title: Treatment of photodamaged skin with trichloroacetic acid and topical tretinoin.
abstract: BACKGROUND
  Photodamaged skin typically displays lentigines, actinic keratoses, wrinkles, and textural alteration. Chemical peeling has been used to treat these, but few controlled studies have been performed to determine its efficacy.
  
  
  OBJECTIVE
  Our purpose was to compare the efficacy of a medium-depth chemical peel with and without tretinoin before and after treatment.
  
  
  METHODS
  Sixteen men with actinic damage including actinic keratoses were treated with a 40% trichloroacetic acid(TCA) chemical peel. Half were pretreated for 6 weeks with topical tretinoin; they also used tretinoin after the peel. Photographs were obtained at baseline and at 6 weeks and 6 months after treatment. Changes in specific features were rated by a panel of three examiners.
  
  
  RESULTS
  Some improvement was noted in all patients. More rapid and even frosting was observed in the patients pretreated with tretinoin. Solar lentigines, actinic keratoses, and skin texture were the features of photoaging most affected; wrinkles were least affected. No statistically significant difference was found between patients treated with TCA and tretinoin (before and after peel) and those with TCA alone.
  
  
  CONCLUSIONS
  A medium-depth chemical peel with 40% TCA alone produced moderate improvement in some manifestations of actinic damage but had little effect on wrinkles. Treatment with tretinoin before and after TCA did not significantly enhance the efficacy of the peel.
authors.affiliation: Department of Dermatology, Hospital of the University of Pennsylvania, USA.
authors.forename: T R
authors.initials: TR
authors.lastname: Humphreys
authors.forename: V
authors.initials: V
authors.lastname: Werth
authors.forename: L
authors.initials: L
authors.lastname: Dzubow
authors.forename: A
authors.initials: A
authors.lastname: Kligman
mesh_terms: D000279:Administration, Cutaneous; D001419:Bacteria / Q000302:isolation & purification; D002280:Basal Cell Carcinoma / Q000175:diagnosis; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis; D002615:Chemexfoliation; D005500:Follow-Up Studies; D006801:Humans; D007641:Keratolytic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D007642:Keratosis / Q000188:drug therapy*; D007911:Lentigo / Q000188:drug therapy*; D008297:Male; D017060:Patient Satisfaction; D010781:Photography; D011292:Premedication; D012629:Sebum / Q000187:drug effects / Q000378:metabolism; D012867:Skin / Q000187:drug effects / Q000378:metabolism / Q000382:microbiology; D015595:Skin Aging / Q000187:drug effects*; D012878:Skin Neoplasms / Q000175:diagnosis; D014212:Tretinoin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D014238:Trichloroacetic Acid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D007641:Keratolytic Agents; D014212:Tretinoin; D014238:Trichloroacetic Acid