Topical Treatments for Photoaged Skin

September 2023 | Volume 22 | Issue 9 | 867 | Copyright © September 2023


Published online August 29, 2023

doi:10.36849/JDD.7753.

Neil Sadick MDa,b, Sukhmani Pannu MDb.c, Zehara Abidi MDb, Suleima Arruda MDb,d

aWeill Cornell Medical College, New York, NY
bSadick Dermatology, New York, NY
cTouro College of Osteopathic Medicine, New York, NY
dArruda Dermatology, São Paolo, Brazil

Abstract
Background: Photoaging due to cumulative lifetime ultraviolet light exposure is the greatest contributing factor to facial aging. With the continued growth of the population of individuals aged ≥65 years and over, demand for safe and effective photoaging treatments will likely increase.
Methods: This qualitative review provides an overview of efficacy and safety of over-the-counter (OTC) and prescription topical treatments for photoaging, including recent data from an investigator-initiated trial of the topical retinoid tazarotene.
Results: OTC and cosmeceutical products comprise the majority of treatment options for photoaging, although clinical data in support of their efficacy are generally lacking. Topical retinoids have been shown to increase collagen and elastic fibers and normalize melanocytes and keratinocytes, yielding improvements in wrinkling, texture, elasticity, and skin tone. Prescription topical retinoids (adapalene, tazarotene, tretinoin) are the most studied and efficacious treatments for photoaging, though their use is typically associated with adverse effects such as erythema, peeling, dryness, and burning/stinging in a concentration-dependent manner. In a 12-week, open-label study, lower-dose tazarotene 0.045% lotion led to significantly reduced signs and severity of photoaging vs baseline.
Conclusion: Prescription topical retinoids are the most potent treatment option for photoaging, though their use may be limited by irritation concerns. Tazarotene 0.045% polymeric emulsion lotion has recently demonstrated significant photoaging improvements with 12 weeks of once-daily treatment, with a favorable safety and tolerability profile.

Citation: Sadick N, Pannu S, Abidi Z, et al. Topical treatments for photoaged skin. J Drugs Dermatol. 2023;22(9):867-873. doi:10.36849/JDD.7753.

INTRODUCTION

Photoaging is the greatest contributing factor to facial aging1 and is among the most prevalent skin conditions in the United States (US).2 Typically defined as extrinsic aging of the skin due to accumulated ultraviolet light (UV) exposure,3-6 effects of visible and infrared light are increasingly recognized.5-7 Skin changes associated with prolonged light exposure are additive with those of chronological aging, resulting in premature age-associated changes in appearance.4,8

Signs of photoaged skin can be distinguished from chronologic skin aging, though there is some overlap (Figure 1).1,4-7,9,10 Photoaged skin may be further divided into atrophic (erythema, fine wrinkling, and greater risk of skin cancer) and hypertrophic (sallowness, abundant and deeper wrinkles, and thickened skin) subtypes, with more severe photoaging associated with ridges and furrows, leathery texture, and dermal and epidermal thickening.6,7

Because photoaging is most attributable to cumulative UV exposure, it is associated with patients age11,12 and geographical regions where UV exposure is greater.4 It is most common among individuals with fairer skin and/or Northern European ancestry4,12; however, prevalence, clinical features, and overall presentation vary across skin types. Lighter phototypes are associated with greater photoaging risk among women and more prominent fine wrinkling,11,12 whereas darker phototypes are associated with greater photodamage risk among men and higher likelihood of lentigines and other pigmentation changes.8,11,12


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