Current status of topical tretinoin in the treatment of photoaged skin.

In 1986, an open study was published which showed that tretinoin 0.05% applied topically to actinically damaged skin could partially reverse the clinical and histological signs of photoaging. These results stimulated other investigators to examine the effects of tretinoin on photodamaged, prematurely aged skin. Double-blind controlled studies in the United States and Europe have confirmed the original claims. Side effects have been limited to a variable irritant reaction (dryness, tightness, erythema) that subsides as the treated skin accommodates. Physicians must counsel patients to have realistic expectations; tretinoin is not a substitute for plastic surgery. Tretinoin is the centrepiece of a treatment programme which includes regular use of sunscreens and moisturisers along with avoidance of harmful behaviours, such as smoking, use of abrasives, and excessive washing.