Current and new treatments of photodamaged skin.

Patients with photodamaged skin need guidance in selecting treatment plans that optimize outcomes, minimize downtime, and reduce adverse effects. The gold standard among cosmeceuticals is the topical retinoids, such as tretinoin. A topical formulation of folic acid and creatine appears to be a viable treatment option for the treatment of photodamaged skin. The use of specific topical cosmeceuticals in combination with nonablative photorejuvenation is recommended in choosing modalities that address the concerns of the patient. A combination of intense pulsed light (IPL), low-intensity diode light, and biostimulating drugs has been shown to provide results superior to those of IPL alone for photorejuvenation. Photodynamic therapy (PDT) with 5-aminolevulinic acid (5-ALA) is the treatment of choice for type C photodamage. Low-strength 5-ALA (1 to 2%) applied several times, every 10 to 15 minutes, and incubated for 30 to 60 minutes with 550 to 630 nm, 530 to 1200 nm, or 570 to 1200 nm light activation improved hyperpigmented lesions, skin smoothing, and skin elasticity with high patient satisfaction. The use of 0.5% liposome-encapsulated 5-ALA spraying has been shown to be an alternative to 20% 5-ALA in a cream base in patients undergoing photorejuvenation. Adipose-derived stem cells and their derived secretory factors may have potential as treatments of photodamage.