) were assessed. Results One participant dropped out. The mean photoaging score reduced 20% and the mean actinic keratosis (AK) count reduced 60% with no difference between treatments. Three efficacy parameters showed opposite effects between the tretinoin treatments (P < 0.05%): (i) thickness of the corneal layer decreased with 0.05% tretinoin and increased by 5%; (ii) dermis echogenicity increased by 0.05% and decreased by 5% and (iii) Ki67 expression increased by 0.05% and decreased by 5%. There was good tolerability for both regimens. Conclusion Tretinoin as a cream 0.05% or peeling (5%) is safe and effective for the treatment of moderate photoaging and forearm field cancerization. The cream was superior in improving ultrasonographic parameters of ageing. Peeling was shown a superior performance in the stabilization of field cancerization.

Chemical peelings for the treatment of actinic keratosis: a systematic review and meta‐analysis

“…Hence, eight studies with an overall sample size of n = 170 (range 13–32) were included in our systematic review (Table 1). 16–23 The studies were published between 1995 and 2018 and were four RCTs, two non‐randomized controlled trials and two single‐arm studies.…”

Evaluation of effect of a vitamin-based barrier cream on the clinical severity of actinic cheilitis: A preliminary study

“…Tretinoin, another vitamin A derivative, has been shown to reverse the effects of photoaging, with a 23–60% progressive reduction in actinic keratoses due to cumulative UVR exposure. This effect is attribuTable to a reduction in the stratum corneum and restoration of the dermis within 120 days of treatment ( 12 , 13 ). This may perhaps explain why the 90-day observation period used in the present study was insufficient; use of the barrier cream for a longer period might have allowed the full effect of the retinol component to manifest itself, with the possibility of complete remission of AC lesions.…”

“…Vitamin-based therapies have been used to reverse cutaneous photodamage and in the treatment of field cancerization ( 12 , 13 ), with particularly promising results for vitamin A analogs. Applied topically, retinoic acid and other metabolites of vitamin A have been used to Fight the signs of photoaging and are capable of reversing the photodamage caused by excessive sun exposure, especially in actinic keratoses; furthermore, they are safe for long-term use ( 12 , 14 ).…”

Treatment of post-menopausal acne with tretinoin lotion 0.05% delivers rapid results and concomitant benefits

“…pain, inflammation, hypopigmentation, scarring), treatment availability, and cost. Two recent studies have suggested that 0.05% tretinoin cream may be a good choice to intercalate with classic treatments such as imiquimod and ingenol mebutate in the treatments of AKs 9 and in the improvement of photoaging and stabilization of field cancerization, 10 although another large randomized study of a topical 0.1% tretinoin versus matching vehicle demonstrated that high-dose topical tretinoin was ineffective at reducing the risk of keratinocyte carcinoma. 11…”