The Experts below are selected from a list of 321 Experts worldwide ranked by ideXlab platform
John J Voorhees - One of the best experts on this subject based on the ideXlab platform.
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Tretinoin treatment of photodamaged skin : cosmesis through medical therapy
Dermatologic Clinics, 2018Co-Authors: Jonathan Weiss, Michael T. Goldfarb, Charles N. Ellis, John J VoorheesAbstract:Topical Tretinoin has been used effectively to ameliorate wrinkles and other cosmetic deficiencies caused by excessive photodamage. Unlike that of simple cosmetics, the use of topical Tretinoin requires the guidance of an experienced dermatologist. This article reviews the use of topical Tretinoin in the treatment of photodamaged skin, contrasting its use to that of a simple cosmetic.
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Photoaging therapy with topical Tretinoin: an evidence-based analysis.
Journal of the American Academy of Dermatology, 1998Co-Authors: Sewon Kang, John J VoorheesAbstract:Topical Tretinoin is established as an effective treatment for photoaging. Yet some confusion still exists about the proper way to use this medication, confusion that can misguide physicians in their clinical approaches and patients in their treatment regimens. Most of the misinformation about Tretinoin has been perpetuated from the early days of the drug, when its efficacy for treating the effects of photoaging was still in dispute. Significant advances in clinical and basic research in this area have dispelled much of the confusion, clearing the way for an evidence-based medical approach to Tretinoin therapy for photoaging. This review summarizes recent relevant advances in Tretinoin therapy to guide physicians in treating patients with this safe and effective hormone. To date, Tretinoin remains the only therapeutic agent proved to repair photodamage.
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concurrent application of Tretinoin retinoic acid partially protects against corticosteroid induced epidermal atrophy
British Journal of Dermatology, 1996Co-Authors: A J Mcmichael, Ted A Hamilton, L J Finkel, C E M Griffiths, Harvinder S Talwar, Elyse S Rafal, John J VoorheesAbstract:Summary Cutaneous atrophy arising from prolonged use of potent topical corticosteroids has long been a concern. Thus, it would be advantageous to find an agent which protects against atrophy produced by corticosteroids but at the same time does not impair their anti-inflammatory effects. Recent work shows that topical all-trans retinoic acid (Tretinoin) prevents skin atrophy in mice treated with topical corticosteroids, but such studies have not been performed in humans. We performed an 8-week clinical, histological and biochemical study to test the ability of Tretinoin to enhance efficacy and inhibit atrophogenicity of topical corticosteroids, when used in the treatment of psoriasis. In each of 20 psoriasis patients, one plaque, and its perilesional skin, was treated once daily with betamethasone dipropionate and Tretinoin 0·1%, and one plaque, and its perilesional skin, treated with once daily betamethasone dipropionate and Tretinoin vehicle. There was no difference in the speed or degree of improvement in plaques treated with either the topical corticosteroid/Tretinoin combination or with corticosteroid alone. Light microscopy revealed a 19% reduction in epidermal thickness, in corticosteroid-treated perilesional skin, as compared with a slight (1%) increase in corticosteroid/ Tretinoin-treated perilesional areas (P= 0.067). Western blot analysis showed a 55% reduction in procollagen I aminopropeptide in perilesional skin treated with corticosteroid alone, as compared with a 45% reduction in corticosteroid/Tretinoin-treated perilesional skin. These data indicate that the addition of Tretinoin does not impair the efficacy of a topical corticosteroid, in the treatment of psoriasis, and partially ameliorates epidermal atrophy produced by the topical corticosteroid.
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two concentrations of topical Tretinoin retinoic acid cause similar improvement of photoaging but different degrees of irritation a double blind vehicle controlled comparison of 0 1 and 0 025 Tretinoin creams
Archives of Dermatology, 1995Co-Authors: Christopher E M Griffiths, Charles N. Ellis, Ted A Hamilton, Sewon Kang, Kwang J Kim, L J Finkel, Lissette C Ortizferrer, Gary M White, John J VoorheesAbstract:Background and Design: The efficacy of topical Tretinoin (all- trans -retinoic acid) in treating photoaging is well established. Questions that remain are (1) whether irritation causes all or part of the improvement; (2) the concentration of Tretinoin that maximizes clinical response with minimal side effects; and (3) the effects of long-term treatment on components of the cutaneous immune system. To address these issues, 99 photoaged patients completed a 48-week study using 0.1% Tretinoin cream (n=32), 0.025% Tretinoin (n=35), or vehicle (n=32) once daily in a double-blind manner. Before and after treatment, we assessed histologic features, keratinocyte expression of HLA-DR and intercellular adhesion molecule-1, numbers of epidermal Langerhans' cells and epidermal and dermal T lymphocytes, and vascularity as measured by dermal endothelial cell area. Results: Both 0.1% and 0.025% Tretinoin produced statistically significant overall improvement in photoaging of the face compared with vehicle; there were no clinically or statistically significant differences in efficacy between the two concentrations of Tretinoin. After 48 weeks, 0.1% and 0.025% Tretinoin produced similar statistically significant epidermal thickening (by 30% and 28%, respectively) compared with vehicle (11% decrease) and increased vascularity (by 100% and 89%, respectively) compared with vehicle (9% decrease). By various analyses, irritant side effects (erythema and scaling) were statistically significantly greater with 0.1% Tretinoin than with 0.025% Tretinoin. No significant changes occurred in any immunologic markers when Tretinoin and vehicle treatments were compared. Conclusions: Tretinoin 0.1% and 0.025% produce similar clinical and histologic changes in patients with photoaging, despite significantly greater incidence of irritation with the higher concentration. The separation between clinical improvement and irritation suggests that mechanisms other than irritation dominate Tretinoininduced repair of photoaging in humans. (Arch Dermatol. 1995;131:1037-1044)
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topical retinoic acid Tretinoin for melasma in black patients a vehicle controlled clinical trial
Archives of Dermatology, 1994Co-Authors: Candance Kimbroughgreen, Christopher E M Griffiths, Ted A Hamilton, Charles Ellis, L J Finkel, Stella M Bulengoransby, John J VoorheesAbstract:Background and Design: Melasma is an acquired, masklike, facial hyperpigmentation. The pathogenesis and treatment of melasma in black (African-American) patients is poorly understood. We investigated the efficacy of topical 0.1% all-trans-retinoic acid (Tretinoin) in the treatment of melasma in black patients. Twenty-eight of 30 black patients with melasma completed a 10-month, randomized, vehicle-controlled clinical trial in which they applied either 0.1% Tretinoin or vehicle cream daily to the entire face. They were evaluated clinically (using our Melasma Area and Severity Index), colorimetrically, and histologically. Results: After 40 weeks, there was a 32% improvement in the Melasma Area and Severity Index score in the Tretinoin treatment group compared with a 10% improvement in the vehicle group. Colorimetric measurements showed lightening of melasma after 40 weeks of Tretinoin treatment vs vehicle. Lightening of melasma, as determined clinically, correlated well with colorimetric measurements. Histologic examination of involved skin revealed a significant decrease in epidermal pigmentation in the Tretinoin group compared with the vehicle group. Side effects were limited to a mild ''retinoid dermatitis'' occurring in 67% of Tretinoin-treated patients. Among the patients in this study in comparison with comparably recruited white patients, melasma was reported to have begun at a later age and was more likely to be in a malar distribution. Conclusions: This controlled study demonstrates that topical 0.1% Tretinoin lightens melasma in black patients, with only mild side effects. (Arch Dermatol. 1994;130:727-733)
Christopher E M Griffiths - One of the best experts on this subject based on the ideXlab platform.
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Treatment Options for Photodamaged Skin
Skin Pharmacology and Physiology, 2009Co-Authors: Christopher E M GriffithsAbstract:Photodamage of the skin can be a detriment to physical and psychological health with a consequent negative impact on both personal and professional life. Medical treatments for photodamaged skin include topical all-trans-retinoic acid (Tretinoin) as well as moisturizers, chemical peels, dermabrasion, Α hydroxy acids and cosmetic surgery. Of these treatment options, only Tretinoin has been subjected to large-scale, controlled studies to substantiate its clinical efficacy and long-term benefits. This review summarizes the use of various therapies and presents available clinical and histologic results of systematic trials, including the few studies of retinoid compounds other than Tretinoin. Among the extensive data on topical Tretinoin are long-term treatment results that provide evidence of ultrastructural changes. These histologic findings suggest that fundamental cellular effects may be responsible for the clinical benefits, which are sustained even when treatment frequency is reduced. It thus appears that Tretinoin therapy at least partially restores photodamaged skin to the predamaged state.
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Adapalene 0.1% gel and adapalene 0.1% cream stimulate retinoic acid receptor mediated gene transcription without significant irritative effects in the skin of healthy human volunteers.
British Journal of Dermatology, 1998Co-Authors: Christopher E M Griffiths, M Poncet, S Michel, P. Ancian, Jonathan D. Humphries, E. Rizova, A ClucasAbstract:A randomized, investigator masked, intra individual comparative study was conducted in 30 healthy volunteers to compare the cutaneous effects of adapalene 0.1% gel and adapalene 0.1% cream with their respective vehicles, using Tretinoin 0.05% cream (n = 21) or Tretinoin 0.1% cream (n = 9) and a Tretinoin cream vehicle (n = 30) as controls. The products were applied to hip/buttock skin for 4 days under occlusive conditions. Cytosolic retinoic acid binding protein-II (CRABP-II) mRNA levels were measured using the RT-PCR technique in punch biopsies taken from 10 subjects. Epidermal thickness was assessed using image analysis of haematoxylin and eosin stained sections from another 11 subjects. Erythema was assessed in all subjects both by a visual scoring system and by chromameter. Adapalene 0.1% gel and adapalene 0.1% cream produced similar significant increases in CRABP-II mRNA levels compared to their vehicles (P < 0.01). The two Tretinoin formulations also resulted in similar significant increases in CRABP-II compared to the cream vehicle (P < 0.001). However, only the two Tretinoin formulations resulted in an increase in epidermal thickness and only the Tretinoin 0.1% cream resulted in significant erythema. Adapalene 0.1% gel and adapalene 0.1% cream induce RAR-mediated gene expression to a similar degree in this model, without the irritant effects of Tretinoin.
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two concentrations of topical Tretinoin retinoic acid cause similar improvement of photoaging but different degrees of irritation a double blind vehicle controlled comparison of 0 1 and 0 025 Tretinoin creams
Archives of Dermatology, 1995Co-Authors: Christopher E M Griffiths, Charles N. Ellis, Ted A Hamilton, Sewon Kang, Kwang J Kim, L J Finkel, Lissette C Ortizferrer, Gary M White, John J VoorheesAbstract:Background and Design: The efficacy of topical Tretinoin (all- trans -retinoic acid) in treating photoaging is well established. Questions that remain are (1) whether irritation causes all or part of the improvement; (2) the concentration of Tretinoin that maximizes clinical response with minimal side effects; and (3) the effects of long-term treatment on components of the cutaneous immune system. To address these issues, 99 photoaged patients completed a 48-week study using 0.1% Tretinoin cream (n=32), 0.025% Tretinoin (n=35), or vehicle (n=32) once daily in a double-blind manner. Before and after treatment, we assessed histologic features, keratinocyte expression of HLA-DR and intercellular adhesion molecule-1, numbers of epidermal Langerhans' cells and epidermal and dermal T lymphocytes, and vascularity as measured by dermal endothelial cell area. Results: Both 0.1% and 0.025% Tretinoin produced statistically significant overall improvement in photoaging of the face compared with vehicle; there were no clinically or statistically significant differences in efficacy between the two concentrations of Tretinoin. After 48 weeks, 0.1% and 0.025% Tretinoin produced similar statistically significant epidermal thickening (by 30% and 28%, respectively) compared with vehicle (11% decrease) and increased vascularity (by 100% and 89%, respectively) compared with vehicle (9% decrease). By various analyses, irritant side effects (erythema and scaling) were statistically significantly greater with 0.1% Tretinoin than with 0.025% Tretinoin. No significant changes occurred in any immunologic markers when Tretinoin and vehicle treatments were compared. Conclusions: Tretinoin 0.1% and 0.025% produce similar clinical and histologic changes in patients with photoaging, despite significantly greater incidence of irritation with the higher concentration. The separation between clinical improvement and irritation suggests that mechanisms other than irritation dominate Tretinoininduced repair of photoaging in humans. (Arch Dermatol. 1995;131:1037-1044)
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topical retinoic acid Tretinoin for melasma in black patients a vehicle controlled clinical trial
Archives of Dermatology, 1994Co-Authors: Candance Kimbroughgreen, Christopher E M Griffiths, Ted A Hamilton, Charles Ellis, L J Finkel, Stella M Bulengoransby, John J VoorheesAbstract:Background and Design: Melasma is an acquired, masklike, facial hyperpigmentation. The pathogenesis and treatment of melasma in black (African-American) patients is poorly understood. We investigated the efficacy of topical 0.1% all-trans-retinoic acid (Tretinoin) in the treatment of melasma in black patients. Twenty-eight of 30 black patients with melasma completed a 10-month, randomized, vehicle-controlled clinical trial in which they applied either 0.1% Tretinoin or vehicle cream daily to the entire face. They were evaluated clinically (using our Melasma Area and Severity Index), colorimetrically, and histologically. Results: After 40 weeks, there was a 32% improvement in the Melasma Area and Severity Index score in the Tretinoin treatment group compared with a 10% improvement in the vehicle group. Colorimetric measurements showed lightening of melasma after 40 weeks of Tretinoin treatment vs vehicle. Lightening of melasma, as determined clinically, correlated well with colorimetric measurements. Histologic examination of involved skin revealed a significant decrease in epidermal pigmentation in the Tretinoin group compared with the vehicle group. Side effects were limited to a mild ''retinoid dermatitis'' occurring in 67% of Tretinoin-treated patients. Among the patients in this study in comparison with comparably recruited white patients, melasma was reported to have begun at a later age and was more likely to be in a malar distribution. Conclusions: This controlled study demonstrates that topical 0.1% Tretinoin lightens melasma in black patients, with only mild side effects. (Arch Dermatol. 1994;130:727-733)
A Clucas - One of the best experts on this subject based on the ideXlab platform.
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Adapalene 0.1% gel and adapalene 0.1% cream stimulate retinoic acid receptor mediated gene transcription without significant irritative effects in the skin of healthy human volunteers.
British Journal of Dermatology, 1998Co-Authors: Christopher E M Griffiths, M Poncet, S Michel, P. Ancian, Jonathan D. Humphries, E. Rizova, A ClucasAbstract:A randomized, investigator masked, intra individual comparative study was conducted in 30 healthy volunteers to compare the cutaneous effects of adapalene 0.1% gel and adapalene 0.1% cream with their respective vehicles, using Tretinoin 0.05% cream (n = 21) or Tretinoin 0.1% cream (n = 9) and a Tretinoin cream vehicle (n = 30) as controls. The products were applied to hip/buttock skin for 4 days under occlusive conditions. Cytosolic retinoic acid binding protein-II (CRABP-II) mRNA levels were measured using the RT-PCR technique in punch biopsies taken from 10 subjects. Epidermal thickness was assessed using image analysis of haematoxylin and eosin stained sections from another 11 subjects. Erythema was assessed in all subjects both by a visual scoring system and by chromameter. Adapalene 0.1% gel and adapalene 0.1% cream produced similar significant increases in CRABP-II mRNA levels compared to their vehicles (P < 0.01). The two Tretinoin formulations also resulted in similar significant increases in CRABP-II compared to the cream vehicle (P < 0.001). However, only the two Tretinoin formulations resulted in an increase in epidermal thickness and only the Tretinoin 0.1% cream resulted in significant erythema. Adapalene 0.1% gel and adapalene 0.1% cream induce RAR-mediated gene expression to a similar degree in this model, without the irritant effects of Tretinoin.
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adapalene 0 1 gel has low skin irritation potential
Journal of The American Academy of Dermatology, 1997Co-Authors: M Verschoore, M Poncet, J Czernielewski, V Sorba, A ClucasAbstract:Abstract Background: Adapalene is a new naphthoic acid derivative with potent retinoid and antiinflammatory properties, developed for the topical treatment of acne vulgaris. Objective: We compare the cutaneous safety of adapalene in different gel vehicles with Tretinoin 0.025% gel. Methods: A total of 42 healthy human subjects were enrolled in two randomized, double-blind, controlled, intraindividual studies. In the first study (study A), adapalene aqueous 0.03% and 0.1% gels were evaluated for their 21-day cumulative irritation potential compared with vehicle alone, patch alone, and Tretinoin 0.025% gel under occlusion. In the second study (study B), adapalene aqueous (0.03% and 0.1%) gels and adapalene alcoholic (0.03% and 0.1%) gels were evaluated for their 5-day cumulative irritation potential compared with their respective vehicles and Tretinoin 0.025% gel. Transepidermal water loss (TEWL) was measured daily at each visit. Results: In study A, adapalene had a slight irritation potential that was in the same range as the gel vehicle and the patch alone, whereas Tretinoin 0.025% gel was a severe irritant. In study B, no irritation was seen with either adapalene aqueous gels or adapalene gel vehicles or patch alone. The adapalene alcoholic gels were slightly irritating, and Tretinoin gel produced intense irritation reactions in the majority of subjects. TEWL increased fourfold at the Tretinoin site but remained unchanged at all adapalene sites. Conclusion: Adapalene 0.1% gel was significantly less irritating than Tretinoin 0.025% gel. (J Am Acad Dermatol 1997;36:S104-9.)
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Adapalene 0.1% gel has low skin-irritation potential.
Journal of the American Academy of Dermatology, 1997Co-Authors: M Verschoore, M Poncet, J Czernielewski, V Sorba, A ClucasAbstract:Adapalene is a new naphthoic acid derivative with potent retinoid and antiinflammatory properties, developed for the topical treatment of acne vulgaris. We compare the cutaneous safety of adapalene in different gel vehicles with Tretinoin 0.025% gel. A total of 42 healthy human subjects were enrolled in two randomized, double-blind, controlled, intraindividual studies. In the first study (study A), adapalene aqueous 0.03% and 0.1% gels were evaluated for their 21-day cumulative irritation potential compared with vehicle alone, patch alone, and Tretinoin 0.025% gel under occlusion. In the second study (study B), adapalene aqueous (0.03% and 0.1%) gels and adapalene alcoholic (0.03% and 0.1%) gels were evaluated for their 5-day cumulative irritation potential compared with their respective vehicles and Tretinoin 0.025% gel. Transepidermal water loss (TEWL) was measured daily at each visit. In study A, adapalene had a slight irritation potential that was in the same range as the gel vehicle and the patch alone, whereas Tretinoin 0.025% gel was a severe irritant. In study B, no irritation was seen with either adapalene aqueous gels or adapalene gel vehicles or patch alone. The adapalene alcoholic gels were slightly irritating, and Tretinoin gel produced intense irritation reactions in the majority of subjects. TEWL increased fourfold at the Tretinoin site but remained unchanged at all adapalene sites. Adapalene 0.1% gel was significantly less irritating than Tretinoin 0.025% gel.
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Split-face comparison of adapalene 0.1% gel and Tretinoin 0.025% gel in acne patients.
Journal of the American Academy of Dermatology, 1997Co-Authors: D Caron, V Sorba, N Kerrouche, A ClucasAbstract:Adapalene is a new naphthoic acid derivative developed for the topical treatment of acne vulgaris. We compared the skin tolerance of adapalene 0.1% gel with Tretinoin 0.025% gel in subjects with acne. Fifteen acne patient volunteers were enrolled in this investigator-masked, left-right comparison, randomized, controlled, intraindividual study. Adapalene 0.1% gel and Tretinoin 0.025% gel were applied once a day to one half-face by the volunteers for 14 consecutive days. Clinical signs (erythema, desquamation, papules, vesicles, edema) and subjective symptoms (tightness, pruritus, burning) were evaluated and scored daily except on weekends. Adapalene 0.1% gel was better tolerated than Tretinoin 0.025% gel. The overall mean score calculated from all features combined was significantly higher with Tretinoin gel than with adapalene gel (p = 0.002). Adapalene 0.1% gel was significantly less irritating than Tretinoin 0.025% gel when tested in acne patients.
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Split-face comparison of adapalene 0.1% gel and Tretinoin 0.025% gel in acne patients
Journal of the American Academy of Dermatology, 1997Co-Authors: D Caron, V Sorba, N Kerrouche, A ClucasAbstract:Abstract Background: Adapalene is a new naphthoic acid derivative developed for the topical treatment of acne vulgaris. Objective: We compared the skin tolerance of adapalene 0.1% gel with Tretinoin 0.025% gel in subjects with acne. Methods: Fifteen acne patient volunteers were enrolled in this investigator-masked, left-right comparison, randomized, controlled, intraindividual study. Adapalene 0.1% gel and Tretinoin 0.025% gel were applied once a day to one half-face by the volunteers for 14 consecutive days. Clinical signs (erythema, desquamation, papules, vesicles, edema) and subjective symptoms (tightness, pruritus, burning) were evaluated and scored daily except on weekends. Results: Adapalene 0.1% gel was better tolerated than Tretinoin 0.025% gel. The overall mean score calculated from all features combined was significantly higher with Tretinoin gel than with adapalene gel ( p = 0.002). Conclusion: Adapalene 0.1% gel was significantly less irritating than Tretinoin 0.025% gel when tested in acne patients. (J Am Acad Dermatol 1997;36:S110-2.)
L J Finkel - One of the best experts on this subject based on the ideXlab platform.
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concurrent application of Tretinoin retinoic acid partially protects against corticosteroid induced epidermal atrophy
British Journal of Dermatology, 1996Co-Authors: A J Mcmichael, Ted A Hamilton, L J Finkel, C E M Griffiths, Harvinder S Talwar, Elyse S Rafal, John J VoorheesAbstract:Summary Cutaneous atrophy arising from prolonged use of potent topical corticosteroids has long been a concern. Thus, it would be advantageous to find an agent which protects against atrophy produced by corticosteroids but at the same time does not impair their anti-inflammatory effects. Recent work shows that topical all-trans retinoic acid (Tretinoin) prevents skin atrophy in mice treated with topical corticosteroids, but such studies have not been performed in humans. We performed an 8-week clinical, histological and biochemical study to test the ability of Tretinoin to enhance efficacy and inhibit atrophogenicity of topical corticosteroids, when used in the treatment of psoriasis. In each of 20 psoriasis patients, one plaque, and its perilesional skin, was treated once daily with betamethasone dipropionate and Tretinoin 0·1%, and one plaque, and its perilesional skin, treated with once daily betamethasone dipropionate and Tretinoin vehicle. There was no difference in the speed or degree of improvement in plaques treated with either the topical corticosteroid/Tretinoin combination or with corticosteroid alone. Light microscopy revealed a 19% reduction in epidermal thickness, in corticosteroid-treated perilesional skin, as compared with a slight (1%) increase in corticosteroid/ Tretinoin-treated perilesional areas (P= 0.067). Western blot analysis showed a 55% reduction in procollagen I aminopropeptide in perilesional skin treated with corticosteroid alone, as compared with a 45% reduction in corticosteroid/Tretinoin-treated perilesional skin. These data indicate that the addition of Tretinoin does not impair the efficacy of a topical corticosteroid, in the treatment of psoriasis, and partially ameliorates epidermal atrophy produced by the topical corticosteroid.
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two concentrations of topical Tretinoin retinoic acid cause similar improvement of photoaging but different degrees of irritation a double blind vehicle controlled comparison of 0 1 and 0 025 Tretinoin creams
Archives of Dermatology, 1995Co-Authors: Christopher E M Griffiths, Charles N. Ellis, Ted A Hamilton, Sewon Kang, Kwang J Kim, L J Finkel, Lissette C Ortizferrer, Gary M White, John J VoorheesAbstract:Background and Design: The efficacy of topical Tretinoin (all- trans -retinoic acid) in treating photoaging is well established. Questions that remain are (1) whether irritation causes all or part of the improvement; (2) the concentration of Tretinoin that maximizes clinical response with minimal side effects; and (3) the effects of long-term treatment on components of the cutaneous immune system. To address these issues, 99 photoaged patients completed a 48-week study using 0.1% Tretinoin cream (n=32), 0.025% Tretinoin (n=35), or vehicle (n=32) once daily in a double-blind manner. Before and after treatment, we assessed histologic features, keratinocyte expression of HLA-DR and intercellular adhesion molecule-1, numbers of epidermal Langerhans' cells and epidermal and dermal T lymphocytes, and vascularity as measured by dermal endothelial cell area. Results: Both 0.1% and 0.025% Tretinoin produced statistically significant overall improvement in photoaging of the face compared with vehicle; there were no clinically or statistically significant differences in efficacy between the two concentrations of Tretinoin. After 48 weeks, 0.1% and 0.025% Tretinoin produced similar statistically significant epidermal thickening (by 30% and 28%, respectively) compared with vehicle (11% decrease) and increased vascularity (by 100% and 89%, respectively) compared with vehicle (9% decrease). By various analyses, irritant side effects (erythema and scaling) were statistically significantly greater with 0.1% Tretinoin than with 0.025% Tretinoin. No significant changes occurred in any immunologic markers when Tretinoin and vehicle treatments were compared. Conclusions: Tretinoin 0.1% and 0.025% produce similar clinical and histologic changes in patients with photoaging, despite significantly greater incidence of irritation with the higher concentration. The separation between clinical improvement and irritation suggests that mechanisms other than irritation dominate Tretinoininduced repair of photoaging in humans. (Arch Dermatol. 1995;131:1037-1044)
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topical retinoic acid Tretinoin for melasma in black patients a vehicle controlled clinical trial
Archives of Dermatology, 1994Co-Authors: Candance Kimbroughgreen, Christopher E M Griffiths, Ted A Hamilton, Charles Ellis, L J Finkel, Stella M Bulengoransby, John J VoorheesAbstract:Background and Design: Melasma is an acquired, masklike, facial hyperpigmentation. The pathogenesis and treatment of melasma in black (African-American) patients is poorly understood. We investigated the efficacy of topical 0.1% all-trans-retinoic acid (Tretinoin) in the treatment of melasma in black patients. Twenty-eight of 30 black patients with melasma completed a 10-month, randomized, vehicle-controlled clinical trial in which they applied either 0.1% Tretinoin or vehicle cream daily to the entire face. They were evaluated clinically (using our Melasma Area and Severity Index), colorimetrically, and histologically. Results: After 40 weeks, there was a 32% improvement in the Melasma Area and Severity Index score in the Tretinoin treatment group compared with a 10% improvement in the vehicle group. Colorimetric measurements showed lightening of melasma after 40 weeks of Tretinoin treatment vs vehicle. Lightening of melasma, as determined clinically, correlated well with colorimetric measurements. Histologic examination of involved skin revealed a significant decrease in epidermal pigmentation in the Tretinoin group compared with the vehicle group. Side effects were limited to a mild ''retinoid dermatitis'' occurring in 67% of Tretinoin-treated patients. Among the patients in this study in comparison with comparably recruited white patients, melasma was reported to have begun at a later age and was more likely to be in a malar distribution. Conclusions: This controlled study demonstrates that topical 0.1% Tretinoin lightens melasma in black patients, with only mild side effects. (Arch Dermatol. 1994;130:727-733)
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topical Tretinoin retinoic acid improves melasma a vehicle controlled clinical trial
British Journal of Dermatology, 1993Co-Authors: C E M Griffiths, Charles N. Ellis, Ted A Hamilton, L J Finkel, Cherie M Ditre, J J VoorheesAbstract:Melasma is a common disorder of cutaneous hyperpigmentation predominantly affecting the faces of women. Little is known about the aetiology of melasma, and treatment is frequently disappointing. Topical Tretinoin is of benefit in treating other forms of hyperpigmentation, for example liver spots, and we therefore investigated its effectiveness in melasma. Thirty-eight women completed a randomized, vehicle-controlled study, in which they applied 0.1% Tretinoin (n = 19) or vehicle cream (n = 19) once daily to the face for 40 weeks. At the end of treatment 13 (68%) of 19 Tretinoin-treated patients were clinically rated as improved or much improved, compared with 1 (5%) of 19 in the vehicle group (P = 0.0006). Significant improvement first occurred after 24 weeks of Tretinoin treatment. Colorimetry (an objective measure of skin colour) demonstrated a 0.9 unit lightening of Tretinoin-treated melasma and a 0.3 unit darkening with vehicle (P = 0.01); these results correlated with clinical lightening (r = 0.55, P = 0.0005). Histologically, epidermal pigment was reduced 36% following Tretinoin treatment, compared with a 50% increase with vehicle (P = 0.002). Reduction in epidermal pigment also correlated with clinical lightening (r = -0.41, P = 0.01). Moderate cutaneous side-effects of erythema and desquamation occurred in 88% of Tretinoin-treated and 29% of vehicle-treated patients. Topical 0.1% Tretinoin produces significant clinical improvement of melasma, mainly due to reduction in epidermal pigment, but improvement is slow.
Ted A Hamilton - One of the best experts on this subject based on the ideXlab platform.
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concurrent application of Tretinoin retinoic acid partially protects against corticosteroid induced epidermal atrophy
British Journal of Dermatology, 1996Co-Authors: A J Mcmichael, Ted A Hamilton, L J Finkel, C E M Griffiths, Harvinder S Talwar, Elyse S Rafal, John J VoorheesAbstract:Summary Cutaneous atrophy arising from prolonged use of potent topical corticosteroids has long been a concern. Thus, it would be advantageous to find an agent which protects against atrophy produced by corticosteroids but at the same time does not impair their anti-inflammatory effects. Recent work shows that topical all-trans retinoic acid (Tretinoin) prevents skin atrophy in mice treated with topical corticosteroids, but such studies have not been performed in humans. We performed an 8-week clinical, histological and biochemical study to test the ability of Tretinoin to enhance efficacy and inhibit atrophogenicity of topical corticosteroids, when used in the treatment of psoriasis. In each of 20 psoriasis patients, one plaque, and its perilesional skin, was treated once daily with betamethasone dipropionate and Tretinoin 0·1%, and one plaque, and its perilesional skin, treated with once daily betamethasone dipropionate and Tretinoin vehicle. There was no difference in the speed or degree of improvement in plaques treated with either the topical corticosteroid/Tretinoin combination or with corticosteroid alone. Light microscopy revealed a 19% reduction in epidermal thickness, in corticosteroid-treated perilesional skin, as compared with a slight (1%) increase in corticosteroid/ Tretinoin-treated perilesional areas (P= 0.067). Western blot analysis showed a 55% reduction in procollagen I aminopropeptide in perilesional skin treated with corticosteroid alone, as compared with a 45% reduction in corticosteroid/Tretinoin-treated perilesional skin. These data indicate that the addition of Tretinoin does not impair the efficacy of a topical corticosteroid, in the treatment of psoriasis, and partially ameliorates epidermal atrophy produced by the topical corticosteroid.
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two concentrations of topical Tretinoin retinoic acid cause similar improvement of photoaging but different degrees of irritation a double blind vehicle controlled comparison of 0 1 and 0 025 Tretinoin creams
Archives of Dermatology, 1995Co-Authors: Christopher E M Griffiths, Charles N. Ellis, Ted A Hamilton, Sewon Kang, Kwang J Kim, L J Finkel, Lissette C Ortizferrer, Gary M White, John J VoorheesAbstract:Background and Design: The efficacy of topical Tretinoin (all- trans -retinoic acid) in treating photoaging is well established. Questions that remain are (1) whether irritation causes all or part of the improvement; (2) the concentration of Tretinoin that maximizes clinical response with minimal side effects; and (3) the effects of long-term treatment on components of the cutaneous immune system. To address these issues, 99 photoaged patients completed a 48-week study using 0.1% Tretinoin cream (n=32), 0.025% Tretinoin (n=35), or vehicle (n=32) once daily in a double-blind manner. Before and after treatment, we assessed histologic features, keratinocyte expression of HLA-DR and intercellular adhesion molecule-1, numbers of epidermal Langerhans' cells and epidermal and dermal T lymphocytes, and vascularity as measured by dermal endothelial cell area. Results: Both 0.1% and 0.025% Tretinoin produced statistically significant overall improvement in photoaging of the face compared with vehicle; there were no clinically or statistically significant differences in efficacy between the two concentrations of Tretinoin. After 48 weeks, 0.1% and 0.025% Tretinoin produced similar statistically significant epidermal thickening (by 30% and 28%, respectively) compared with vehicle (11% decrease) and increased vascularity (by 100% and 89%, respectively) compared with vehicle (9% decrease). By various analyses, irritant side effects (erythema and scaling) were statistically significantly greater with 0.1% Tretinoin than with 0.025% Tretinoin. No significant changes occurred in any immunologic markers when Tretinoin and vehicle treatments were compared. Conclusions: Tretinoin 0.1% and 0.025% produce similar clinical and histologic changes in patients with photoaging, despite significantly greater incidence of irritation with the higher concentration. The separation between clinical improvement and irritation suggests that mechanisms other than irritation dominate Tretinoininduced repair of photoaging in humans. (Arch Dermatol. 1995;131:1037-1044)
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topical retinoic acid Tretinoin for melasma in black patients a vehicle controlled clinical trial
Archives of Dermatology, 1994Co-Authors: Candance Kimbroughgreen, Christopher E M Griffiths, Ted A Hamilton, Charles Ellis, L J Finkel, Stella M Bulengoransby, John J VoorheesAbstract:Background and Design: Melasma is an acquired, masklike, facial hyperpigmentation. The pathogenesis and treatment of melasma in black (African-American) patients is poorly understood. We investigated the efficacy of topical 0.1% all-trans-retinoic acid (Tretinoin) in the treatment of melasma in black patients. Twenty-eight of 30 black patients with melasma completed a 10-month, randomized, vehicle-controlled clinical trial in which they applied either 0.1% Tretinoin or vehicle cream daily to the entire face. They were evaluated clinically (using our Melasma Area and Severity Index), colorimetrically, and histologically. Results: After 40 weeks, there was a 32% improvement in the Melasma Area and Severity Index score in the Tretinoin treatment group compared with a 10% improvement in the vehicle group. Colorimetric measurements showed lightening of melasma after 40 weeks of Tretinoin treatment vs vehicle. Lightening of melasma, as determined clinically, correlated well with colorimetric measurements. Histologic examination of involved skin revealed a significant decrease in epidermal pigmentation in the Tretinoin group compared with the vehicle group. Side effects were limited to a mild ''retinoid dermatitis'' occurring in 67% of Tretinoin-treated patients. Among the patients in this study in comparison with comparably recruited white patients, melasma was reported to have begun at a later age and was more likely to be in a malar distribution. Conclusions: This controlled study demonstrates that topical 0.1% Tretinoin lightens melasma in black patients, with only mild side effects. (Arch Dermatol. 1994;130:727-733)
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topical Tretinoin retinoic acid improves melasma a vehicle controlled clinical trial
British Journal of Dermatology, 1993Co-Authors: C E M Griffiths, Charles N. Ellis, Ted A Hamilton, L J Finkel, Cherie M Ditre, J J VoorheesAbstract:Melasma is a common disorder of cutaneous hyperpigmentation predominantly affecting the faces of women. Little is known about the aetiology of melasma, and treatment is frequently disappointing. Topical Tretinoin is of benefit in treating other forms of hyperpigmentation, for example liver spots, and we therefore investigated its effectiveness in melasma. Thirty-eight women completed a randomized, vehicle-controlled study, in which they applied 0.1% Tretinoin (n = 19) or vehicle cream (n = 19) once daily to the face for 40 weeks. At the end of treatment 13 (68%) of 19 Tretinoin-treated patients were clinically rated as improved or much improved, compared with 1 (5%) of 19 in the vehicle group (P = 0.0006). Significant improvement first occurred after 24 weeks of Tretinoin treatment. Colorimetry (an objective measure of skin colour) demonstrated a 0.9 unit lightening of Tretinoin-treated melasma and a 0.3 unit darkening with vehicle (P = 0.01); these results correlated with clinical lightening (r = 0.55, P = 0.0005). Histologically, epidermal pigment was reduced 36% following Tretinoin treatment, compared with a 50% increase with vehicle (P = 0.002). Reduction in epidermal pigment also correlated with clinical lightening (r = -0.41, P = 0.01). Moderate cutaneous side-effects of erythema and desquamation occurred in 88% of Tretinoin-treated and 29% of vehicle-treated patients. Topical 0.1% Tretinoin produces significant clinical improvement of melasma, mainly due to reduction in epidermal pigment, but improvement is slow.
