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Chapter 89: Photoaging

Noori Kim; Sewon Kang; Anna L. Chien

PHOTOAGING

Therapeutic Approach

Photoaging, also called extrinsic skin aging, is premature skin changes resulting from cumulative exposure to solar radiation. Primary clinical features of photoaging include fine and coarse wrinkles, dyspigmentation, altered skin texture, and loss of elasticity. Therapy should be based on the predominant features of photoaging and patient goals. In the authors’ experience, management of photoaging begins with prevention in the form of photoprotection. Topical therapy with a retinoid is usually initiated as first-line treatment. Procedural options can be added to enhance the therapeutic effects or in recalcitrant cases. See Table 89-1.

Table 89-1Photoaging Treatment Tableb
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Table 89-1 Photoaging Treatment Tableb
MEDICATION NAME INDICATION MECHANISM OF ACTION DOSING ADVERSE EFFECTS SUGGESTED MONITORING LEVEL OF EVIDENCE (REFERENCE)
Sunscreen            
Organic and inorganic Prevention of sunburn, fine wrinkles, dyspig- mentation Organic sunscreens absorb high-energy UV rays; inorganic sunscreens reflect or scatter light Various topical formulations, frequency of application dependent on activity and skin type Skin irritation, allergic contact dermatitis None IB1-2
Medical Therapy            
Tretinoin Fine wrinkles, dyspig- mentation Increases collagen production, induces epidermal hyperplasia, decreases keratinocyte and melanocyte atypia, inhibits matrix metalloproteinases 0.01%, 0.02%,a 0.025%, 0.04%, 0.05%,a 0.06%, 0.08%, 0.1% topical; apply nightly as tolerated Skin irritation (patient counseling and dose titration needed) None IA3-12
Tazarotene Fine wrinkles, dyspig- mentation Increases collagen production, induces epidermal hyperplasia, decreases keratinocyte and melanocyte atypia, inhibits matrix metalloproteinases 0.045%, 0.05%, 0.1%a topical; apply nightly as tolerated Skin irritation (patient counseling and dose titration needed) None IA9,10,13
Adapalene Fine wrinkles, dyspig- mentation Increases collagen production, induces epidermal hyperplasia, decreases keratinocyte and melanocyte atypia, inhibits matrix metalloproteinases 0.1%, 0.3% topical; apply nightly as tolerated Skin irritation (patient counseling and dose titration needed) None IB14-15
Fluorouracil Wrinkles, dyspig-mentation, altered skin texture Induces epidermal injury, wound healing, and remodeling of the dermal matrix 0.5%, 1%, 2%, 5% topical; apply daily to twice daily for 2-3 wk as tolerated Skin irritation (patient counseling needed) None IIB16-18
Cosmeceutical Therapy
Ascorbic acid Fine wrinkles, dyspig- mentation Antioxidant, increases collagen synthesis Various topical concentrations available, apply daily Generally well-tolerated, occasional mild skin irritation None IIB19-20
L-ascorbic acid, alpha-tocopherol, and ferulic acid Fine wrinkles, dyspig- mentation, UV-induced erythema Inhibits formation of thymine dimers and p53, reduces sun burn cells, downregulates IL-1α, IL-6, IL-8, IL-10 15% L-ascorbic acid, 1% alpha-tocopherol, and 0.5% ferulic acid, apply topically daily Generally well-tolerated, occasional mild skin irritation None IIB21
Niacinamide Fine wrinkles, dyspig- mentation Increases DNA excision repair and enhances repair of cyclobutane pyrimidine dimers and 8-oxo-7,8-dihydro-2′-deoxyguanosine Various topical concentrations available, apply daily Generally well-tolerated, occasional mild skin irritation None IIB22-23
Green tea Fine wrinkles, dyspig- mentation Induces IL-12 to increase the production of enzymes that repair UV-induced DNA damage, reduces UV-induced erythema, ...

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