INTRODUCTION
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.