The Effectiveness of a 5% Retinoic Acid Peel Combined with Microdermabrasion for Facial Photoaging: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial

Hindawi Dermatology Research and Practice Volume 2017, Article ID 8516527, 6 pages https://doi.org/10.1155/2017/8516527 Clinical Study The Effectiveness of a 5% Retinoic Acid Peel Combined with Microdermabrasion for Facial Photoaging: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial Gita Faghihi,1 Saghi Fatemi-Tabaei,1 Bahareh Abtahi-Naeini,2,3 Amir Hossein Siadat,1 Giti Sadeghian,3 Mohammad Ali Nilforoushzadeh,4 and Hamed Mohamadian-shoeili5 1 Skin Diseases and Leishmaniasis Research Center, Department of Dermatology, Isfahan University of Medical Sciences, Isfahan, Iran Cancer Research Center, Semnan University of Medical Sciences, Semnan, Iran 3 Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran 4 Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran 5 Department of Internal Medicine, Kermanshah University of Medical Science, Imam Reza Hospital, Kermanshah, Iran 2 Correspondence should be addressed to Saghi Fatemi-Tabaei; Received 7 September 2016; Revised 8 December 2016; Accepted 21 December 2016; Published 15 February 2017 Academic Editor: Bruno A. Bernard Copyright © 2017 Gita Faghihi et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Tretinoin has been shown to improve photoaged skin. This study was designed to evaluate the efficacy and tolerability of a 5% retinoic acid peel combined with microdermabrasion for facial photoaging. Materials and Methods. Forty-five patients, aged 35–70, affected by moderate-to-severe photodamage were enrolled in this trial. All patients received 3 sessions of full facial microdermabrasion and 3 sessions of either 5% retinoic acid peel or placebo after the microdermabrasion. Efficacy was measured using the Glogau scale. Patients were assessed at 2 weeks and 1, 2, and 6 months after treatment initiation. Results. The mean ± SD age of participants was 49.55 ± 11.61 years, and the majorities (73.3%) were female. Between 1 month and 2 months, participants reported slight but statistically significant improvements for all parameters (𝑃 < 0.001). In terms of adverse effects, there were statistically significant differences reported between the 5% retinoic acid peel groups and the control group (𝑃 < 0.001). The majority of adverse effects reported in the study were described as mild and transient. Conclusion. This study demonstrated that 5% retinoic acid peel cream combined with microdermabrasion was safe and effective in the treatment of photoaging in the Iranian population. This trial is registered with IRCT2015121112782N8. 1. Introduction Facial skin aging is characterized by wrinkles, laxity, roughness, lentigines, telangiectasia, and actinic keratosis [1–3]. Skin aging is influenced by several factors including genetics, environmental exposure (including Ultra-Violate (UV) radiation, xenobiotics, and mechanical stress), hormonal changes, and metabolic processes [4]. Solar UV radiation, via the process of photoaging, is the single mostcommon factor responsible for skin aging [5]. Many treatment options are available to control and reverse photoaging in facial skin [4]. Clinical studies as well as histological data suggest that tretinoin improves facial appearance following photodamage if used in the proper way [4]. In several double-blind, placebo-controlled studies, the efficacy of topical tretinoin was evaluated as a treatment for photoaging [6, 7]. Chemical peelings have also been found to be an effective treatment for moderate to severe photoaging [8]. Over the last few years, the number of clinical studies researching combination therapies to find more effective clinical treatments and cosmetic procedures for photoaging has increased [9]. Beneficial effects from microdermabrasion followed by a 5% retinoic acid chemical peel have been reported in a small study [10]. To the best of our knowledge, the long-term benefits of a combination of 5% retinoic acid peel with microdermabrasion for moderate to severe photoaging have not been 2 Dermatology Research and Practice Table 1: Glogau classification of photoaging. Group Classification Typical age Description I Mild 28–35 No wrinkles II Moderate 35–50 Wrinkles in motion III Advanced 50–65 Wrinkles at rest IV Severe 60–75 Only wrinkles studied in a randomized, double-blind, placebo-controlled study. Therefore, we investigated the efficacy and safety of a much higher concentration of topical 5% retinoic acid peel cream combined with microdermabrasion in patients with photoaging during a 6-month follow-up period after treatment initiation. 2. Materials and Methods 2.1. Participants. This was a randomized, comparative, split-face, evaluator-blinded clinical study. The Institutional Review Board of Isfahan University of Medical Sciences, Isfahan, Iran, approved the protocol of this study (Grant Number 394084). Written informed consent was obtained from each patient before enrollment. The participants were comprised of 45 healthy Caucasian subjects with Fitzpatrick skin prototypes II and III, aged 35–70 years, who either attended or were referred to the dermatology clinics of Al-Zahra and Noor hospitals for the treatment of moderate to severe facial photoaging according to the Glogau classification (Table 1). Patients were not included in the study if they had been pregnant, were breastfeeding, had any genodermatoses which may interfere with aging skin changes, showed premature aging, were using other concomitant treatments, had connective tissue disorders, were previously treated with oral retinoids in the six months prior to the study, used superficial chemical peels or microdermabrasion in the three months prior to the study, received medium or deep chemical peels or laser ablation within six months of the study, met the criteria for alcohol addiction, had infectious or inflammatory facial dermatoses, had photodermatosis, and did not need to avoid sun exposure. 2.2. Interventions. After cleaning the skin, all patients received a microdermabrasion treatment (30 cmHg, aluminum oxide crystals, Zagromed) symmetrically across their entire face, without causing bleeding. After removing the crystals with 0.9% normal saline (0.9% sodium chloride, PLC, Tehran, Iran), a thin layer of each peel was applied a single time on each side of the face, with the control or intervention peel selected randomly. Faces were washed 4 hours after the Skin characteristics Early photoaging: mild pigment changes, no keratosis, minimal wrinkles, minimal or no makeup Early to moderate photoaging: early brown spots visible, keratosis palpable but not visible, parallel smile lines begin to appear, wears some foundation Advanced photoaging: obvious discolorations, visible capillaries (telangiectasia), visible k (...truncated)