Improvement In Photodamaged Skin Research Articles

Evaluation of a Neck Cream Developed to Enhance Nitric Oxide Availability in Aging Skin.

To meet the unique needs of aging skin of the neck, a new neck cream that enhances nitric oxide availability has been developed to visibly improve signs of aging and overall quality of skin. The primary objective of this dual center, open label clinical trial was to assess the efficacy and tolerability of the new neck cream applied twice daily over 12 weeks in aging women with mild-to-moderate lines and wrinkles of the neck (Group 1, N=26). A second group with mild-to-moderate lines and wrinkles and photodamage of the neck and décolleté (Group 2, N=10) applied the neck cream (AM/PM) in combination with a double-conjugated retinoid/alpha hydroxy acid (AHA-Ret; PM) to both the neck and décolleté over 12 weeks. Group 1 demonstrated significant improvements from baseline in the neck of 21% (P=.007) for wrinkles and lines, 27% (P=.004) for skin texture, and 26% (P=.003) for skin tone at 12 weeks. Significant improvements were also observed at 4 and 8 weeks. In Group 2, significant improvements were observed from baseline in the neck and décolleté areas with a 34% (P=.01) improvement in photodamaged skin in the décolleté area. The neck cream was well tolerated with few mild and transient adverse events. A new neck cream formulated to enhance nitric oxide availability to the skin when applied alone or in combination with AHA-Ret provided statistically significant improvements from baseline in skin appearance of the neck and décolleté, most notably in lines and wrinkles, skin texture, and skin tone. Robinson DM, Kaufman J, Giannini A, et al. Evaluation of a neck cream developed to enhance nitric oxide availability in aging skin. J Drugs Dermatol. 2023;22(9):881-886. doi:10.36849/JDD.7210.

4-Hexyl-1,3-phenylenediol, a nuclear factor-κB inhibitor, improves photodamaged skin and clinical signs of ageing in a double-blinded, randomized controlled trial.

The nuclear factor-κB (NF-κB) pathway is a key mediator of inflammation; however, few studies have examined the direct effects of NF-κB inhibition on the skin. To investigate NF-κB activity in cultured human fibroblasts and to investigate the effects of 4-hexyl-1,3-phenylenediol (an NF-κB inhibitor) on elastin and collagen gene expression in vitro and on the clinical appearance of photodamaged skin. The amount and activity of NF-κB in human fibroblasts obtained from donors (17-78 years old) was measured after transfection with a NF-κB reporter and a luciferase promoter system. The expression of extracellular matrix (ECM) genes was determined using quantitative polymerase chain reaction. Women with moderate skin photodamage were randomized to daily treatment with a topical lotion containing 4-hexyl-1,3-phenylenediol (n = 30) or vehicle (n = 29) for 8 weeks, with clinical assessments at baseline and weeks 2, 4 and 8. Fibroblasts obtained from donors older than 50 years had higher NF-κB activity compared with cells from younger donors; inhibition of the NF-κB pathway with 4-hexyl-1,3-phenylenediol enhanced the expression of ECM genes. In women, treatment for 8 weeks with 4-hexyl-1,3-phenylenediol significantly improved crow's feet fine lines, cheek wrinkles, age spots, mottled pigmentation and radiance compared with both the vehicle and baseline. Furthermore, treatment with 4-hexyl-1,3-phenylenediol resulted in a twofold greater clinical improvement in overall photodamage compared with the vehicle group. Inhibition of the proinflammatory NF-κB pathway resulted in increased expression of ECM proteins in vitro and significant clinical improvement in photodamaged skin.

Favre-Racouchot syndrome.

Favre-Racouchot syndrome.

Oral administration of French maritime pine bark extract (Flavangenol®) improves clinical symptoms in photoaged facial skin

BackgroundFrench maritime pine bark extract (PBE) has gained popularity as a dietary supplement in the treatment of various diseases due to its polyphenol-rich ingredients. Oligometric proanthocyanidins (OPCs), a class of bioflavonoid complexes, are enriched in French maritime PBE and have antioxidant and anti-inflammatory activity. Previous studies have suggested that French maritime PBE helps reduce ultraviolet radiation damage to the skin and may protect human facial skin from symptoms of photoaging. To evaluate the clinical efficacy of French maritime PBE in the improvement of photodamaged facial skin, we conducted a randomized trial of oral supplementation with PBE.MethodsOne hundred and twelve women with mild to moderate photoaging of the skin were randomized to either a 12-week open trial regimen of 100 mg PBE supplementation once daily or to a parallel-group trial regimen of 40 mg PBE supplementation once daily.ResultsA significant decrease in clinical grading of skin photoaging scores was observed in both time courses of 100 mg daily and 40 mg daily PBE supplementation regimens. A significant reduction in the pigmentation of age spots was also demonstrated utilizing skin color measurements.ConclusionClinically significant improvement in photodamaged skin could be achieved with PBE. Our findings confirm the efficacy and safety of PBE.

5‐Fluorouracil superficial peel for multiple actinic keratoses

Chronically photodamaged skin usually presents with multiple, widespread, actinic keratoses (AKs), and treatment of the entire affected area is recommended. We report our experience with a combination of Jessner's solution or 70% glycolic acid (GA) with 5% 5-fluorouracil (5-FU) solution for superficial pulse peeling used in the treatment of widespread AKs in 31 patients. Pulse peelings were performed at biweekly intervals. The endpoint for treatment was complete or maximum clearance of the lesions at clinical evaluation. Pre- and post-skin biopsy and histopathologic examination were performed in three patients for the purpose of demonstrating the pulse peel effects. All patients achieved a satisfactory result, including the complete regression, or at least 80% clearing, of AK lesions and an overall improvement of photodamaged skin. We consider this superficial 5-FU pulse peel to be a safe, well-tolerated, very effective, and highly inexpensive therapeutic option for the treatment of multiple, diffuse AKs. Its benefit/cost ratio will be of interest to public health services, mainly in developing countries.

Immunohistochemical expression of matrix metalloproteinases in photodamaged skin by photodynamic therapy

Photodynamic therapy (PDT) has been described for photoageing treatment, but its mechanism of action is not clarified. Although PDT-induced matrix metalloproteinase (MMP) expression and collagen production have been studied in normal skin and in inflammatory disease, there is no report about the effect of PDT on the extracellular matrix in photodamaged skin. To evaluate skin remodelling induced by methyl aminolaevulinate (MAL)-PDT in photodamaged skin by histological and immunohistochemical studies. Fourteen patients were treated with two sessions of MAL-PDT. The light source was a light-emitting diode (635 nm, 37 J cm(-2)). Skin biopsies were performed in all patients before and at 3 and 6 months after treatment. Immunohistochemical studies evaluated collagen types I and III, MMP-1, MMP-3, MMP-7, MMP-9, MMP-12 and tissue inhibitor of metalloproteinases-1. Global improvement in photodamaged skin was observed. A significant increase in expression of MMP-9 in the dermis was detected at 3 months after treatment (P = 0.002). Significant increases in the expression of collagen type I at 3 months (P = 0.002) and at 6 months after treatment (P = 0.001) were also observed. Skin remodelling induced by MAL-PDT was demonstrated in photodamaged skin. Two sessions of MAL-PDT increases immunohistochemical expression of MMP-9 in the dermis at 3 months after treatment, and also of collagen type I.

A Prospective Study of Fractional Scanned Nonsequential Carbon Dioxide Laser Resurfacing

Although unparalleled in its efficacy, carbon dioxide (CO2) laser resurfacing has a high risk:benefit ratio. A modified device uses a novel handpiece and software to deliver nonsequential fractional ablative CO2 laser exposures. To evaluate the safety and efficacy of this fractional ablative, scanned, nonsequential CO2 laser in the treatment of photo-damaged skin and to evaluate histologic and ultrastructural changes after the treatment. Ten subjects with Fitzpatrick skin types I to III with photo-damaged facial skin underwent a single CO2 ablative laser treatment using a scanning handpiece in a nonsequential fractional mode. Clinical improvement and histologic and ultrastructrural changes were assessed. All subjects completed the study with no serious or long-term complications. Blinded evaluator and subject assessment documented improvement in cutaneous photoaging. Light microscopy revealed changes consistent with a wound repair mechanism, and electron microscopy confirmed evidence of new collagen deposition. Nonsequential scanned fractional CO2 laser resurfacing can lead to improvement in photo-damaged skin, accompanied by histologic and ultrastructural evidence of wound repair and subsequent new collagen formation.

Evaluation of plasma skin regeneration technology for cutaneous remodeling

Plasma skin regeneration is a novel type of skin rejuvenation technology developed over the last 3 years. Plasma is the fourth state of matter in which electrons are stripped from atoms to form an ionized gas. Although high-temperature plasmas have been used in surgery for over a decade, plasma had previously been used as a conduction medium for electric current. Unlike lasers, which rely on the principle of selective photothermolysis to deliver heat to specific targets in the skin, plasma technology delivers heat energy directly to tissue upon contact without reliance on skin chromophores. The plasma itself produces controlled thermal damage to the skin surface to elicit changes such as new collagen formation and improvement in photodamaged skin. The technology can be used at varying energies for different depths of effect, from superficial epidermal effects to deeper dermal heating.

Split-Face Comparison of Photodynamic Therapy with 5-Aminolevulinic Acid and Intense Pulsed Light Versus Intense Pulsed Light Alone for Photodamage

Photodynamic therapy (PDT) with a 5-aminolevulinic acid (ALA) photosensitizing agent and a variety of lasers and light sources has been shown to enhance the treatment of photodamaged skin and its associated actinic keratoses (AKs). The efficacy of short-contact, full-face ALA by PDT in photorejuvenation has also been demonstrated. To evaluate short-contact (30 to 60 min) ALA-PDT with intense pulsed light (IPL) activation by comparing ALA-PDT-IPL with IPL alone. METHODS Sixteen patients were enrolled in a split-face study. One side of each patient's face received ALA-PDT-IPL and the other side received IPL alone. Three treatments were given at 1-month intervals, and follow-up visits occurred at 1 and 3 months after the final treatment. Thirteen patients completed the trial. Three months after the final treatment, improvement was greater in the ALA-PDT-IPL side than in IPL-alone side for all facets of photodamage-crow's feet appearance (55 vs 29.5%), tactile skin roughness (55 vs 29.5%), mottled hyperpigmentation (60.3 vs 37.2%), and telangectasias (84.6 vs 53.8%). The clearance rate of AK lesions was also higher (78 vs 53.6%). Short-contact ALA-PDT-IPL brings about greater improvement in photodamaged skin and greater clearance of AK lesions than IPL alone, further confirming the usefulness of ALA-PDT in photorejuvenation.

Split-Face Comparison of Photodynamic Therapy with 5-Aminolevulinic Acid and Intense Pulsed Light Versus Intense Pulsed Light Alone for Photodamage

BACKGROUND Photodynamic therapy (PDT) with a 5-aminolevulinic acid (ALA) photosensitizing agent and a variety of lasers and light sources has been shown to enhance the treatment of photodamaged skin and its associated actinic keratoses (AKs). The efficacy of short-contact, full-face ALA by PDT in photorejuvenation has also been demonstrated. OBJECTIVE To evaluate short-contact (30 to 60 min) ALA-PDT with intense pulsed light (IPL) activation by comparing ALA-PDT-IPL with IPL alone. METHODS Sixteen patients were enrolled in a split-face study. One side of each patient's face received ALA-PDT-IPL and the other side received IPL alone. Three treatments were given at 1-month intervals, and follow-up visits occurred at 1 and 3 months after the final treatment. RESULTS Thirteen patients completed the trial. Three months after the final treatment, improvement was greater in the ALA-PDT-IPL side than in IPL-alone side for all facets of photodamage—crow's feet appearance (55 vs 29.5%), tactile skin roughness (55 vs 29.5%), mottled hyperpigmentation (60.3 vs 37.2%), and telangectasias (84.6 vs 53.8%). The clearance rate of AK lesions was also higher (78 vs 53.6%). CONCLUSION Short-contact ALA-PDT-IPL brings about greater improvement in photodamaged skin and greater clearance of AK lesions than IPL alone, further confirming the usefulness of ALA-PDT in photorejuvenation.

A Prospective Controlled Assessment of Microdermabrasion for Damaged Skin and Fine Rhytides

Aged skin is characterized by rhytides but also by epidermal and dermal atrophy, rough skin texture, irregular pigmentation, telangiectasias, and laxity. Microdermabrasion is an office-based mechanical resurfacing technique alternative to traditional dermabrasion. It has been used in Europe since 1992 with great acceptance. The purpose of this study was to evaluate and quantify the degree of visible improvement in photodamaged skin and fine rhytides following a series of microdermabrasion treatments. A single operator treated 20 patients with varying degrees of photodamage and rhytides with a series of eight microdermabrasion treatments at 1-week intervals; 17 subjects completed the entire study protocol. Standardized photographic documentation was performed before and after each treatment, and a survey questionnaire was completed by each subject. Punch biopsy specimens (3 mm) were collected on treated and matched nontreated control sites and evaluated for histological characteristics. Preprocedure and postprocedure photographs were rated on a 5-point scale by independent blinded observers. A total of 30 blinded observers (16 plastic surgeons and 14 laypersons) rated all photographs. The results showed that all observers rated a significant improvement of hyperchromic discoloration (p = 0.004), while only nonmedical observers observed improvement in fine rhytides. All patients were very satisfied with the results. Common side effects were mild to moderate discomfort occurring on bony areas during the treatment and an itching and tingling sensation for 2 days after treatment. No infections or scars were observed postoperatively. The average epidermal thickness in the untreated samples was 103 +/- 23 microM (mean +/- SD) before treatment compared with 148 +/- 41 microM after treatment (p < 0.001). Histologic analysis of the matched punch biopsy specimens showed an increase in organized collagen in treated versus nontreated sites. Treatment of aged skin using a series of microdermabrasion treatments is an effective, noninvasive method of skin rejuvenation with minimal risk and patient downtime. It is safe and improves skin quality by minimizing certain hyperchromic pigmentations.

Nonablative dermal remodeling with a 585-nm, 350-microsec, flashlamp pulsed dye laser: clinical and ultrastructural analysis.

A nonablative 350-microsec, 585-nm, flashlamp pulsed dye laser is currently being used for the treatment of rhytides. To analyze both clinical rhytid improvement and electron microscopic evidence of ultrastructural changes after treatment with a nonablative 350-microsec, 585-nm, flashlamp pulsed dye laser. At 6 months after two treatments, 40% of the treated subjects noted mild improvement in rhytid appearance. Nontreating physician evaluation revealed some degree of improvement in 50% of the treated subjects. Mild improvement in quality and texture of the skin was also reported by 50% of the subjects. Electron microscopic evaluation showed ultrastructural changes that are consistent with new collagen formation. Treatment with a nonablative 350-microsec, 585-nm, flashlamp pulsed dye laser can lead to both clinical and electron microscopic evidence of improvement in photo-damaged skin.

ERBIUM:YAG CUTANEOUS LASER RESURFACING

The short-pulsed Er:YAG laser system is an excellent ablative tool for cutaneous resurfacing. This system is most efficacious for patients with milder cutaneous involvement, including mild photoinduced facial rhytides, mildly atrophic scars, and textural changes caused by fibrosis and dermatochalasis. The Er:YAG laser cannot achieve the same dramatic clinical and histologic improvements produced with the CO2 laser but does offer some distinct advantages that make it a valuable addition to the laser surgeon's armamentarium. The Er:YAG laser, because of its higher affinity for water-containing tissues, effects a much finer level of tissue ablation. Although erbium laser resurfacing results in decreased postoperative morbidity with a shorter recovery period, it cannot effect the same degree of improvement in photodamaged skin as can the CO2 laser. Excellent results, however, can be achieved with this laser, up to 50% or more overall clinical improvement, in patients with milder photodamage and scarring (Glogau classes I and II). In darker-skinned patients, the Er:YAG laser is often the preferred treatment modality. Continued research in the field has already led to the development of longer-pulsed Er:YAG lasers, which offer a compromise between the CO2 laser and the short-pulsed Er:YAG lasers in terms of clinical benefits while maintaining the safety profile of the traditional short-pulsed system. In addition, many surgeons now use a combination approach with the CO2 and Er:YAG lasers in an effort to maximize collagen contraction in certain areas and limit postoperative morbidity. As more research is conducted within the field of cutaneous resurfacing, newer systems will be developed in the continuing effort to create the ideal laser system--one which ameliorates the signs of photoaging without risk of major side effects or significant postoperative recovery.

Noninvasive rejuvenation of photodamaged skin using serial, full-face intense pulsed light treatments.

Photodamaged skin is characterized not only by rhytides, but also by epidermal and dermal atrophy, rough skin texture, irregular pigmentation, telangiectasias, laxity, and enlarged pores. There is growing interest in the development of noninvasive methods to treat photodamaged skin. Skin photorejuvenation is the visible improvement of photodamaged skin using a laser or other light source. A noncoherent, broadband, pulsed light source is effective in the treatment of vascular and pigmented lesions of the skin. This study evaluates the role of intense pulsed light in the rejuvenation of photo aged skin. The purpose of this study was to evaluate and quantify the degree of visible improvement in photodamaged skin following a series of full-face, intense pulsed light treatments. Forty-nine subjects with varying degrees of photo-damage were treated with a series of four or more full-face treatments at 3-week intervals using a nonablative, nonlaser intense pulsed visible light source. Fluences varied from 30 to 50 J/cm2. Subject evaluation and skin biopsies were used to assess treatment results. All aspects of photodamage including wrinkling, skin coarseness, irregular pigmentation, pore size, and telangiectasias showed visible improvement in more than 90% of subjects with minimal downtime and no scarring. Eighty-eight percent of subjects were satisfied with the overall results of their treatments. Treatment of photodamaged facial skin using a series of full-face treatments with intense pulsed light is a new and effective noninvasive method of skin rejuvenation with minimal risk and no patient downtime.

Ultrastructure of collagen thermally denatured by microsecond domain pulsed carbon dioxide laser.

Clinical improvement in photodamaged skin after carbon dioxide (CO2) laser resurfacing is thought to result in part from thermal collagen shrinkage. The presence of such collagen has not been unequivocally demonstrated. To identify and characterize the morphological features of collagen after CO2 laser exposure, we irradiated ex vivo human facial skin and bovine calcaneus tendon with microsecond domain pulsed CO2 laser energy and examined specimens for histopathological and ultrastructural changes in collagen. In dermis and tendon, 3 zones of collagen structure were apparent on electron microscopy. The first, most superficial zone demonstrated loss of collagen structure. The second zone consisted of admixed normal collagen fibers and thickened collagen fibers. Zone 3 consisted of normal-appearing collagen fibers. Ultrastructural examination of irradiated collagen revealed distinct morphological zones of denatured collagen fibers. Partially denatured fibers had an increased diameter consistent with lineal shrinkage. Zonal distinction was undetectable by light microscopy. Ultrastructurally, the zones of denatured collagen located above the normal fibers correlated with the zone of altered material seen on light microscopy. These findings suggest that collagen fiber shrinkage does occur after pulsed CO2 laser irradiation and that this phenomenon contributed, at least in part, to the immediate tissue contraction observed clinically.

Sustained improvement in photodamaged skin with reduced tretinoin emollient cream treatment regimen: Effect of once-weekly and three-times-weekly applications

Background: Previous studies have documented reversal of long-term photodamage with once-daily applications of topical tretinoin. Objective: Our purpose was to assess the effectiveness of tretinoin emollient cream in maintaining improvement in photodamage with a reduced frequency of applications. Methods: A total of 126 subjects who completed 48 weeks of once-daily treatment with tretinoin emollient cream 0.05% were enrolled for an additional 24 weeks of tretinoin once weekly, three times weekly, or no therapy. Results: The clinical improvement observed during 48 weeks of once-daily treatment was sustained with three-times weekly applications and to a lesser extent with once-weekly dosing, whereas effects tended to regress in subjects off therapy. The overall incidence of adverse events in the skin and subcutaneous tissues appeared to vary with dose frequency. Conclusion: After 48 weeks of once-daily treatment, the continued use of tretinoin emollient cream 0.05% at a dose of three times per week maintains and, in some cases, may further enhance improvement in photodamage. Discontinuation of therapy results in some reversal of beneficial effects. (J Am Acad Dermatol 1997;37:227-30.)

Topical Tretinoin for Treatment of Photodamaged Skin

The clinical and histologic effects of a new emollient cream formulation of topical tretinoin at concentrations of 0.05% and 0.01% were examined in 251 subjects with mild to moderate photodamaged facial skin in a randomized, double-blind, vehicle-controlled, multicenter study. Seventy-nine percent of the subjects who received 0.05% tretinoin for 24 weeks showed overall improvement in photodamaged skin compared with improvement in 48% of the vehicle-treated control subjects. Significant reductions were found in fine wrinkling, mottled hyperpigmentation, roughness, and laxity after 0.05% tretinoin therapy when compared with controls. In addition, histologic changes of increased epidermal thickness, decreased melanin content, and stratum corneum compaction provide independent evidence supporting clinical improvement. Side effects of erythema, peeling, and stinging were usually mild and well tolerated.