Humphreys T R, Werth V, Dzubow L, Kligman A
Department of Dermatology, Hospital of the University of Pennsylvania, USA.
J Am Acad Dermatol. 1996 Apr;34(4):638-44. doi: 10.1016/s0190-9622(96)80065-x.
Photodamaged skin typically displays lentigines, actinic keratoses, wrinkles, and textural alteration. Chemical peeling has been used to treat these, but few controlled studies have been performed to determine its efficacy.
Our purpose was to compare the efficacy of a medium-depth chemical peel with and without tretinoin before and after treatment.
Sixteen men with actinic damage including actinic keratoses were treated with a 40% trichloroacetic acid(TCA) chemical peel. Half were pretreated for 6 weeks with topical tretinoin; they also used tretinoin after the peel. Photographs were obtained at baseline and at 6 weeks and 6 months after treatment. Changes in specific features were rated by a panel of three examiners.
Some improvement was noted in all patients. More rapid and even frosting was observed in the patients pretreated with tretinoin. Solar lentigines, actinic keratoses, and skin texture were the features of photoaging most affected; wrinkles were least affected. No statistically significant difference was found between patients treated with TCA and tretinoin (before and after peel) and those with TCA alone.
A medium-depth chemical peel with 40% TCA alone produced moderate improvement in some manifestations of actinic damage but had little effect on wrinkles. Treatment with tretinoin before and after TCA did not significantly enhance the efficacy of the peel.
光损伤皮肤通常表现为雀斑样痣、光化性角化病、皱纹和质地改变。化学剥脱术已被用于治疗这些问题，但很少有对照研究来确定其疗效。
我们的目的是比较在治疗前后，使用和不使用维甲酸的中度化学剥脱术的疗效。
16名患有包括光化性角化病在内的光损伤男性接受了40%三氯乙酸（TCA）化学剥脱术治疗。其中一半患者在术前6周外用维甲酸进行预处理；术后他们也继续使用维甲酸。在基线、治疗后6周和6个月时拍摄照片。由三名检查人员组成的小组对特定特征的变化进行评分。
所有患者均有一定改善。在使用维甲酸预处理的患者中观察到更快速且均匀的霜化现象。日光性雀斑样痣、光化性角化病和皮肤质地是受光老化影响最大的特征；皱纹受影响最小。在接受TCA加维甲酸治疗（术前和术后）的患者与仅接受TCA治疗的患者之间未发现统计学上的显著差异。
单独使用40% TCA进行中度化学剥脱术在光损伤的某些表现上产生了适度改善，但对皱纹影响不大。在TCA治疗前后使用维甲酸并未显著提高剥脱术的疗效。
