School of Medicine, New York Medical College, 40 Sunshine Road, Valhalla, NY, 10595, USA.
Department of Dermatology, Metropolitan Hospital, New York, NY, USA.
Am J Clin Dermatol. 2024 Nov;25(6):873-890. doi: 10.1007/s40257-024-00893-w. Epub 2024 Sep 30.
Many morphological and histological changes take place in aging skin. Topical tretinoin is the gold standard anti-aging agent used to reduce signs of aging through stimulation of epidermal growth and differentiation and inhibition of collagenase.
The aim of this systematic review is to summarize studies evaluating the efficacy of tretinoin compared with other topical medications and cosmeceuticals in reducing the appearance of skin aging.
A systematic review was conducted following the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. The literature search was conducted using the PubMed and Embase databases from conception to December 2023. Studies were included if they compared anti-aging outcomes of topical medications with those of topical tretinoin (also called all-trans retinoic acid and retinoic acid). Studies were excluded if they compared non-topical anti-aging treatments with tretinoin or were conducted on animal models.
The literature search resulted in 25 studies that met all inclusion and exclusion criteria. The most common study comparators to tretinoin included other forms of vitamin A. Outcomes were reported on the basis of visual reduction of aging signs, histological assessment of the epidermis and dermis, and protein expression. Although comparators to tretinoin had variable efficacy (greater in 7 studies, equivalent in 13 studies, and less in 3 studies), most studies found the comparator to be less irritating and better tolerated by patients than tretinoin.
Tretinoin is currently the gold standard therapy for the treatment of photoaging, but its poor tolerability often limits its use. Unfortunately, given that most studies comparing topical therapies with tretinoin are of poor quality and/or demonstrate bias, there is a lack of substantial evidence to support an alternative first-line therapy. However, given there are some data to support the efficacy of retinoid precursors, namely retinaldehyde, pro-retinal nanoparticles, and conjugated alpha-hydroxy acid and retinoid (AHA-ret), these agents can be considered a second-line option for anti-aging treatment in patients who cannot tolerate tretinoin.
衰老皮肤会发生许多形态和组织学变化。局部维甲酸是一种金标准的抗衰老药物，通过刺激表皮生长和分化以及抑制胶原酶来减少衰老迹象。
本系统评价旨在总结评估维甲酸与其他局部药物和化妆品在减少皮肤衰老外观方面疗效的研究。
按照系统评价和荟萃分析的首选报告项目（PRISMA）指南进行系统评价。文献检索使用 PubMed 和 Embase 数据库，从概念到 2023 年 12 月进行。如果比较了局部药物的抗衰老结果与局部维甲酸（也称为全反式视黄酸和视黄酸），则纳入研究。如果比较了非局部抗衰老治疗与维甲酸，或在动物模型上进行的研究，则排除在外。
文献检索产生了 25 项符合所有纳入和排除标准的研究。最常见的与维甲酸比较的研究对照物包括其他形式的维生素 A。结果是基于视觉上减少衰老迹象、表皮和真皮的组织学评估以及蛋白质表达来报告的。虽然维甲酸的对照物疗效不同（7 项研究中疗效更大，13 项研究中疗效相当，3 项研究中疗效更小），但大多数研究发现对照物比维甲酸刺激性更小，患者耐受性更好。
维甲酸目前是治疗光老化的金标准疗法，但由于其耐受性差，往往限制了其使用。不幸的是，由于大多数比较局部治疗与维甲酸的研究质量较差且/或存在偏倚，因此缺乏支持替代一线治疗的实质性证据。然而，鉴于有一些数据支持视黄醛、前视黄醇纳米颗粒、共轭α-羟基酸和视黄醇（AHA-ret）等视黄酸前体的疗效，这些药物可被视为不能耐受维甲酸的患者抗衰老治疗的二线选择。
