Tretinoin emollient cream: a new therapy for photodamaged skin. Photodamage pilot study: a double-blind, vehicle-controlled study to assess the efficacy and safety of tazarotene 0.1% gel. Topical tretinoin improves the appearance of photo damaged skin. Tretinoin emollient cream 0.01% for the treatment of photoaged skin. Combined CO2/erbium:YAG laser resurfacing of peri-oral rhytides and side-by-side comparison with carbon dioxide laser alone. Treatment of perioral rhytides: a comparison of dermabrasion and superpulsed carbon dioxide laser. Topical tretinoin improves photoaged skin. A double-blind vehicle-controlled study. Comparison of erbium:YAG and carbon dioxide lasers in resurfacing of facial rhytides. Treatment of upper lip wrinkles: a comparison of the 950 microsec dwell time carbon dioxide laser to manual tumescent dermabrasion. Short contact 70% glycolic acid peels as a treatment for photodamaged skin. A pilot study. A double-blind randomized clinical trial on the effectiveness of a daily glycolic acid 5% formulation in the treatment of photoaging. Tazarotene cream for the treatment of facial photodamage: a multicenter, investigator-masked, randomized, vehicle-controlled, parallel comparison of 0.01%, 0.025%, 0.05%, and 0.1% tazarotene creams with 0.05% tretinoin emollient cream applied once daily for 24 weeks. The effect of Vivida cream as compared with placebo cream in the treatment of sun-damaged or age-damaged facial skin. One-pass CO2 versus multiple-pass Er:YAG laser resurfacing in the treatment of rhytides: a comparison side-by-side study of pulsed CO2 and Er:YAG lasers. Two concentrations of topical tretinoin (retinoic acid) cause similar improvement of photoaging but different degrees of irritation. A double-blind, vehicle-controlled comparison of 0.1% and 0.025% tretinoin creams. Topical tretinoin (retinoic acid) treatment for liver spots associated with photodamage. Variable pulse erbium:YAG laser skin resurfacing of perioral rhytides and side-by-side comparison with carbon dioxide laser. Topical tretinoin for treatment of photodamaged skin. A multicenter study. Natural cartilage polysaccharides for the treatment of sun-damaged skin in females: a double-blind comparison of Vivida and Imedeen. Special natural cartilage polysaccharides for the treatment of sun-damaged skin in females. Use of topical ascorbic acid and its effects on photodamaged skin topography. Tretinoin cream 0.02% for the treatment of photodamaged facial skin: a review of 2 double-blind clinical studies. Isotretinoin improves the appearance of photodamaged skin: results of a 36-week, multicenter, double-blind, placebo-controlled trial. Topical 8% glycolic acid and 8% L-lactic acid creams for the treatment of photodamaged skin. A double-blind vehicle-controlled clinical trial. Treatment of upper lip wrinkles: a comparison of 950 microsec dwell time carbon dioxide laser with unoccluded Baker's phenol chemical peel. A controlled evaluation of dermabrasion versus CO2 laser resurfacing for the treatment of perioral wrinkles.
Tretinoin administered topically in 0.1% concentration has been shown to improve the wrinkling and irregular pigmentation of photoaged skin.
                The purpose of this study was to assess the safety and efficacy of various concentrations of tretinoin in a new emollient cream base in the treatment of photoaged skin.
                Three concentrations of tretinoin (0.05%, 0.01%, and 0.001%) in a new emollient cream formulation were compared with vehicle in a 24-week, double-blind, randomized, multicenter study of 296 subjects with photodamaged facial skin.
                Tretinoin emollient cream 0.05% gave a significantly better global response to therapy than vehicle (p less than 0.001), with 68% of subjects exhibiting improvement at the end of therapy, compared with 43% of subjects in the vehicle group. An excellent or good response was found in 26% of subjects treated with tretinoin emollient cream 0.05% versus 11% of vehicle-treated subjects. Fine wrinkling, mottled hyperpigmentation, and roughness were more improved in subjects who received tretinoin emollient cream 0.05% than in vehicle-treated subjects (p less than 0.05). No significant difference was found between vehicle and tretinoin emollient cream 0.01% or 0.001%. Histologic examination showed increases in epidermal and granular layer thickness, decreased melanin content and compaction of the stratum corneum after therapy with tretinoin emollient cream 0.05% or 0.01%. Mild to moderate skin reactions, such as erythema, peeling, and burning, were the most common side effects and, although most prevalent in the group using the 0.05% concentration, generally did not limit tretinoin use.
                Tretinoin emollient cream 0.05% appears to be safe and effective in the treatment of photodamaged skin. Tazarotene, a potent acetylenic retinoid for topical use, might be expected to benefit photodamaged skin, including improving the classical signs of fine wrinkles, mottled hyperpigmentation, and roughness.
                Our purpose was to determine the efficacy and safety of tazarotene 0.1% gel in the treatment of photodamaged dorsal forearm skin.
                Ten healthy female volunteers, aged 45 to 65 years, with moderately photodamaged forearm skin applied tazarotene 0.1% gel to one arm and vehicle gel to the other once daily for 12 weeks. The study was a double-blind, randomized, paired-comparison evaluation conducted at a single site.
                Tazarotene showed beneficial effects for several efficacy variables. It was more efficacious than vehicle in reducing skin roughness and fine wrinkling based on objective measurements. Tazarotene also corrected epidermal atrophy and atypia and improved skin hydration properties.
                In this 12-week pilot study tazarotene redressed abnormalities associated with photo-damaged skin. A multicentre clinical trial has been conducted to assess the efficacy and safety of tretinoin 0.05% cream (Retin-A) in the treatment of photo-damaged Australian skin. Subjects with cutaneous facial photodamage were randomised to treatment with tretinoin (62) or vehicle (63) cream. After an initial two week run-in, all subjects applied the cream to the face, neck and left forearm/hand, once nightly for 24 weeks. Changes in clinical signs of photodamage and parameters of cutaneous irritation were assessed by investigators using a 7 point scale, whilst changes in signs of photodamage were rated by subjects using a 5 point scale. Changes in skin biopsies and silicone skin surface replicas were also assessed. Significant improvements in skin wrinkles, mottled hyperpigmentation, laxity, lentigines and roughness of tretinoin treated subjects were noted by investigators. Subjects receiving tretinoin noted significant improvements in skin wrinkles, tightness, colour and pores. Improvement in overall severity of photodamage was significantly greater for tretinoin treated subjects and was progressive over the study period. Histological findings included a significant increase in mean epidermal thickness. Significant topographical changes were not detected in skin surface replica sets. Cutaneous irritation, the most common side effect, was usually mild and transient. We conclude that tretinoin 0.05% cream significantly improved the appearance of photo-damaged skin. Tretinoin emollient cream 0.01% was used to treat 40 patients with photoaged skin of the face and forearms in a 48-week, randomized, double-blind, placebo-controlled study. On the face, a significant difference between treatment groups was found in the investigator's global evaluation (P < .001), and in fine wrinkling (P < .001) and coarse wrinkling (P = .02) at 24 weeks. Tretinoin-treated forearms showed significantly greater improvement in roughness, mottled hyperpigmentation, fine wrinkling, and lentigines at 24 and 48 weeks. More consistent improvement was seen on the forearms than on the face. Adverse experiences on the face in both treatment groups included dryness, peeling, and acne. No significant difference in reported adverse experiences was found between forearms in both treatment groups. On forearms, dermatitis was the most common adverse event. Tretinoin 0.01% was generally well tolerated, and skin irritation was minimal. Tretinoin emollient cream 0.01% is a potentially safe, effective treatment for photodamaged skin. Laser resurfacing of facial rhytids has become a popular treatment option for many patients with wrinkles, photoaging, and acne scarring. Laser wavelength options and optimization of techniques continue to evolve in an attempt to shorten the healing phase associated with laser skin resurfacing.
                To prospectively study the clinical effects of pulsed carbon dioxide (CO2) laser resurfacing of facial rhytids used alone, compared with a combination of CO2 and the pulsed Erbium:YAG (Er:YAG) laser.
                Forty treatment sites on 20 patients were randomized and evaluated following treatment of the upper lip region with a combination of CO2 laser resurfacing alone or with the same CO2 laser treatment followed by 3 passes with the Er:YAG laser. Patient diaries were maintained to assess erythema, crusting, pain, itching, swelling, pigmentary changes, and the day of first make-up application. Blinded objective grading of improvement was independently assessed by 4 blinded observers at time intervals 3, 6, and 10 days, and 1, 2, and 4 months. Chromometer measurements of erythema were also analyzed and percentage moisture recorded.
                Subjectively, all patients reported, on average, 10 days of redness and 2.4 days of pain, with no significant difference noted between the two procedures. On average, patients were able to apply make-up 5.5 days postoperatively, regardless of which procedure used. However, the combined CO2/Er:YAG laser treatment patients experienced reduced duration of crusting, compared to the patients treated with CO2 alone. The duration of crusting was reduced on average from 7.4 to 6.5 days, and also the duration of itching was reduced in patients receiving combined treatment from 5.5 to 4.8 days. Chromometer measurements noted no significant difference between techniques in the rate of resolution of erythema. Blinded objective grading revealed that crusting was reduced on average from 7.2 to 6.0 days, and swelling was reduced from 6.3 to 6.0 days in patients receiving the combined procedure. No cases of permanent hyperpigmentation, hypopigmentation, or scarring occurred in any patients.
                The addition of the Er:YAG laser following CO2 laser resurfacing reduces the duration of crusting, swelling, and itching postoperatively. Medium to deep (Grade III) facial rhytids were improved by 70% with both procedures with no significant difference noted between techniques. To directly compare the cosmetic outcome and adverse effects of dermabrasion and superpulsed carbon dioxide laser for the treatment of perioral rhytides.
                Subjects were randomly assigned to receive treatment with carbon dioxide laser resurfacing to one side of the perioral area and dermabrasion to the other side in a prospective, comparative clinical study. The duration of follow-up by blinded observers was 4 months.
                University hospital-based dermatologic surgery clinic.
                Fifteen healthy fair-skinned volunteers with moderate to severe perioral rhytides and no history of prior cosmetic surgical procedures to the same anatomic area.
                One half of the perioral area was treated with the LX-20SP Novapulse carbon dioxide laser (Luxar Corp, Bothell, Wash), and the other half was treated with dermabrasion using either a hand engine-driven diamond fraise or a medium-grade drywall sanding screen (3M Corp, St Paul, Minn).
                Improvement in rhytides, patients' subjective reports of postoperative pain, time to reepithelialization, degree of postoperative crusting, and duration of postoperative erythema were observed for both methods. Standardized scoring systems were used to quantify outcome measures. Paired t tests were used for statistical comparisons of the 2 resurfacing methods.
                The difference in rhytide scores for the 2 methods was not statistically significant (P= .35) at 4 months. Less postoperative crusting and more rapid reepithelialization were noted with the dermabrasion-treated skin. Postoperative erythema was of longer duration on laser-treated skin. Patients reported less pain with dermabrasion treatment. Subtle differences that were difficult to quantify were also noted between the methods.
                Both dermabrasion and carbon dioxide laser resurfacing are effective in the treatment of perioral rhytides. Both methods have unique advantages and disadvantages. In a 16-week randomized, double-blind, vehicle-controlled study of topical tretinoin in the treatment of photoaging, all patients applied topical tretinoin to one forearm and vehicle cream to the other. Half of the patients received tretinoin to the face, and half received vehicle cream. All 30 patients who completed the study showed statistically significant improvement in photoaging on the tretinoin-treated forearms, but not on the vehicle-treated forearms. Fourteen of the 15 patients who received tretinoin to the face had improvement in photoaging, whereas none of the vehicle-treated patients' faces improved, a statistically significant difference in response between the two groups. Statistically significant histologic changes were seen in forearm skin treated with tretinoin, but not with vehicle cream. Side effects were limited to irritation of tretinoin-exposed skin. To compare the efficacy, adverse effects, and histological findings of erbium:YAG (Er:YAG) and carbon dioxide (CO2) laser treatment in removing facial rhytides.
                An intervention study of 21 subjects with facial rhytides. All participants were followed up for 6 months. The end points of the study were wrinkle improvement and duration of adverse effects.
                Academic referral center.
                Nineteen female and 2 male volunteers with skin type I to III and wrinkle class I to III participated in the study.
                In all subjects, 1 side of the face was treated with a CO2 laser and other side with an Er:YAG laser. Skin biopsies were performed in 6 subjects before treatment and immediately, 1 day, 2 days, and 6 months after treatment. Observations were recorded by subjects, investigators, and a blinded panel of experts.
                Improvement in wrinkles and severity and duration of adverse effects.
                The CO2 laser-treated side had relatively better wrinkle improvement when evaluating all subjects (P<.03). However, in subjects receiving more than 5 passes of Er:YAG laser, improvement scores were not significantly different from those for 2 to 3 passes of CO2 laser treatment. Posttreatment erythema was noted at 2 weeks in 14 subjects (67%) on the Er:YAG laser-treated side and 20 subjects (95%) on the CO2 laser-treated side. The frequency of erythema was significantly less after Er:YAG laser treatment at 2 (P=.001) and 8 (P=.03) weeks. Hypopigmentation was seen in 1 Er:YAG-treated (5%) and 9 CO2-treated (43%) sides (chi2, P<.05). Histological evaluation showed residual thermal damage of up to 50 microm on the Er:YAG-treated side and up to 200 microm on the CO2-treated side.
                Erbium:YAG laser is safe and effective in removing facial rhytides. Subjects treated with Er:YAG laser recover more quickly from the procedure than those receiving CO2 laser treatment. High-energy pulsed or computer-scanned continuous-wave carbon dioxide (CO2) laser resurfacing has gained popularity as a wrinkle treatment because of its minimal thermal injury and precise control of tissue vaporization depth. Manual tumescent dermabrasion has also been effective for treating facial wrinkles. This is, to our knowledge, the first study comparing the use of CO2 laser to manual tumescent dermabrasion for the treatment of wrinkles on the upper lip.
                To compare prospectively the clinical efficacy of the 950 microsec dwell time CO2 laser to that of manual tumescent dermabrasion in the treatment of upper lip wrinkles.
                Twenty female subjects with moderate to severe upper lip wrinkles were randomly treated with the 950 microsec dwell time CO2 laser on one side of the upper lip and manual tumescent dermabrasion on the other.
                The average upper lip laser-treated wrinkle score (0 = none to 5 = severe) decreased from 4.3 +/- 0.2 before treatment to 1.8 +/- 0.3 at 6 months after treatment. The average upper lip dermabrasion-treated wrinkle score decreased from 4.4 +/- 0.2 to 1.5 +/- 0.3. The degree to which the wrinkle score improved after laser treatment compared with that after dermabrasion was not statistically significant (P =.216).
                Manual tumescent dermabrasion and 950 microsec dwell time CO2 laser resurfacing are equally effective for the treatment of upper lip wrinkles. Glycolic acid has been one of the more commonly used alpha hydroxy acids for the treatment of photodamaged skin. Its value as a quick "skin refreshing" peeling agent has been widely touted. This type of peel differs from a conventional therapeutic peel (eg, phenol, trichloroacetic acid, or a longer time exposure alpha hydroxy acid peel) in that there is little skin reaction and patients can go about their daily routine without concern.
                To assess the potential value of glycolic acid-based refresher peels as a cosmetic procedure.
                Twelve healthy subjects with at least a moderate degree of photodamage were treated with monthly serial 70% glycolic acid peels over a period of 4 months. In addition to the "peels," six subjects were randomized to a 10% glycolic acid-based moisturizer twice daily. Patients were evaluated monthly and graded on a clinical scale using objective measures.
                No conclusive differences were noted on histologic evaluation. Ninety percent (9/10) of patients felt that overall they noticed significant improvement, however, there was no distinction between the two treatment options. The improvement in fine wrinkling and pigmentation was primarily seen in the patients who additionally received 10% glycolic emollient twice daily.
                In this limited pilot study, no specific benefit could be assigned to the concomitant use of monthly glycolic acid refresher "peels" in the treatment of photodamaged skin. Low-strength daily formulations of glycolic acid are widely promoted for the treatment of photoaging. However, there are few clinical studies that objectively confirm the benefits of such formulations.
                The purpose of this study was to determine the effectiveness of a 5% unneutralized formulation of glycolic acid in the treatment of facial and neck photoaging.
                Seventy-five volunteers were recruited to take part in this double-blind randomized placebo-controlled clinical study. Participants applied either the 5% glycolic acid cream or the placebo cream to the face and neck for a period of 3 months. Pre- and posttreatment clinical assessments of photoaging effects were made by the same physician and were analyzed for statistical significance.
                Overall there were trends towards greater improvement or less worsening in the glycolic acid group for all clinical assessments for photoaging. There was statistically significant improvement favoring the active-cream in general skin texture and discoloration. There was a trend favoring glycolic acid in reduction of wrinkles, but this did not achieve statistical significance.
                Unneutralized 5% glycolic acid topical cream when used on a regular daily basis can improve some photoaging effects. To assess the safety and efficacy of 4 concentrations of tazarotene cream in the treatment of facial photodamage.
                Prospective weekly multicenter, investigator-masked, randomized, parallel-group study.
                University hospitals and clinical research centers.
                Three hundred forty-nine subjects with facial photodamage.
                Daily topical application of tazarotene cream (0.01%, 0.025%, 0.05%, and 0.1%) compared with its vehicle and with 0.05% tretinoin emollient cream.
                Tazarotene cream and tretinoin cream significantly improved mottled hyperpigmentation and fine wrinkles. At week 24, treatment success rates based on global responses were 67% (39 of 58 subjects) with 0.1% tazarotene, 52% (30 of 58 subjects) with 0.05% tazarotene, 36% (21 of 58 subjects) with 0.025% tazarotene, 41% (24 of 59 subjects) with 0.01% tazarotene, 55% (32 of 58 subjects) with 0.05% tretinoin, and 22% (13 of 58 subjects) with vehicle. Local adverse events, although more frequent with tazarotene at higher concentrations, were generally mild to moderate.
                Tazarotene in a cream formulation is safe and is associated with positive changes in the treatment of photodamaged facial skin. Vivida when used orally has been previously shown to be effective in treating degenerated skin of women. In the present study, 30 women with moderate to severe sun-damaged facial skin applied Vivida cream twice daily for 120 days on one side of the face and placebo to the other. Vivida was significantly (P < 0.001) more effective than placebo in improving wrinkles. The effects of Vivida cream on mottles and telangiectasis were also significantly (P < 0.01) greater than those of placebo. Scanner measurement showed that epidermal thickness increased from 0.13 mm to 0.29 mm and dermal thickness from 0.91 mm to 1.29 mm on the Vivida-treated side; only minimal changes were observed on the placebo-treated side. The elasticity index increased from about 50% to 69% on the Vivida-treated side and from 49% to 50% on the placebo-treated side. The CO2 laser is normally described as an aggressive resurfacing tool, whereas the erbium:YAG laser has enjoyed a reputation as the ideal tool for superficial resurfacing. The implication from many studies is that the CO2 laser is incapable of "minimally invasive" resurfacing.
                To compare a short-pulsed CO2 laser with an Er:YAG laser over a range of parameters intended to produce equivalent microscopic and clinical injuries.
                A prospective, randomized, comparative interventional trial was conducted in a tertiary care teaching hospital. Thirteen patients with facial wrinkles were enrolled in the study. A side-by-side comparison was performed using periorbital and perioral regions as treatment sites. One side was treated with a pulsed CO2 laser and the other with an Er:YAG laser. Postauricular skin was treated in an identical fashion to the study sites and biopsied for microscopic analysis. The biopsies were obtained before treatment, immediately after treatment, and either 3 or 6 months after treatment to evaluate the acute level of injury and subsequent degree of fibroplasia. Photographs were taken at baseline, immediately after treatment, 1, 2, and 6 weeks, and 3 and 6 months after treatment. Nine physicians evaluated the photographs for erythema, pigmentation, and wrinkle improvement.
                Investigator assessment showed no statistically significant differences between the lasers with respect to hyperpigmentation and wrinkle reduction. There was less erythema at the CO2 laser-treated sites 2 weeks after treatment; the differences had resolved by 6 weeks after treatment. Histologic examination demonstrated equivalent dermal thermal injury on immediate postoperative biopsies and equivalent fibroplasia on subsequent biopsies. Both CO2 and Er:YAG laser-treated sites showed overall modest wrinkle improvement compared to the pretreatment photographs.
                When CO2 and Er:YAG lasers are used in a manner such that there are equivalent immediate postoperative histologic results, equivalent healing and cosmetic improvement occurs. One can use CO2 laser with one pass to mimic a moderately aggressive Er:YAG laser treatment. The efficacy of topical tretinoin (all-trans-retinoic acid) in treating photoaging is well established. Questions that remain are (1) whether irritation causes all or part of the improvement; (2) the concentration of tretinoin that maximizes clinical response with minimal side effects; and (3) the effects of long-term treatment on components of the cutaneous immune system. To address these issues, 99 photoaged patients completed a 48-week study using 0.1% tretinoin cream (n = 32), 0.025% tretinoin (n = 35), or vehicle (n = 32) once daily in a double-blind manner. Before and after treatment, we assessed histologic features, keratinocyte expression of HLA-DR and intercellular adhesion molecule-1, numbers of epidermal Langerhans' cells and epidermal and dermal T lymphocytes, and vascularity as measured by dermal endothelial cell area.
                Both 0.1% and 0.025% tretinoin produced statistically significant overall improvement in photoaging of the face compared with vehicle; there were no clinically or statistically significant differences in efficacy between the two concentrations of tretinoin. After 48 weeks, 0.1% and 0.025% tretinoin produced similar statistically significant epidermal thickening (by 30% and 28%, respectively) compared with vehicle (11% decrease) and increased vascularity (by 100% and 89%, respectively) compared with vehicle (9% decrease). By various analyses, irritant side effects (erythema and scaling) were statistically significantly greater with 0.1% tretinoin than with 0.025% tretinoin. No significant changes occurred in any immunologic markers when tretinoin and vehicle treatments were compared.
                Tretinoin 0.1% and 0.025% produce similar clinical and histologic changes in patients with photoaging, despite significantly greater incidence of irritation with the higher concentration. The separation between clinical improvement and irritation suggests that mechanisms other than irritation dominate tretinoin-induced repair of photoaging in humans. The hyperpigmented lesions commonly called liver spots distress patients, in part because such lesions are associated with aging. We investigated their treatment with topical 0.1 percent tretinoin (retinoic acid).
                Fifty-eight patients completed a 10-month randomized, double-blind study in which they applied either 0.1 percent tretinoin (n = 28) or vehicle (n = 30) cream daily to the face, upper extremities, or both. Fifteen patients who responded well were than randomly assigned to continue tretinoin therapy or use vehicle alone for six more months. Patients were evaluated by physical examination every month and by analysis of biopsy specimens of lesions obtained at base line and at the end of the 10-month trial.
                After one month of treatment the patients treated with tretinoin had significant lightening of hyperpigmented lesions as compared with the patients who received vehicle (P less than 0.002). After 10 months, 20 (83 percent) of the 24 patients with facial lesions who were treated with tretinoin had lightening of these lesions, as compared with 8 (29 percent) of the 28 patients with facial lesions who received vehicle. The results for lesions of the upper extremities were similar. As compared with vehicle, tretinoin caused a significant decrease in the degree of epidermal pigmentation and increases in the degree of compaction of stratum corneum, thickness of the granular cell layer, and epidermal thickness. Reductions in epidermal pigmentation evident on histologic analysis were significantly correlated with the degree of clinical lightening of lesions (r = -0.53, P less than 0.0001). During the 6-month follow-up study, specifically identified lesions that had disappeared during the first 10 months of tretinoin treatment did not return in any patient, and six of seven patients who continued to use tretinoin had further improvement.
                Topical 0.1 percent tretinoin significantly improves both clinical and microscopical manifestations of liver spots; these lesions do not return for at least six months after therapy is discontinued. Laser resurfacing of facial rhytides has become a popular treatment option for many patients with wrinkles, photoaging, and acne scarring. Laser wavelength/pulse duration options and new techniques continue to shorten the healing phase associated with laser skin resurfacing while maintaining clinical efficacy. Variable pulse erbium:YAG (Er:YAG) laser systems are now available that offer the surgeon the ability to vary the Er:YAG pulse duration from a pulse that is primarily ablative to one that is more thermal. The objective of this study was to evaluate the histologic effects created with a variable pulse Er:YAG laser. To study prospectively the clinical effects on upper lip rhytides with a variable pulse Er:YAG laser when compared side by side with pulsed carbon dioxide (CO(2)) laser resurfacing.
                Forty-two treatment sites on 21 patients were randomized and evaluated after treatment of the upper lip region with CO(2) laser resurfacing on one side and a variable pulse Er:YAG laser on the other. Patient diaries were maintained to assess erythema, crusting, pain, and pigmentary changes. Blinded objective grading of improvement was performed. Chromometer measurements were obtained to analyze erythema.
                The variable pulse Er:YAG laser treatment reduced the duration of crusting on average from 7.7 days with CO(2) to 3.4 days. Chromometer measurements noted decreased postoperative erythema. Grading by physicians in a blinded manner showed 63% improvement for the CO(2) treatment site and 48% improvement in the variable pulse Er:YAG site. No cases of permanent hyperpigmentation, hypopigmentation, or scarring occurred.
                The variable pulse Er:YAG laser resurfacing is a safe and effective resurfacing tool, which combines ablative and thermal modalities. The protocol used in this study approaches but does not equal the results we have traditionally seen with CO(2) laser resurfacing.
                Copyright 2000 Wiley-Liss, Inc. The clinical and histologic effects of a new emollient cream formulation of topical tretinoin at concentrations of 0.05% and 0.01% were examined in 251 subjects with mild to moderate photodamaged facial skin in a randomized, double-blind, vehicle-controlled, multicenter study. Seventy-nine percent of the subjects who received 0.05% tretinoin for 24 weeks showed overall improvement in photodamaged skin compared with improvement in 48% of the vehicle-treated control subjects. Significant reductions were found in fine wrinkling, mottled hyperpigmentation, roughness, and laxity after 0.05% tretinoin therapy when compared with controls. In addition, histologic changes of increased epidermal thickness, decreased melanin content, and stratum corneum compaction provide independent evidence supporting clinical improvement. Side effects of erythema, peeling, and stinging were usually mild and well tolerated. Evidence is accumulating that cartilage polysaccharides derived from marine fish have a repairing effect on solar elastosis. In a double-blind trial, the efficacy and safety of two commercial preparations, Vivida and Imedeen, were compared in the treatment of sun-damaged skin in women aged 40-60 years. A group of 15 women received 500 mg/day Vivida and another 15 women received 380 mg/day Imedeen orally for 90 days. Subjective assessment revealed statistically significant improvements in skin condition in both treatment groups but Vivida was significantly (P less than 0.01) more effective than Imedeen for all parameters. In the Vivida group, mean epidermal thickness increased from 0.14 to 0.26 mm, dermal thickness from 0.90 to 1.51 mm and the elasticity index from 47% to 71%. In the Imedeen group, epidermal thickness increased from 0.13 to 0.18 mm, dermal thickness from 0.80 to 0.97 mm and the elasticity index from 48% to 56%. After 90 days, the differences between the two groups for all three parameters were statistically significant (P less than 0.001). The mean erythemal index decreased from 0.24 to 0.20 in the Vidida group, but increased from 0.23 to 0.25 in the Imedeen group. In the Vivida group, five patients developed transient, mild pimples during the first weeks of treatment, but no other adverse effects occurred. In the present double-blind investigation, the effects of a new formulation of natural cartilage polysaccharides on sundamaged skin were studied in women aged 40-60 years. A group of 15 women were treated orally with 500 mg/day active substance (Vivida) for 90 days and a second group of 15 women received 500 mg/day placebo for 90 days. Clinical examinations after 45 and 90 days' treatment showed significant improvements in skin condition in the actively treated group but not in the placebo group (P less than 0.001). In the Vivida-treated patients, the epidermal thickness increased after 90 days from 0.11 mm to 0.29 mm, dermal thickness from 0.74 mm to 1.39 mm, skin elasticity index from 44% to 73% and the erythemal index decreased from 0.301 to 0.205. No changes were observed in the placebo group and no adverse effects were reported by either treatment group. To determine the efficacy of topical ascorbic acid application in treating mild to moderate photodamage of facial skin using an objective, computer-assisted image analysis of skin surface topography and subjective clinical, photographic, and patient self-appraisal questionnaires.
                A 3-month, randomized, double-blind, vehicle-controlled study.
                Facial plastic surgery private practice.
                Nineteen evaluable volunteer sample patients aged between 36 and 72 years with Fitzpatrick skin types I, II, and III who were in good physical and mental health with mild to moderately photodamaged facial skin were considered for analysis.
                Coded, unmarked medications were randomly assigned to the left and right sides of each subject's face, one containing the active agent, topical ascorbic acid (Cellex-C high-potency serum; Cellex-C International, Toronto, Ontario), the other, the vehicle serum (Cellex-C International). Three drops (0.5 mL) of each formulation were applied daily to the randomly assigned hemifaces over the 3-month study period. Treatment assignments were not disclosed to subjects, clinicians, or personnel involved in analyzing skin replicas.
                Specific clinical parameters were evaluated and graded on a 0- to 9-point scale (0, none; 1-3, mild; 4-6, moderate; and 7-9, severe). Reference photographs were used to standardize grading criteria. Overall investigator scores were compared with baseline and graded as excellent (much improved), good (improved), fair (slightly improved), no change, or worse. Patient self-appraisal questionnaires rated the degree of improvement (much improved, improved, slightly improved, no change, or worse) and reported adverse effects (burning, stinging, redness, peeling, dryness, discoloration, itching, and rash). Standard photographs were taken at baseline, including anteroposterior and left and right oblique views to facilitate subsequent clinical evaluations, and at the end of therapy for comparison. Optical profilometry analysis was performed on the skin surface replicas of the lateral canthal (crow's feet) region, comparing baseline to end-of-study specimens. Using this computer-based system, the resulting image was digitally analyzed, and numeric values were assigned to reflect surface features. The parameters obtained included Rz, Ra, and shadows. These values provided objective data that document pretreatment and posttreatment texture changes proportional to the degree of wrinkling, roughness, and other surface irregularities.
                Optical profilometry image analysis demonstrated a statistically significant 73.7% improvement in the Ra and shadows north-south facial axis values with active treatment greater than vehicle control, as well as a trend for improvement in the Rz north-south facial axis parameter, showing a 68.4% greater improvement of active treatment vs vehicle control. Clinical assessment demonstrated significant improvement with active treatment greater than control for fine wrinkling, tactile roughness, coarse rhytids, skin laxity/tone, sallowness/yellowing, and overall features. Patient questionnaire results demonstrated statistically significant improvement overall, active treatment 84.2% greater than control. Photographic assessment demonstrated significant improvement, active treatment 57.9% greater than control.
                A 3-month daily regimen of topical ascorbic acid provided objective and subjective improvement in photodamaged facial skin. Skin replica optical profilometry is an objective method for quantification of the skin surface texture changes. In extensive clinical studies and practical use since its US Food and Drug Administration approval in 1995, tretinoin emollient cream 0.05% has been shown to be safe and effective in the treatment of fine facial wrinkles, mottled hyperpigmentation, and skin roughness. To provide additional prescribing flexibility for various patient needs, a new lower concentration formulation, tretinoin cream 0.02% was chosen for further development. Two multicenter, randomized, double-blind, vehicle-controlled clinical., studies were conducted to evaluate the safety and efficacy of the lower concentration tretinoin formulation in the treatment of moderate-to-severe facial photodamage. Results indicate statistically significant improvement in fine wrinkling, coarse wrinkling, and yellowing with the use of tretinoin cream 0.02% at week-24 end point, compared with placebo. Therapy with tretinoin cream 0.02% was well tolerated overall and demonstrated a favorable safety profile. Both studies demonstrated that tretinoin cream 0.02% is safe and effective for the treatment of moderate-to-severe photodamaged facial skin. Photodamaged skin occurs as a result of long-term exposure to ultraviolet radiation. The incidence of photodamage in European and North American populations with Fitzpatrick skin types I, II, and III is estimated at 80% to 90%. We conducted a double-blind clinical trial to test the efficacy and safety of 0.1% isotretinoin versus vehicle cream in 800 patients with moderate to severe photodamaged skin. Patients applied either 0.1% isotretinoin or matching vehicle cream to the face, forearms, and hands once nightly for 36 weeks. Local irritation and adverse events were assessed, and plasma retinoid levels were measured before and during treatment. Treatment response increased throughout the 36-week treatment period and the overall appearance of photodamaged skin was significantly better than with the vehicle alone. Topical application of 0.1% isotretinoin is an effective and well-tolerated treatment leading to clinically apparent improvement in the appearance of photodamaged skin of the face, forearms, and hands. To evaluate the efficacy and tolerability of 2 widely used topical alpha-hydroxy acids at low concentrations, 8% glycolic acid and 8% lactic (L-isoform) acid creams, in the treatment of photodamaged skin.
                A single-center, 22-week, double-blind, vehicle-controlled, randomized clinical trial assessed the overall severity of photodamage on the faces and forearms of volunteers, based on 7 individual clinical components of cutaneous photodamage.
                The study was performed in an outpatient clinical research unit at the Massachusetts General Hospital, Boston.
                Seventy-four women, aged 40 to 70 years, with moderately severe photodamaged facial skin were enrolled in the study. One subject withdrew from the study early because of skin irritation, and 6 subjects withdrew from the study for personal reasons.
                Glycolic acid, L-lactic acid, or vehicle creams were applied twice daily to the face and outer aspect of the forearms.
                Improvement in alpha-hydroxy acid-treated photodamaged skin as determined by patient self-assessments and physician evaluations of efficacy and irritancy.
                The percentage of patients using either 8% glycolic acid or 8% L-lactic acid creams on the face achieving at least 1 grade of improvement (using a scale from 0 through 9) in overall severity of photodamage was significantly greater than with the vehicle cream (76% glycolic acid, 71% lactic acid, and 40% vehicle; P < .05). On the forearms, after 22 weeks, treatment with glycolic acid cream was superior to the vehicle in improving the overall severity of photodamage and sallowness (P < .05). L-Lactic acid cream was significantly superior to the vehicle in reducing the overall severity of photodamage (P < .05), mottled hyperpigmentation (P < .05), sallowness (P < .05), and roughness on the forearms (P < .05) at week 22.
                Topical 8% glycolic acid and 8% L-lactic acid creams are modestly useful in ameliorating some of the signs of chronic cutaneous photodamage. These agents are well tolerated and available without prescription. The high energy, pulsed, or computer-scanned continuous wave carbon dioxide laser (CO2 laser) has gained popularity as a wrinkle treatment because of its minimal thermal injury and precise control of tissue vaporization depth. Chemical peels such as phenol have also been effective in treating facial wrinkles. This is, to our knowledge, the first study comparing the use of CO2 laser to phenol for treatment of wrinkles on the upper lip.
                To compare the effectiveness and side effect profile of the 950 microsec dwell time CO2 laser to that of unoccluded Baker's phenol chemical peel in the treatment of upper lip wrinkles.
                Twenty female subjects with moderate to severe upper lip wrinkles were randomly treated with Baker's phenol on one side of the upper lip and the 950 microsec dwell time CO2 laser on the other side.
                The average upper lip laser-treated wrinkle score (0 = none to 5 = severe) decreased from 4.30+/-0.20 before treatment to 1.11+/-0.28 at 6 months after treatment. The average upper lip phenol-treated wrinkle score decreased from 4.20+/-0.20 to 0.47+/-0.12. The degree in which the wrinkle score improved after phenol treatment compared with that after laser treatment was statistically significant (p<0.03).
                Treatment of upper lip wrinkles with Baker's phenol resulted in greater improvement than treatment with the 950 microsec dwell time CO2 laser. Facial skin treatments with laser resurfacing, dermabrasion, and chemical peels were responsible for a significant portion of the 2.7 million cosmetic procedures performed in 1998. Perioral wrinkles are a common problem for which plastic surgical consultation is obtained. The aim of this study was to compare and quantify the advantages and disadvantages of laser resurfacing versus dermabrasion in the treatment of perioral wrinkles. Twenty female patients provided informed consent and participated in the study. Half of the perioral area was treated with dermabrasion and half was treated with the UltraPulse CO2 laser. The two procedures were compared using high-quality photographs; a biophysical evaluation of skin color, hydration, and mechanical properties; and patient evaluation of outcomes. Photographs were evaluated by 10 board-certified plastic surgeons who were blinded to the treatment methods. The laser treatment had a significantly higher erythema score at 1 month and a small but significantly greater improvement in perioral wrinkles at 6 months. Thirteen subjects selected the laser treatment as producing the best result, despite the greater intraoperative pain for this procedure. Biomechanical measurements suggest that the laser treatment produced a skin state more similar to skin in younger patients, presumably with higher levels and/or greater organization of the collagen and elastin. Patient preference was inferred from the resurfacing method that they would recommend to a friend. Although the laser was selected as the best result in a majority of cases, patient preference was equally distributed between the two treatments. The authors think that by studying and quantifying the biophysical changes that occur as a result of CO2 laser resurfacing, greater improvements in restoring actinic damage (e.g., wrinkles) can be achieved. Patients consider more than the objective skin changes from a resurfacing technique when making a recommendation to a friend.