Interventions for photodamaged skin

 

Abstract

Background

Photodamage describes skin changes such as fine and coarse wrinkles, roughness, freckles and pigmentation changes that occur as a result of prolonged exposure to the sun. Many treatments are available to reverse the damage, but it is unclear which work and at what cost in terms of unwanted side effects.

Objectives

To assess the effects of topically applied treatments, tablet treatments, laser and surgical procedures for photodamaged skin.

Search methods

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, Issue 1 2002, MEDLINE (1966-June 2002), EMBASE (1974-June 2002), Health Periodicals (1976-June 2002). We checked references of articles and communicated with authors and the pharmaceutical industry.

Selection criteria

Randomised controlled trials which compared drug or surgical interventions with no treatment, placebo or another drug, in adults with mild, moderate or severe photodamage of the face or forearms.

Data collection and analysis

Two reviewers independently extracted data and assessed trial quality.

Main results

Thirty studies of variable quality were included.

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). For example, the relative risk of improvement for 0.05% tretinoin cream, compared to placebo (3 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 (1 study) or 0.01% (3 studies). A dose-response relationship was evident for both effectiveness and skin irritation.

One small within-patient study showed benefit from topical ascorbic acid compared with placebo.

Tazarotene (0.01% to 0.1%) and isotretinoin (0.1%) both showed significant improvement over placebo for moderate photodamage (one study each).

There is limited evidence (one trial), to show that the effectiveness of 0.05% tretinoin, is equivalent to the effects of 0.05% and 0.1% tazarotene.

One small study showed greater improvement in upper lip wrinkles with CO₂ laser technique compared to Baker's phenol chemical peel, at six months.

Three small RCTs comparing CO₂ laser with dermabrasion found no difference in wrinkle score at four to six months, suggesting that both methods are equally efficacious, but more erythema was reported with the laser.

The effectiveness of other interventions such as hydroxy acids and natural polysaccharides was not clear.

Authors' conclusions

There is conclusive evidence that topical tretinoin improves the appearance of mild to moderate photodamage on the face and forearms, in the short-term. However erythema, scaling/dryness, burning/stinging and irritation may be experienced initially.

There is limited evidence that tazarotene and isotretinoin benefit patients with moderate photodamage on the face: both are associated with skin irritation and erythema. The effectiveness of other interventions remains uncertain.

 

Plain language summary

Treatments for sun-damaged (photodamaged) skin

Tretinoin cream improves skin changes (fine and coarse wrinkles, roughness, freckles and pigmentation) associated with prolonged sun exposure (photodamage). The greatest improvements occurred with higher concentrations of tretinoin, but at the expense of greater local irritation. Tazarotene and isotretinoin creams are also found to be effective, but again at the expense of skin irritation. More evidence is needed before any recommendations can be made on oral or topical polysaccharides or hydroxy acids. It is unclear how useful surgical, laser or chemical peels are in the absence of suitable control groups and both techniques lead to pain and redness after the procedure.

 

摘要

背景

對於光傷害皮膚的治療

光傷害是指在較長時間曝露在陽光之後造成的細紋或粗紋，粗糙感，雀斑以及色素改變。有很多治療可以逆轉這種傷害，但是到底哪一種治療有效以及有什麼樣的副作用並不清楚。

目標

評估各種治療對於光傷害皮膚的療效，包括外用治療、雷射、和外科手術。

搜尋策略

我們搜尋了Cochrane Central Register of Controlled Trials (CENTRAL) 2002年第一期，MEDLINE (1966到2002年6月) ，EMBASE (1974到2002年6月) ，Health Periodicals (1976到2002年6月) 。我們查詢文章的參考文獻並與作者和藥商溝通。

選擇標準

在輕微、中度、或重度皮膚光傷害的成人，比較藥物或手術治療在病人臉部或前臂，相對於無治療、安慰劑、或是其他藥物的隨機對照試驗。

資料收集與分析

兩位審查員獨立地調閱資料並評估試驗的品質

主要結論

總共收入了30個設計品質不一的臨床試驗。8個試驗指出濃度0.02% 以上的外用tretinoin藥膏比起安慰劑而言，對於輕度至重度臉上及前臂光傷害的受試者有較顯著的改善 (雖然大部份的試驗都有相當比例的人失去追蹤) 。舉例來說，在治療24週後，0.05% 的tretinoin比起安慰劑 (有3個試驗) 的相對改善機率為1.73倍 (95% 信賴區間為1.39至2.14) 。這種效果在0.001% 的外用tretinoin (1個試驗) 或是0.01% 的 (3個試驗) 都看不到。在效果和剌激性上都很明顯與劑量呈現正相關性。一個小型的病人內試驗顯示了維生素C比安慰劑更有好處。對於中度光傷害皮膚而言tazarotene (0.01% 至0.1%) 及isotretinoin (0.1%) 比起安慰劑而言有更顯著的改善效果 (各有一個試驗) 。有限的証據 (1個試驗) 顯示0.05% 的tretinoin藥膏效果相當於0.05% 和0.1% tazarotene藥膏。有一個小型試驗顯示在6個月的追蹤時，二氧化碳雷射比起Baker's phenol化學換膚對上唇細紋改善效果更好。有三個小型的隨機試驗顯示在4到6個月治療後，二氧化碳雷射比起磨皮而言，兩者在皺紋改善分數上無顯著差異；但是雷射產生的發紅較為明顯。其他治療的效果，像是hydroxy acids以及polysaccarides，還不是很明確。

作者結論

短期來說我們有結論性的証據證明外用tretinoin可以改善臉部和前臂輕度至中度的光傷害。然而一開始可能會有紅，脫皮/乾燥，燒灼感/剌痛感和剌激感。Tazarotene和isotretinoin對於臉部中度光傷害的好處其証據相當有限；兩者都會造成皮膚剌激和紅疹。其他治療的療效仍不確定。

翻譯人

本摘要由馬偕醫院黃政傑翻譯。

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

Tretinoin藥膏可以改善因長期日光照射 (光傷害) 引起的皮膚變化 (細紋和粗紋，粗糙，雀斑和色素) 。高濃度的tretinoin有最好的效果，但是局部剌激也最厲害。Tazarotene和isotretinoin藥膏也有效，但同樣的也會造成局部剌激。口服或者是外用的polysaccharides或hydroxy acid則需要更多的証據。由於沒有對照組，手術、雷射、或是化學換膚的效果如何則不得而知，而且每種治療皆會導致疼痛和發紅。