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Clinics in Dermatology (2008) 26, 633–635
Cosmeceuticals: focus on topical retinoids in photoaging
Riccarda Serri, MDa,⁎
, Matilde Iorizzo, MDb
aDepartment of Dermatology, University of Milan, Milan, ItalybDepartment of Dermatology, University of Bologna, Bologna, Italy
Abstract Evidence from a randomized clinical trial showed that, in spite of the many surgical procedureseffective in ameliorating the clinical appearance of photoaged skin, the only medical therapy withproven benefits in photoaged skin are topical retinoids, in particular tretinoin, isotretinoin, andtazarotene. The application of retinoids might not only clinically and biochemically repair photoagedskin, but their use might also prevent photoaging. Furthermore, new evidence suggests a beneficial roleof topical retinoids in the treatment of intrinsically aged skin.
2008 Elsevier Inc. All rights reserved.
Tretinoin, isotretinoin, alitretinoin, tazarotene, and ada-
palene are registered as drugs; the others are cosmeceuticals
Vitamin A and its derivatives, both natural and synthetic,
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
modulates the expression of the genes involved in cellular
The following topical retinoids are recognized as being
differentiation and proliferation, normalizing cell keratinization.
Retinoids might also act independently from the binding
to nuclear receptors. Each of them exerts its own activity,
offering a further choice to the dermatologists who deal with
Although there are several studies proving the efficacy of
tretinoin as topical treatment of photoaging, few studies are
Kligman and Willisfirst introduced retinoids for use as
photoaging agents. After its application, the author noticedimprovement of skin depigmentation and rejuvenation.
When used on photodamaged skin, tretinoin's clinical
⁎ Corresponding author. 46-7 Via della Moscova, Milan 20121, Italy.
effects include improvement of wrinkles, roughness, mottled
pigmentation, and skin appearance as a whole.
0738-081X/$ – see front matter 2008 Elsevier Inc. All rights reserved.
The histologic changes observed are decreased corneo-
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
and elastin, and angiogenesis. Tretinoin enhances epidermalcell turnover, decreasing contact time between keratinocytesand melanocytes and promoting a rapid loss of pigmentthrough epidermopoesis.
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
a 3-month period.The only clinical improvement thatappears after only 1 month is skin smoothness. To maintainthe results, long-term treatment is necessary. There are nolimits to the duration of tretinoin topical use.
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 atrophyIt 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 theexpression of retinoid receptors in skin cells, thus limiting
Even if usually indicated for acne, adapalene has also
been tested for the treatment of Once-daily
application of adapalene 0.1% gel for 4 weeks, followed by atwice-daily application for up to 9 months, significantlyreduced actinic keratoses and lentigines.
There are no studies comparing its effectiveness with that
of tretinoin, although retinol does not appear to be aseffective. In photoaging, it is used as a cream in differentconcentrations, ranging from 0.075% to 1%. It can be
considered a “light” alternative to tretinoin in case ofsensitive
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