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Topical retinoids have been shown to improve the texture and fine lines of photodamaged skin. Chronologic aging leads to skin that is thin, lax, finely wrinkled, fragile, easily traumatized, and slow to heal. Prescription topical retinoids are often too irritating to use on such skin. In this randomized, double-blind, vehicle-controlled comparison study, 36 subjects age 80 or older (mean age, 87) had 0.4% retinol applied to one arm and vehicle only to the other, as often as three times weekly for 24 weeks. Treatments were skipped when irritation or excessive dryness occurred at the treatment sites.
Of 36 subjects, 5 withdrew because of irritation or pruritus, and 8 withdrew because of reasons unrelated to the treatment. Observers, who were blinded to treatment, used a 10-point scale to evaluate mean changes from baseline to the end of treatment. Fine wrinkling improved by 1.64 points on the treatment arm and 0.08 on the control arm. Tactile roughness improved by 0.53 on the treatment arm but did not change on the control arm. Overall, the effects of aging improved by 1.25 points on the treatment arm and worsened by 0.06 on the control arm. At 8 weeks after the start of the study, all differences were statistically significant. Most subjects experienced some mild irritation on the retinol-treated arm. Skin biopsies showed a statistically significant increase in glycosaminoglycan expression and procollagen immunostaining on the treatment arm compared with the control arm. The clinical improvement returned to baseline by 24 weeks after retinol treatment ended.
Kafi R et al. Improvement of naturally aged skin with vitamin A (retinol). Arch Dermatol 2007 May; 143:606-12.
Comment
Retinol seems to temporarily reverse signs of chronologic aging, just as it reverses actinically induced aging. Rejuvenation of chronologically aged skin may help to reduce skin fragility and its associated morbidity. Retinol effective at this concentration may supplant some of the more irritating prescription topical retinoids in patients who have difficulty tolerating them. Some cost savings may also be realized, as retinol tends to be less expensive than prescription topical retinoids. Four of these authors are named inventors on a patent application for methods of treating aging skin, and these findings form part of the basis for the application. Nevertheless, this study is well designed and the findings important.