Currently, the best available topical anti-aging treatment is prescription tretinoin (Retin-A, Retin-A Micro, Renova, Avita, or generic). Tretinoin is also called vitamin A acid or retinoic acid; but it is a different chemical from regular vitamin A - one form of which is called retinol. A prescription is required for tretinoin because it produces significant changes in the structure of the skin.

Tretinoin was developed many years ago and is often prescribed for acne because it reduces sebum build-up in pores; but a large number of peer-reviewed medical studies done since the early 1980s also show that tretinoin can also improve fine lines, skin texture, and uneven pigmentation.

Pores and Scars

Tretinoin may also improve the appearance of large pores and some scars. It is has been shown conclusively that tretinoin acts to improve collagen in the dermis, thicken the epidermis, and smooth the skin surface. The effects are modest with most people, but a few people achieve significant improvement.

For medical studies, see for example "Treatment of Photodamage with Topical Tretinoin: an Overview", Journal of the American Academy of Dermatology, 36(3 Pt 2), S27-36, 1997 Mar; "Short- and Long-Term Histologic Effects of Topical Tretinoin on Photodamaged Skin," International Journal of Dermatology, 37(4), 286-292, 1998 Apr; "Treatment of Photoaged Skin With Topical Tretinoin," Skin Pharmacology, 6 Suppl 1(), 78-82, 1993; and "Topical Tretinoin Improves the Appearance of Photo Damaged Skin," Australasian Journal of Dermatology, 35(1), 1-9, 1994 (abstracts available free online using the medical index Medline at the National Library of Medicine, www.ncbi.nlm.nih.gov and at many other medical websites).

Tretinoin and related chemicals, called retinoids, are some of the most important discoveries in dermatology. In addition to tretinoin, other retinoids are available for treating skin conditions including adapalene (brand name Differin) and tazarotene (brand name Tazorac).

Currently, there are no published medical studies on adapalene as a treatment for photoaging, but tazarotene has recently been shown to be effective for this, though it may cause more irritation than tretinoin. See for example "Tazarotene Cream for the Treatment of Facial Photodamage," Archives of Dermatology, 137(12), 1597-1604, 2001; and "Efficacy of 0.1% Tazarotene Cream for the Treatment of Photodamage: A 12-Month Multicenter, Randomized Trial," Archives of Dermatology, 138(11), 1486-1493, 2002 Nov (abstracts available on Medline).

Preliminary results indicate that improvement with 0.1% tazarotene is comparable to 0.05% and 0.1% tretinoin. Tazarotene is not yet available as a generic in the U.S., and the brand name product Tazorac is more expensive than generic tretinoin. Further studies may be done to compare the effectiveness of tazarotene to tretinoin for photoaging. You can search on both words using Medline to check for the results of these studies.

Tretinoin Medical Studies

Ortho Pharmaceuticals has published before-and-after photos from the tretinoin medical studies online and in magazine ads that show significant improvement in fine lines and discoloration for some of the test subjects. In studies lasting from six months to one year, approximately 65% of the test subjects had some noticeable improvement in their skin appearance, though most had modest improvement. Nearly all subjects showed improvement to their skin under microscopic examination.

Net reviews of tretinoin are almost all positive, though people with sensitive skin often complain of some irritation. The results of the medical studies and anecdotal evidence over the years show that tretinoin is an effective topical treatment for photoaging, but it should not be considered a wrinkle cure.

Controversy

Initially, there was some controversy about tretinoin. It's effects were wildly exaggerated in the media, sometimes with help from doctors. Then the initial manufacturer got into trouble with the FDA for promoting tretinoin as a prescription wrinkle treatment before it had been approved for that use. Also, many people experienced irritation with some forms of tretinoin. Because of all this, you don't read nearly as much in the media today about tretinoin.

Another problem is that now only one brand of tretinoin cream called Renova can legally be advertised as a treatment for photoaging, though all forms contain the same active chemical. (This is an unfortunate consequence of FDA regulations.) However, doctors can also legally prescribe any other brand of tretinoin for general skin improvement, though this is called an "off-label use" if you don't have acne.

Most of the studies showing skin improvement with tretinoin have been done with a 0.05%-concentration formula. However, many people find that regular 0.05% tretinoin cream initially causes peeling and redness. They often give up on tretinoin because of this.

Tretinoin Tips

To avoid this possibility, it is best to start out with a tube of 0.025% cream. Initially, apply only a tiny amount to your face at night and check for peeling and redness the next day. You can use moisturizer during the day if necessary.

Work your way up gradually to no more than a pea-size amount nightly for the whole face. You can also apply a small amount to any other areas that have received a lot of sun exposure such as your ears, neck, chest, back, arms and hands. (Apply it only lightly to the ears or you will get a lot of peeling.) It is very important not to use tretinoin during the day because exposure to light, especially sunlight, will decrease its potency.

Don't apply other products to your face at the same time, since they could inactivate the tretinoin. The regular tretinoin creams are appropriate for most people because they are very light, and don't contain oils.

However, if you find the 0.025% cream too irritating, you can try Ortho's 0.02% or 0.05% Renova brand products, which are emollient creams for sensitive skin. If you have no problems with the regular .025% cream, your doctor can next prescribe the 0.05% cream.

People with more skin oil may be able to use the 0.1% cream or 0.1% Retin-A Micro, which is a special time-release formula usually used for acne. There is also a 0.025% gel that is more potent than the creams. However, the gel does not spread as easily, and it contains alcohol, which can be irritating. A very potent 0.05% alcohol-based liquid is also available, but most people find it too irritating, and it is easy to accidently spill it.