Treatment of Facial Photodamage With Mass Market Topical Products vs Non-ablative Fractional Laser
November 2016 | Volume 15 | Issue 11 | Original Article | 1366 | Copyright © 2016
Hilary Reich MD,a,b Irmina Wallander BA,a Lacie Schulte MS BA,a Molly Goodier BS,a and Brian Zelickson MDa
aZel Skin & Laser Specialists, Edina, MN bDepartment of Dermatology, University of Minnesota Medical School, Minneapolis, MN
METHODS: In this split-face, evaluator-blinded study, 18 subjects were randomly assigned to receive either the SSR or NFL treatments on each side of the face. For the SSR facial sides subjects followed two morning-evening regimens. On the NFL sides subjects were treated 3 times with the 1927-nm laser at 4-week intervals. Three physician evaluators were asked to rate hyperpigmentation, global photoaging, and ne lines and wrinkles for each side of the face at baseline and at 3 months using a 5-point scale. RESULTS: The SSR and NFL treatments provided comparable results for each skin attribute. Improvement from baseline was signi - cant in both treatment programs for each skin attribute. The greatest 3-month improvement for both programs was in hyperpigmen- tation. For global photoaging and ne lines and wrinkles, positive responses were slightly greater in the NFL than in the SSR facial sides. Subject preference for the SSR over the NFL was greatest for ne lines around the eyes, ne lines around the mouth, smooth texture, radiant complexion, and overall improvement while the NFL was preferred for skin rmness and evenness. When the study was completed5 of 18 split-face subjects decided to undergo NFR laser treatment on the non laser treated side along with using the SSR product and 13 of the 18 subjects continued to use the SSR products to their full face after the study. CONCLUSION: The mass market skin care system of the present study provides improvement in hyperpigmentation, global photoaging, and ne lines and wrinkles comparable to that of a series of treatments with a non-ablative fractional laser. J Drugs Dermatol. 2016;15(11):1366-1372.
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Treatments to reduce the clinical manifestations of photodamage range from over-the-counter (OTC) and prescription topical products to more aggressive chemical peels and lasers. In general, the more aggressive the treatment the greater the improvement in irregular pigmentation, fine rhytids, and other signs of photodamage. To our knowledge the efficacy and safety of a mass market topical skin care program has not been compared directly to that of a series of laser treatments. Mass market is defined in this study as available in mass retail.The most effective topical products include all-trans-retinoic acid (tretinoin), a metabolite of retinol used since 1969 to treat acne and to reduce the signs of photoaging,1-3 and hydroquinone (1,4-dihydroxybenzene) for the treatment of cutaneous pigmentation disorders such as melasma, actinic lentigines, and ephilides. A tyrosine inhibitor, hydroquinone halts the pathway of melanogenesis.4,5 As ingredients of both OTC and prescription products, retinoic acid and hydroquinone are widely used to treat photodamaged skin. A recent study6 showed that a novel OTC mass market topical program with both retinoic acid and hydroquinone can yield the same clinical improvement as a prescription-based topical program. While retinoic acid and hydroquinone are effective, laser and light-based devices also reduce irregular pigmentation and improve the texture of photoaged skin.7,8 Non-ablative fractional lasers, for example, improve dyspigmentation and texture safely and with minimal downtime. The 1927-nm fractional laser (Fraxel Dual ReStore laser, Solta Medical, Inc., Hayward, CA) is designed to reduce recovery time and increase safety by using microbeams of light to penetrate the epidermis and superficial dermis of a small area of skin. The resulting focal injury leads to neocollagenesis and rapid healing. Since the 1927-nm wavelength has a relatively high absorption coefficient for water and does not absorb skin pigments, the laser microbeams easily penetrate the epidermis and superficial dermis, resulting in coagulation of the target tissue.9,10It is commonly believed that lasers are more effective against photodamage than topical products. However, we know of no published studies to confirm this belief. The present study compares the efficacy and safety of a mass market skin care program to that of a series of non-ablative fractional laser treatments for reducing the signs of photodamage.