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  • A total of 180 studies were initially examined, of which 7 randomized controlled trials were included in this review.

  • Four studies included only women as their participants, while the rest demonstrated women as their majority subjects. All studies that indicated topical tretinoin were safe and well tolerated in all patients.

  • Topical tretinoin dosage varied from 0.025% to 5% while duration of treatment ranged from 3 months up to 24 months.

  • With regard to efficacy, all studies consistently reported that topical tretinoin was efficacious in improving clinical appearance of photoaging in terms of wrinkling, mottled hyperpigmentation, sallowness, and lentigines as early as 1 month and lasted after 24 months.

  • Facial movements and expressions, such as squinting or smiling, lead to fine lines and wrinkles. 

  • Each time you use a facial muscle, a groove forms beneath the surface of the skin.

  • As skin ages, it loses its flexibility and is no longer able to spring back in place like before. 

Common reported symptoms:

  • Fine lines, wrinkles and rough skin. 

  • Skin dullness, Visible pores.

  • Dry, Uneven skin tone.

Pharmacology treatments if recommended. Any bad reactions to these meds, STOP:

  •  Retinoids (tretinoin, Altreno, Retin-A, Renova, Tazorac). Among medical treatments, this is by far the most proven and effective way of bettering signs of aging such as uneven pigmentation, roughness, and wrinkling. 

  • Tazarotene is a potent retinol formulated to treat acne and fine lines. It works by enhancing cell turnover and promoting collagen production, thereby unclogging pores and improving skin texture.

Recommend non comedogenic oils/lotion, which don't clog pores and keep dry skin supple and oily skin acne-free. OTHERWISE, SKIN WILL BE FLAKY AND DRY. 

  • Grapeseed/Sunflower/Neem oil/Cetaphil. 

  • Sweet almond/ Hemp seed oil/Cerave.

Over all treatment efficacy 

  • Skin photoaging due to repeated exposure to UV light manifests as fine and coarse wrinkles, skin roughness, mottled hyperpigmentation, lentigines, and sallowness.

  •  At an advanced stage, it may progress into actinic keratosis and skin cancer.

  •  Various ingredients are currently available to address each of the clinical signs; however, formulation challenges still exist. This systematic review evaluated the use of tretinoin, which has been used for many years and is approved for the treatment of acne and photodamaged skin.

  • All included studies showed positive effects of tretinoin in improving the clinical appearance of photoaging.

  • Most studies found monotherapy of topical tretinoin could significantly improve wrinkling, mottled hyperpigmentation, sallowness, and lentigines, while 2 studies indicated no improvement of tactile roughness compared with placebo.14,15 Many publications have described the mechanism of tretinoin in improving fine and coarse wrinkles.26–28 Tretinoin counteracts the destruction of collagen and elastic fibers by inhibiting the regulation of MMPs.

  • It also induces MRC2 and prolidase to increase collagen-1 recycling.29 In the study by Kang et al.,15 subjects treated with topical tretinoin showed a significant increase in immunohistologic indicators of procollagen synthesis.

  • As a result, this leads to restoration of the dermal matrix, improved wrinkling, and skin laxity. Moreover, the majority of the articles found a vital role of tretinoin in improving UV-induced dyspigmentation.

  •  A study by Bagatin et al.10 on 128 subjects demonstrated that 71.9% of subjects showed improvement of melanosis after 24-week application of tretinoin 0.05% cream. 

  • Tretinoin has been shown to improve dyspigmentation by inhibiting tyrosinase, reducing melanosome transfer, and increasing the shedding of melanin-containing keratinocytes. However, in terms of hyperpigmentation, the study by Draelos18 found that 4% hydroquinone/retinol 0.3% cream was superior to tretinoin emollient in overall Melasma Area and Severity Index score and clinical evaluation of mottled hyperpigmentation. 

  • The potential ability of hydroquinone to reduce melanocyte pigmentation production may give advantage to this combination, while tretinoin primarily decreases melanosome transfer.  In addition, the application of tretinoin can also facilitate improved penetration of hydroquinone.

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