Single-Center, Prospective, Double-Blind, Evaluator-Blind, non-Randomized, Vehicle-Controlled Trial With a 1927 Nm Non-Ablative Fractionated Laser and Topical 0.05% Tretinoin Lotion for Facial Dyspigmentation and Photodamage

November 2021 | Volume 20 | Issue 11 | Original Article | 1174 | Copyright © November 2021


Published online October 22, 2021

Rawaa Almukhtar MD MPH, Emily Carr MD, Kunal Angra MD, Michael Lipp DO, Monica Boesn MD, Mitchel P. Goldman MD

Cosmetic Laser Dermatology: A West Dermatology Company, San Diego, CA

Abstract
Background: Dyspigmentation and photodamage are common concerns in patients who seek aesthetic consultation. A number of treatment modalities have been utilized to address this issue. 1927 nm thulium fiber laser is a fractionated non-ablative laser that has been shown to be safe and effective in treatment of photoaging. Topical retinoids have been used for over two decades for photoaging to promote epidermal hyperplasia and collagen synthesis and to decrease melanin production. There has been lack of data to support the combination of topical retinoids with laser treatments in the management of facial dyspigmentation and photodamage.
Objective: The primary objective of this study is to evaluate the benefits and subject satisfaction resulting from use of a 1927 nm thulium fiber laser with and without 0.05% tretinoin lotion for facial dyspigmentation and photodamage.
Results: Both groups showed a significant change in Investigator Assessed Overall Hyperpigmentation and Investigator Assessed Overall Photodamage over time (P<0.001). No statistically significant differences were seen between groups at any time point as measured by investigator reported and subject reported efficacy scales except for Subject Global Aesthetic Improvement Scale and Subject Satisfaction at 30 days after laser treatment, at which patients who received 0.05% tretinoin lotion reported a lower level of improvement (2.8 ± 0.86 in the treatment group vs 2 ± 0.85 in the vehicle group, P=0.009) and lower patient satisfaction when compared to the vehicle group (2.87 ± 1.55 in the treatment groups vs 1.53 ± 0.64 in the vehicle group, P=0.001).
Conclusion: In our study, patients tolerated the combination of 1927 nm thulium fiber laser and 0.05% tretinoin lotion well. Both groups resulted in significant reduction of hyperpigmentation and photodamage. Subject satisfaction and perceived improvement were temporarily lower at 30 days only when, combining 0.05% tretinoin lotion with 1927 nm thulium fiber laser. Future studies are needed to investigate the impact on efficacy when combining laser procedures with a longer duration of use or a higher concentration of topical tretinoin.

J Drugs Dermatol. 2021;20(11):1174-1179. doi:10.36849/JDD.6182

INTRODUCTION

Dyspigmentation and photodamage are common concerns in patients who seek aesthetic dermatologic consultation. Intrinsic aging and cumulative sun exposure, along with other extrinsic factors such as pollution and smoking, lead to decreased collagen synthesis, increased matrix metalloproteases (MMP), and increased melanin production.1 There are several techniques for diminishing the signs of photodamage ranging from topical anti-aging cosmeceuticals to laser and energy based- therapies.

Given its safety, efficacy, and limited downtime, fractionated non-ablative resurfacing has become a mainstay treatment for photoaging. The 1927 nm thulium fiber laser (TFL) is a fractionated non-ablative laser that induces superficial epidermal resurfacing to a maximum depth of 300 μm.2 TFL has a relatively high absorption coefficient for water leading to its ability to target epidermal process such as dyschromia and signs of photodamage. Furthermore, the TFL produces columns of thermal necrosis in the superficial skin layers. This leads to collagen stimulation in the dermis and clearance of epidermal pigment.3

Topical retinoids such as tretinoin have been used for over two decades for photoaging to promote epidermal hyperplasia, MMP inhibition, collagen synthesis, and dispersion of melanin granules.4 A novel 0.05% tretinoin lotion was recently introduced for the treatment of moderate to severe acne.5 This novel 0.05% tretinoin lotion was formulated using polymeric emulsion technology, with the specific aim of providing more efficient delivery of retinoid into the dermal layers with less skin irritation and higher tolerability profile.6