Clinical efficacy and patient tolerance of topical tretinoin therapy in photo-ageing.

A total of 89 patients (mean age 42 years) with clinical signs of photo-ageing were evaluated in an open study to determine the clinical efficacy and tolerance of topical tretinoin therapy. Each evening for 6 months about 1 cm of cream containing tretinoin was applied to the face. Patient compliance and tolerance were maximized by gradually increasing the tretinoin concentration in the cream over the treatment period: 0.01% tretinoin for 1 month, then 0.025% for 1 month and finally 0.05% for 4 months. By the end of the 6 months' treatment period, 95.8% of patients showed improvement in the clinical symptoms of photo-ageing (coarse and fine wrinkling, skin thinning, mottled hyperpigmentation and laxity), except for xerosis. During treatment, 17 (19.1%) patients withdrew from the study, in five (5.6%) this was due to treatment-related side-effects. Patient compliance was rated as excellent in 47.0% of cases, good in 48.5% and fair in 4.5%; tolerability was excellent in 51.4% of cases, good in 44.4% and fair in 4.2%. Improvements were confirmed by scanning electron microscopy, computerized profilometry and computerized image analysis of skin replicas of the same areas taken before and after treatment, with a reduction in width and depth of wrinkles, improved skin texture and increased follicle density.