A Cochrane review [Abstract] 1 [withdrawn from publication] included 30 studies with a total of 3 319 subjects. Eight trials showed that topical tretinoin cream, in concentrations of 0.02% or higher, was superior to placebo for participants with mild to severe photodamage on the face and forearms (although losses to follow-up were relatively high in most studies). Relative risk of improvement for 0.05% tretinoin cream, compared to placebo (three studies), at 24 weeks, was 1.73 (95% confidence interval 1.39 to 2.14). This effect was not seen for 0.001% topical tretinoin (one study) or 0.01% (three studies). A dose-response relationship was evident for both effectiveness and skin irritation.
Tazarotene (0.01% to 0.1%) and isotretinoin (0.1%) both showed significant improvement over placebo for moderate photodamage (one study each). Effectiveness of 0.05% tretinoin appears to be equivalent to the effects of 0.05% and 0.1% tazarotene.
There is limited evidence of benefit from topical ascorbic acid compared with placebo, and CO2 laser technique compared with dermabrasion.
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