From the Guidelines
Topical retinoids are the most effective agents for maintaining skin youthfulness.
Effective Agents
- Topical retinoids, such as adapalene 0.3%, tretinoin 0.1% and 0.05%, and topical isotretinoin 0.1%, have been shown to have a modest benefit in improving lentigines and reducing wrinkles 1.
- These products are usually used for sustained treatment rather than a limited course, and have been found to be effective in achieving AK count reduction after 9 months.
- Adapalene 0.3% was found to be significantly more efficacious than adapalene 0.1% in achieving AK count reduction after 9 months 1.
Important Considerations
- The use of topical retinoids may have additional benefits beyond maintaining skin youthfulness, such as chemoprevention of skin cancer.
- However, the evidence for this is not strong, and some studies have been stopped early due to excessive all-cause mortality in the treatment group 1.
- As such, topical retinoids should be used with caution and under the guidance of a healthcare professional.
From the Research
Effective Topical Agents
- Retinol and retinoic acid are effective anti-aging treatments that increase epidermal thickness, upregulate genes for collagen type 1 and 3, and improve skin appearance 2, 3, 4
- Topical retinol treatment induces the expression of hyaluronic acid synthases (HAS) genes and HA production in human skin, contributing to improved skin moisture and reduced wrinkles 5
- Other topical agents, such as alpha hydroxy acids (AHAs), vitamin C, beta hydroxy acids, anti-oxidants, and tocopherol, are also used for skin rejuvenation, often in combination with retinoids 6
Effective Systemic Agents
- Oral retinoids are available as a systemic therapy for aging skin, although their use may be limited due to potential side effects 6
- Vitamin C is also used as a systemic therapy, with potential benefits for skin health and appearance 6
Mechanisms of Action
- Retinoids utilize a complex signaling pathway to promote remodeling of photoaged epidermis and dermis, leading to improved cutaneous signs of photoaging 4
- Topical retinol treatment stimulates production of new, undamaged collagen, allowing fibroblasts to attach and receive mechanical information, balancing collagen production and degradation 3
- Hyaluronic acid production is increased by topical retinol treatment, contributing to improved skin moisture and reduced wrinkles 5