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J Cosmet Med 2022; 6(2): 67-71

Published online December 31, 2022

https://doi.org/10.25056/JCM.2022.6.2.67

Review of topical vitamins in photoaging skin

Cheuk Hung Lee, MBBS (HK), FHKAM (MED), FHKCP, MScPD (Cardiff), MRCP (UK), DPD (Wales), DipDerm (Glasgow), PGDipClinDerm (London), MRCP (London), GradDipDerm (NUS), DipMed (CUHK)1 , Kar Wai Alvin Lee, MBChB (CUHK), DCH (Sydney), Dip Derm (Glasgow), MScClinDerm (Cardiff), MScPD (Cardiff), DipMed (CUHK), DCH (Sydney)1 , Kwin Wah Chan, MBChB (CUHK), MScPD (Cardiff), PgDipPD (Cardiff), PGDipClinDerm (Lond), DipMed (CUHK), DCH (Sydney)1 , Kar Fai Victor Lee, MBBS, MRCP (UK), FRCP (Glasgow), FHKCP, FHKAM (Medicine)2 , Kar Wai Phoebe Lam, MBCHB (OTAGO), MRCS (EDIN), MSCPD (CARDIFF)3

1Ever Keen Medical Centre, Hong Kong
2London Heart Practice, Hong Kong
3Perfect Skin Solution, Hong Kong

Correspondence to :
Kar Wai Alvin Lee
E-mail: alvin429@yahoo.com

Received: October 27, 2022; Revised: November 20, 2022; Accepted: November 21, 2022

© Korean Society of Korean Cosmetic Surgery & Medicine

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Photoaging is a process of normal skin architecture damage caused by ultraviolet radiation. Topical vitamins have been used to treat these conditions. The authors aimed to understand the mechanism and level of evidence of topical vitamins used to treat photodamaged skin. A range of topical vitamins has been used in cosmetic medicine for many years to treat photodamaged skin. This review article compares their efficacy and level of evidence. This study was a systematic review to evaluate the efficacy of different topical vitamins. Keywords including “Photoaging,” “Botanicals,” “Peptides,” “Retinoids,” “Vitamins” were searched on Ovid, PubMed, MEDLINE for relevant studies published on photoaging treatment. There is a wealth of Level I evidence supporting the use of topical retinoic acid, vitamins B and C. There is evidence supporting the use of topical vitamin E although it is mainly drawn from Level IV studies of the evidence hierarchy. Topical vitamins can effectively treat photodamaged skin.
Level of Evidence: I

Keywords: ascorbic acid, niacinamide, retinoids, skin aging, tocopherols, vitamins

The process of damage to normal skin architecture caused by ultraviolet light is called photoaging. It is associated with a series of histological changes, including uneven basal melanocyte distribution (irregular dyspigmentation), cytological atypia, reduction of Langerhans cells, elastic fibers, dermal collagen degeneration, increment of dermal inflammatory cells, and increased epidermal thickness variability. Furthermore, dermal elastosis is also observed in photoaging, which is caused by abnormal amorphous elastic material deposition in the papillary dermis [1,2].

With the advent of topical vitamins, they provide a novel and non-invasive way to rejuvenate photodamaged skin.

This systematic review article summarizes topical vitamin treatment of photoaging.

Keywords including “Photoaging,” “Botanicals,” “Peptides,” “Retinoids,” and “Vitamins” were searched in the Ovid, PubMed, and MEDLINE databases for relevant studies published on photoaging treatment. Some papers were further reviewed using objective endpoint measurements, a double-blinding approach, control usage, randomization usage, and sample size. All studies were classified according to the Oxford Center for evidence-based medicine evidence hierarchy (Fig. 1) [3].

Fig. 1.Evidence hierarchy according to Oxford Center for evidence-based medicine [3]. RCT, randomized controlled trials; SR, systematic review.

Vitamin A research

Preclinical studies

Through the production of types I and III procollagen, transforming growth factor-β (TGF-β) induction has been observed by topical trans-retinoic acid application to mouse and human skin [4,5]. In photoaged human skin, increased collagen fibril deposition is observed since all trans-retinoic acid can promote types I and III procollagen gene expression [6]. Kligman et al. [7] compared topical retinoic acid with a placebo for skin repair promotion in mouse skin after ultraviolet irradiation. The retinoic acid group had a larger reconstruction zone than that of the placebo group. Griffiths et al. [8] enrolled 29 photodamaged patients treated with 0.1% tretinoin versus vehicle cream. In the control group, collagen was reduced by 14%, whereas collagen I production increased by 80%, as confirmed by immunohistological assessment (Level IIb).

Vitamin A on photodamaged skin evidence

Kang et al. [9] enrolled 568 photodamaged patients in their study, which was placebo-controlled, double-blinded, randomized, and multi-center. A 0.1% tazarotene was used against vehicle cream (control) and showed that 0.1% tazarotene significantly decreased elastosis, dyspigmentation, and fine wrinkles (Level Ib). Bhawan et al. [10] also involved 533 patients in another placebo-controlled, double-blind, randomized controlled study on topical retinoid effectiveness in photoaging. They showed that patients’ skin had increased granular layer thickness and melanin content reduction compared to vehicle cream, as shown by computerized images and histological analyses (Level Ib). Another large study was conducted by Weinstein et al. [11], who enrolled 251 mild-to-moderated photodamaged patients. In this multi-center, vehicle-controlled, randomized controlled study, we used 0.05% topical tretinoin versus vehicle cream. The researchers analyzed the results by assessing the histological structure, which showed melanin reduction and epidermal thickness (Level Ib). A subjective assessment revealed a decrease in roughness, laxity, mottled pigmentation, and wrinkling. A review was performed by the Cochrane collaboration on eight controlled trials on the effect of topical retinoids on photodamaged skin [12], with topical isotretinoin (0.1%), topical tazarotene (0.01%–0.1%), and topical tretinoin cream (0.02% or higher concentration) showing that photodamaged skin significantly improved with their usage (Level Ia).

Creidi et al. [13] enrolled 120 photodamaged patients in a randomized controlled study to compare the effectiveness of topical retinoids with vehicle cream. Using optical profilometry techniques, the left crow’s feet area silicone replica was analyzed. The team found that skin roughness and rhytides were significantly reduced in the retinoid treatment group (Level IIb).

Griffiths et al. [8] also demonstrated that tretinoin cream could significantly increase vascularity and epidermal thickening in randomized controlled, vehicle-controlled, and double-blind studies. Two concentrations of tretinoin cream (0.025% and 0.1%) were used in comparison with the vehicle cream to treat photodamaged skin for 48 weeks (Level Ib).

In summary, with preclinical research demonstrating clear molecular mechanisms and multiple Level I evidence, retinoic acid (vitamin A) is very effective in treating photodamaged skin.

Vitamin B research

Kawada et al. [14] enrolled 30 patients with periorbital rhytides in their study to analyze the effect of 4% nicotinamide cream. This was a placebo-controlled and randomized controlled split-face study. Through objective and subjective computer analyses, 4% nicotinamide cream showed significantly decreased rhytides compared to that of vehicle cream. This study was unblinded, but the level of evidence was not low (Level Ib). Bissett et al. [15] included 50 patients in their split-face randomized controlled study to compare the effectiveness of topical nicotinamide cream with that of the control cream. Reduction of sallowness, erythema, hyperpigmentation, and rhytides was statistically significant when compared to the control cream (Level Ib).

Vitamins C research

Ten photodamaged patients were enrolled in the split-face double-blind controlled study by Fitzpatrick and Rostan [16] in 2002. The effectiveness of topical vitamin C was compared with that of placebo cream. Histologically, the skin area treated with topical vitamin C showed increased type I collagen and Granz zone collagen. Furthermore, clinical investigators have also assessed and found improvements in skin inflammation, pigmentation, hydration, and wrinkle scores. Although few patients were included, the level of evidence was not low (Level Ib). Traikovich [17] also analyzed the effectiveness of vitamin C in photoaging using 10% ascorbic acid. They enrolled 19 photoaging patients in their study, which was designed as vehicle-controlled, double-blind, and randomized controlled. The study period was 3 months, with vehicle cream used as the control cream. Using skin surface topography computer-assisted image analysis and optical profilometry, the team found significant improvements in overall features, yellowing/sallowness, coarse wrinkles, tactile roughness, and fine rhytides (Level Ib).

Vitamin E research

Interestingly, most clinical studies analyzing topical vitamin E were involved with topical vitamin C. Lin et al. [18] used the skin of pigs to compare the photoprotective effect of topical vitamins C and E, versus topical vitamin C, versus topical vitamin E. The team concluded that the best photoprotective effect was a combination of topical vitamins C and E. Nevertheless, topical vitamins C and E alone could also lower thymine dimers, sunburn cells, and erythema with ultraviolet (UV) irradiation (Level IV). Eberlein-König et al. [19] enrolled 20 photoaged patients in a placebo-controlled, double-blinded study to analyze the photoprotective effects of topical vitamins C and E. In response to sunlight, after 8 days of treatment, there was an increment in the minimal erythema dose (the minimal ultraviolet light dose induced cutaneous blood flow together with erythematous response), while in the control group, the dose was reduced (Level IIb).

Only one pharmaceutical agent has a large evidence base for use in photoaging. It is a retinoid (vitamin A).

Retinoids are β-carotene derivatives. By binding promoter DNA sequences, retinoic acid influences the expression of genes encoding active chemicals after oxidation and hydrolysis of beta-carotene and its metabolites. Retinoids cause pigment loss and inhibit tyrosinase and matrix metalloproteinases through epidermopoiesis. They can also increase the amount of dermal collagen through the synthesis of TGF-β procollagen and stimulation of water content (by stimulating glycosaminoglycan synthesis). Furthermore, they exhibit antioxidant properties and UV light-absorbing features [20].

Vitamin B3 (niacinamide or nicotinamide) and vitamin B5 (Panthenol) have good pharmacological effects on photoaging skin. nicotinamide adenine dinucleotide phosphate, nicotinamide adenine dinucleotide, and nicotinamide adenine dinucleotide phosphate hydrogen are antioxidants derived from the reduction of nicotinamide adenine dinucleotide. They can decrease the glycation of proteins (skin yellowness causation), inhibit the transfer of melanosomes, and decrease transepidermal loss of water. Vitamin B5 is related to coenzyme A, which is its precursor and plays an important role in multiple metabolic pathways. It affects the rehydration of the skin, enhancement of re-epithelialization of the epidermis, and proliferation of fibroblasts [21].

Vitamin C, also known as l-ascorbic acid, has a powerful therapeutic effect on photoaging skin. Its mechanism involves neutralizing free radicals by donating electrons, which reduce the damage to cells, dermal collagen, and DNA, which are the mediators of photodamage. It also reduces pigmentation by L-dopaquinone depletion (melanin precursor) and stimulates collagen synthesis during collagen cross-linking. Furthermore, it stabilizes collagen by acting as a co-factor for lysyl and prolyl hydroxylases [22].

Vitamin E is an antioxidant and the most abundant form is alpha-tocopherol. In response to ultraviolet light, it can decrease the risk of carcinogenesis, rhytide formation, and erythema of the skin. It reduces skin ultrastructural oxidative damage by scavenging lipid peroxyl radicals [23].

There is a wealth of Level I evidence supporting the use of topical retinoic acid, vitamin B, and vitamin C. Evidence supporting the use of topical vitamin E is mainly drawn from studies from Level IV of the evidence hierarchy.

  1. Poon F, Kang S, Chien AL. Mechanisms and treatments of photoaging. Photodermatol Photoimmunol Photomed 2015;31:65-74.
    Pubmed CrossRef
  2. Yaar M, Gilchrest BA. Photoageing: mechanism, prevention and therapy. Br J Dermatol 2007;157:874-87.
    Pubmed CrossRef
  3. Centre for Evidence-Based Medicine. Oxford centre for evidence-based medicine: levels of evidence (March 2009) [Internet]. Oxford: University of Oxford; c2009 [cited 2022 Dec 5].
    Available from: https://www.cebm.ox.ac.uk/resources/levels-of-evidence/oxford-centre-for-evidence-based-medicine-levels-of-evidence-march-2009.
  4. Glick AB, Flanders KC, Danielpour D, Yuspa SH, Sporn MB. Retinoic acid induces transforming growth factor-beta 2 in cultured keratinocytes and mouse epidermis. Cell Regul 1989;1:87-97.
    Pubmed KoreaMed CrossRef
  5. Kim HJ, Bogdan NJ, D'Agostaro LJ, Gold LI, Bryce GF. Effect of topical retinoic acids on the levels of collagen mRNA during the repair of UVB-induced dermal damage in the hairless mouse and the possible role of TGF-β as a mediator. J Invest Dermatol 1992;98:359-63.
    Pubmed CrossRef
  6. Griffiths CE, Russman AN, Majmudar G, Singer RS, Hamilton TA, Voorhees JJ. Restoration of collagen formation in photodamaged human skin by tretinoin (retinoic acid). N Engl J Med 1993;329:530-5.
    Pubmed CrossRef
  7. Kligman LH, Duo CH, Kligman AM. Topical retinoic acid enhances the repair of ultraviolet damaged dermal connective tissue. Connect Tissue Res 1984;12:139-50.
    Pubmed CrossRef
  8. Griffiths CE, Kang S, Ellis CN, Kim KJ, Finkel LJ, Ortiz-Ferrer LC, et al. 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. Arch Dermatol 1995;131:1037-44.
    Pubmed CrossRef
  9. Kang S, Krueger GG, Tanghetti EA, Lew-Kaya D, Sefton J, Walker PS, et al; Tazarotene Cream in Photodamage Study Group. A multicenter, randomized, double-blind trial of tazarotene 0.1% cream in the treatment of photodamage. J Am Acad Dermatol 2005;52:268-74.
    Pubmed CrossRef
  10. Bhawan J, Gonzalez-Serva A, Nehal K, Labadie R, Lufrano L, Thorne EG, et al. Effects of tretinoin on photodamaged skin. A histologic study. Arch Dermatol 1991;127:666-72. Erratum in: Arch Dermatol 1991;127:1382.
    Pubmed CrossRef
  11. Weinstein GD, Nigra TP, Pochi PE, Savin RC, Allan A, Benik K, et al. Topical tretinoin for treatment of photodamaged skin. A multicenter study. Arch Dermatol 1991;127:659-65.
    Pubmed CrossRef
  12. Samuel M, Brooke RC, Hollis S, Griffiths CE. Interventions for photodamaged skin. Cochrane Database Syst Rev 2005;1:CD001782.
    CrossRef
  13. Creidi P, Vienne MP, Ochonisky S, Lauze C, Turlier V, Lagarde JM, et al. Profilometric evaluation of photodamage after topical retinaldehyde and retinoic acid treatment. J Am Acad Dermatol 1998;39:960-5.
    Pubmed CrossRef
  14. Kawada A, Konishi N, Oiso N, Kawara S, Date A. Evaluation of anti-wrinkle effects of a novel cosmetic containing niacinamide. J Dermatol 2008;35:637-42.
    Pubmed CrossRef
  15. Bissett DL, Miyamoto K, Sun P, Li J, Berge CA. Topical niacinamide reduces yellowing, wrinkling, red blotchiness, and hyperpigmented spots in aging facial skin. Int J Cosmet Sci 2004;26:231-8.
    Pubmed CrossRef
  16. Fitzpatrick RE, Rostan EF. Double-blind, half-face study comparing topical vitamin C and vehicle for rejuvenation of photodamage. Dermatol Surg 2002;28:231-6.
    Pubmed CrossRef
  17. Traikovich SS. Use of topical ascorbic acid and its effects on photodamaged skin topography. Arch Otolaryngol Head Neck Surg 1999;125:1091-8.
    Pubmed CrossRef
  18. Lin JY, Selim MA, Shea CR, Grichnik JM, Omar MM, Monteiro-Riviere NA, et al. UV photoprotection by combination topical antioxidants vitamin C and vitamin E. J Am Acad Dermatol 2003;48:866-74.
    Pubmed CrossRef
  19. Eberlein-König B, Placzek M, Przybilla B. Protective effect against sunburn of combined systemic ascorbic acid (vitamin C) and d-alpha-tocopherol (vitamin E). J Am Acad Dermatol 1998;38:45-8.
    Pubmed CrossRef
  20. Fisher GJ, Voorhees JJ. Molecular mechanisms of retinoid actions in skin. FASEB J 1996;10:1002-13.
    Pubmed CrossRef
  21. Wohlrab J, Kreft D. Niacinamide - mechanisms of action and its topical use in dermatology. Skin Pharmacol Physiol 2014;27:311-5.
    Pubmed CrossRef
  22. Al-Niaimi F, Chiang NYZ. Topical vitamin C and the skin: mechanisms of action and clinical applications. J Clin Aesthet Dermatol 2017;10:14-7.
    Pubmed KoreaMed
  23. Thiele JJ, Hsieh SN, Ekanayake-Mudiyanselage S. Vitamin E: critical review of its current use in cosmetic and clinical dermatology. Dermatol Surg 2005;31(7 Pt 2):805-13; discussion 813.
    Pubmed CrossRef

Article

Review Article

J Cosmet Med 2022; 6(2): 67-71

Published online December 31, 2022 https://doi.org/10.25056/JCM.2022.6.2.67

Copyright © Korean Society of Korean Cosmetic Surgery & Medicine.

Review of topical vitamins in photoaging skin

Cheuk Hung Lee, MBBS (HK), FHKAM (MED), FHKCP, MScPD (Cardiff), MRCP (UK), DPD (Wales), DipDerm (Glasgow), PGDipClinDerm (London), MRCP (London), GradDipDerm (NUS), DipMed (CUHK)1 , Kar Wai Alvin Lee, MBChB (CUHK), DCH (Sydney), Dip Derm (Glasgow), MScClinDerm (Cardiff), MScPD (Cardiff), DipMed (CUHK), DCH (Sydney)1 , Kwin Wah Chan, MBChB (CUHK), MScPD (Cardiff), PgDipPD (Cardiff), PGDipClinDerm (Lond), DipMed (CUHK), DCH (Sydney)1 , Kar Fai Victor Lee, MBBS, MRCP (UK), FRCP (Glasgow), FHKCP, FHKAM (Medicine)2 , Kar Wai Phoebe Lam, MBCHB (OTAGO), MRCS (EDIN), MSCPD (CARDIFF)3

1Ever Keen Medical Centre, Hong Kong
2London Heart Practice, Hong Kong
3Perfect Skin Solution, Hong Kong

Correspondence to:Kar Wai Alvin Lee
E-mail: alvin429@yahoo.com

Received: October 27, 2022; Revised: November 20, 2022; Accepted: November 21, 2022

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Photoaging is a process of normal skin architecture damage caused by ultraviolet radiation. Topical vitamins have been used to treat these conditions. The authors aimed to understand the mechanism and level of evidence of topical vitamins used to treat photodamaged skin. A range of topical vitamins has been used in cosmetic medicine for many years to treat photodamaged skin. This review article compares their efficacy and level of evidence. This study was a systematic review to evaluate the efficacy of different topical vitamins. Keywords including “Photoaging,” “Botanicals,” “Peptides,” “Retinoids,” “Vitamins” were searched on Ovid, PubMed, MEDLINE for relevant studies published on photoaging treatment. There is a wealth of Level I evidence supporting the use of topical retinoic acid, vitamins B and C. There is evidence supporting the use of topical vitamin E although it is mainly drawn from Level IV studies of the evidence hierarchy. Topical vitamins can effectively treat photodamaged skin.
Level of Evidence: I

Keywords: ascorbic acid, niacinamide, retinoids, skin aging, tocopherols, vitamins

Introduction

The process of damage to normal skin architecture caused by ultraviolet light is called photoaging. It is associated with a series of histological changes, including uneven basal melanocyte distribution (irregular dyspigmentation), cytological atypia, reduction of Langerhans cells, elastic fibers, dermal collagen degeneration, increment of dermal inflammatory cells, and increased epidermal thickness variability. Furthermore, dermal elastosis is also observed in photoaging, which is caused by abnormal amorphous elastic material deposition in the papillary dermis [1,2].

With the advent of topical vitamins, they provide a novel and non-invasive way to rejuvenate photodamaged skin.

This systematic review article summarizes topical vitamin treatment of photoaging.

Materials and methods

Keywords including “Photoaging,” “Botanicals,” “Peptides,” “Retinoids,” and “Vitamins” were searched in the Ovid, PubMed, and MEDLINE databases for relevant studies published on photoaging treatment. Some papers were further reviewed using objective endpoint measurements, a double-blinding approach, control usage, randomization usage, and sample size. All studies were classified according to the Oxford Center for evidence-based medicine evidence hierarchy (Fig. 1) [3].

Figure 1. Evidence hierarchy according to Oxford Center for evidence-based medicine [3]. RCT, randomized controlled trials; SR, systematic review.

Results

Vitamin A research

Preclinical studies

Through the production of types I and III procollagen, transforming growth factor-β (TGF-β) induction has been observed by topical trans-retinoic acid application to mouse and human skin [4,5]. In photoaged human skin, increased collagen fibril deposition is observed since all trans-retinoic acid can promote types I and III procollagen gene expression [6]. Kligman et al. [7] compared topical retinoic acid with a placebo for skin repair promotion in mouse skin after ultraviolet irradiation. The retinoic acid group had a larger reconstruction zone than that of the placebo group. Griffiths et al. [8] enrolled 29 photodamaged patients treated with 0.1% tretinoin versus vehicle cream. In the control group, collagen was reduced by 14%, whereas collagen I production increased by 80%, as confirmed by immunohistological assessment (Level IIb).

Vitamin A on photodamaged skin evidence

Kang et al. [9] enrolled 568 photodamaged patients in their study, which was placebo-controlled, double-blinded, randomized, and multi-center. A 0.1% tazarotene was used against vehicle cream (control) and showed that 0.1% tazarotene significantly decreased elastosis, dyspigmentation, and fine wrinkles (Level Ib). Bhawan et al. [10] also involved 533 patients in another placebo-controlled, double-blind, randomized controlled study on topical retinoid effectiveness in photoaging. They showed that patients’ skin had increased granular layer thickness and melanin content reduction compared to vehicle cream, as shown by computerized images and histological analyses (Level Ib). Another large study was conducted by Weinstein et al. [11], who enrolled 251 mild-to-moderated photodamaged patients. In this multi-center, vehicle-controlled, randomized controlled study, we used 0.05% topical tretinoin versus vehicle cream. The researchers analyzed the results by assessing the histological structure, which showed melanin reduction and epidermal thickness (Level Ib). A subjective assessment revealed a decrease in roughness, laxity, mottled pigmentation, and wrinkling. A review was performed by the Cochrane collaboration on eight controlled trials on the effect of topical retinoids on photodamaged skin [12], with topical isotretinoin (0.1%), topical tazarotene (0.01%–0.1%), and topical tretinoin cream (0.02% or higher concentration) showing that photodamaged skin significantly improved with their usage (Level Ia).

Creidi et al. [13] enrolled 120 photodamaged patients in a randomized controlled study to compare the effectiveness of topical retinoids with vehicle cream. Using optical profilometry techniques, the left crow’s feet area silicone replica was analyzed. The team found that skin roughness and rhytides were significantly reduced in the retinoid treatment group (Level IIb).

Griffiths et al. [8] also demonstrated that tretinoin cream could significantly increase vascularity and epidermal thickening in randomized controlled, vehicle-controlled, and double-blind studies. Two concentrations of tretinoin cream (0.025% and 0.1%) were used in comparison with the vehicle cream to treat photodamaged skin for 48 weeks (Level Ib).

In summary, with preclinical research demonstrating clear molecular mechanisms and multiple Level I evidence, retinoic acid (vitamin A) is very effective in treating photodamaged skin.

Vitamin B research

Kawada et al. [14] enrolled 30 patients with periorbital rhytides in their study to analyze the effect of 4% nicotinamide cream. This was a placebo-controlled and randomized controlled split-face study. Through objective and subjective computer analyses, 4% nicotinamide cream showed significantly decreased rhytides compared to that of vehicle cream. This study was unblinded, but the level of evidence was not low (Level Ib). Bissett et al. [15] included 50 patients in their split-face randomized controlled study to compare the effectiveness of topical nicotinamide cream with that of the control cream. Reduction of sallowness, erythema, hyperpigmentation, and rhytides was statistically significant when compared to the control cream (Level Ib).

Vitamins C research

Ten photodamaged patients were enrolled in the split-face double-blind controlled study by Fitzpatrick and Rostan [16] in 2002. The effectiveness of topical vitamin C was compared with that of placebo cream. Histologically, the skin area treated with topical vitamin C showed increased type I collagen and Granz zone collagen. Furthermore, clinical investigators have also assessed and found improvements in skin inflammation, pigmentation, hydration, and wrinkle scores. Although few patients were included, the level of evidence was not low (Level Ib). Traikovich [17] also analyzed the effectiveness of vitamin C in photoaging using 10% ascorbic acid. They enrolled 19 photoaging patients in their study, which was designed as vehicle-controlled, double-blind, and randomized controlled. The study period was 3 months, with vehicle cream used as the control cream. Using skin surface topography computer-assisted image analysis and optical profilometry, the team found significant improvements in overall features, yellowing/sallowness, coarse wrinkles, tactile roughness, and fine rhytides (Level Ib).

Vitamin E research

Interestingly, most clinical studies analyzing topical vitamin E were involved with topical vitamin C. Lin et al. [18] used the skin of pigs to compare the photoprotective effect of topical vitamins C and E, versus topical vitamin C, versus topical vitamin E. The team concluded that the best photoprotective effect was a combination of topical vitamins C and E. Nevertheless, topical vitamins C and E alone could also lower thymine dimers, sunburn cells, and erythema with ultraviolet (UV) irradiation (Level IV). Eberlein-König et al. [19] enrolled 20 photoaged patients in a placebo-controlled, double-blinded study to analyze the photoprotective effects of topical vitamins C and E. In response to sunlight, after 8 days of treatment, there was an increment in the minimal erythema dose (the minimal ultraviolet light dose induced cutaneous blood flow together with erythematous response), while in the control group, the dose was reduced (Level IIb).

Discussion

Only one pharmaceutical agent has a large evidence base for use in photoaging. It is a retinoid (vitamin A).

Retinoids are β-carotene derivatives. By binding promoter DNA sequences, retinoic acid influences the expression of genes encoding active chemicals after oxidation and hydrolysis of beta-carotene and its metabolites. Retinoids cause pigment loss and inhibit tyrosinase and matrix metalloproteinases through epidermopoiesis. They can also increase the amount of dermal collagen through the synthesis of TGF-β procollagen and stimulation of water content (by stimulating glycosaminoglycan synthesis). Furthermore, they exhibit antioxidant properties and UV light-absorbing features [20].

Vitamin B3 (niacinamide or nicotinamide) and vitamin B5 (Panthenol) have good pharmacological effects on photoaging skin. nicotinamide adenine dinucleotide phosphate, nicotinamide adenine dinucleotide, and nicotinamide adenine dinucleotide phosphate hydrogen are antioxidants derived from the reduction of nicotinamide adenine dinucleotide. They can decrease the glycation of proteins (skin yellowness causation), inhibit the transfer of melanosomes, and decrease transepidermal loss of water. Vitamin B5 is related to coenzyme A, which is its precursor and plays an important role in multiple metabolic pathways. It affects the rehydration of the skin, enhancement of re-epithelialization of the epidermis, and proliferation of fibroblasts [21].

Vitamin C, also known as l-ascorbic acid, has a powerful therapeutic effect on photoaging skin. Its mechanism involves neutralizing free radicals by donating electrons, which reduce the damage to cells, dermal collagen, and DNA, which are the mediators of photodamage. It also reduces pigmentation by L-dopaquinone depletion (melanin precursor) and stimulates collagen synthesis during collagen cross-linking. Furthermore, it stabilizes collagen by acting as a co-factor for lysyl and prolyl hydroxylases [22].

Vitamin E is an antioxidant and the most abundant form is alpha-tocopherol. In response to ultraviolet light, it can decrease the risk of carcinogenesis, rhytide formation, and erythema of the skin. It reduces skin ultrastructural oxidative damage by scavenging lipid peroxyl radicals [23].

Conclusion

There is a wealth of Level I evidence supporting the use of topical retinoic acid, vitamin B, and vitamin C. Evidence supporting the use of topical vitamin E is mainly drawn from studies from Level IV of the evidence hierarchy.

Conflicts of interest

The authors have nothing to disclose.

Fig 1.

Figure 1.Evidence hierarchy according to Oxford Center for evidence-based medicine [3]. RCT, randomized controlled trials; SR, systematic review.
Journal of Cosmetic Medicine 2022; 6: 67-71https://doi.org/10.25056/JCM.2022.6.2.67

References

  1. Poon F, Kang S, Chien AL. Mechanisms and treatments of photoaging. Photodermatol Photoimmunol Photomed 2015;31:65-74.
    Pubmed CrossRef
  2. Yaar M, Gilchrest BA. Photoageing: mechanism, prevention and therapy. Br J Dermatol 2007;157:874-87.
    Pubmed CrossRef
  3. Centre for Evidence-Based Medicine. Oxford centre for evidence-based medicine: levels of evidence (March 2009) [Internet]. Oxford: University of Oxford; c2009 [cited 2022 Dec 5]. Available from: https://www.cebm.ox.ac.uk/resources/levels-of-evidence/oxford-centre-for-evidence-based-medicine-levels-of-evidence-march-2009.
  4. Glick AB, Flanders KC, Danielpour D, Yuspa SH, Sporn MB. Retinoic acid induces transforming growth factor-beta 2 in cultured keratinocytes and mouse epidermis. Cell Regul 1989;1:87-97.
    Pubmed KoreaMed CrossRef
  5. Kim HJ, Bogdan NJ, D'Agostaro LJ, Gold LI, Bryce GF. Effect of topical retinoic acids on the levels of collagen mRNA during the repair of UVB-induced dermal damage in the hairless mouse and the possible role of TGF-β as a mediator. J Invest Dermatol 1992;98:359-63.
    Pubmed CrossRef
  6. Griffiths CE, Russman AN, Majmudar G, Singer RS, Hamilton TA, Voorhees JJ. Restoration of collagen formation in photodamaged human skin by tretinoin (retinoic acid). N Engl J Med 1993;329:530-5.
    Pubmed CrossRef
  7. Kligman LH, Duo CH, Kligman AM. Topical retinoic acid enhances the repair of ultraviolet damaged dermal connective tissue. Connect Tissue Res 1984;12:139-50.
    Pubmed CrossRef
  8. Griffiths CE, Kang S, Ellis CN, Kim KJ, Finkel LJ, Ortiz-Ferrer LC, et al. 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. Arch Dermatol 1995;131:1037-44.
    Pubmed CrossRef
  9. Kang S, Krueger GG, Tanghetti EA, Lew-Kaya D, Sefton J, Walker PS, et al; Tazarotene Cream in Photodamage Study Group. A multicenter, randomized, double-blind trial of tazarotene 0.1% cream in the treatment of photodamage. J Am Acad Dermatol 2005;52:268-74.
    Pubmed CrossRef
  10. Bhawan J, Gonzalez-Serva A, Nehal K, Labadie R, Lufrano L, Thorne EG, et al. Effects of tretinoin on photodamaged skin. A histologic study. Arch Dermatol 1991;127:666-72. Erratum in: Arch Dermatol 1991;127:1382.
    Pubmed CrossRef
  11. Weinstein GD, Nigra TP, Pochi PE, Savin RC, Allan A, Benik K, et al. Topical tretinoin for treatment of photodamaged skin. A multicenter study. Arch Dermatol 1991;127:659-65.
    Pubmed CrossRef
  12. Samuel M, Brooke RC, Hollis S, Griffiths CE. Interventions for photodamaged skin. Cochrane Database Syst Rev 2005;1:CD001782.
    CrossRef
  13. Creidi P, Vienne MP, Ochonisky S, Lauze C, Turlier V, Lagarde JM, et al. Profilometric evaluation of photodamage after topical retinaldehyde and retinoic acid treatment. J Am Acad Dermatol 1998;39:960-5.
    Pubmed CrossRef
  14. Kawada A, Konishi N, Oiso N, Kawara S, Date A. Evaluation of anti-wrinkle effects of a novel cosmetic containing niacinamide. J Dermatol 2008;35:637-42.
    Pubmed CrossRef
  15. Bissett DL, Miyamoto K, Sun P, Li J, Berge CA. Topical niacinamide reduces yellowing, wrinkling, red blotchiness, and hyperpigmented spots in aging facial skin. Int J Cosmet Sci 2004;26:231-8.
    Pubmed CrossRef
  16. Fitzpatrick RE, Rostan EF. Double-blind, half-face study comparing topical vitamin C and vehicle for rejuvenation of photodamage. Dermatol Surg 2002;28:231-6.
    Pubmed CrossRef
  17. Traikovich SS. Use of topical ascorbic acid and its effects on photodamaged skin topography. Arch Otolaryngol Head Neck Surg 1999;125:1091-8.
    Pubmed CrossRef
  18. Lin JY, Selim MA, Shea CR, Grichnik JM, Omar MM, Monteiro-Riviere NA, et al. UV photoprotection by combination topical antioxidants vitamin C and vitamin E. J Am Acad Dermatol 2003;48:866-74.
    Pubmed CrossRef
  19. Eberlein-König B, Placzek M, Przybilla B. Protective effect against sunburn of combined systemic ascorbic acid (vitamin C) and d-alpha-tocopherol (vitamin E). J Am Acad Dermatol 1998;38:45-8.
    Pubmed CrossRef
  20. Fisher GJ, Voorhees JJ. Molecular mechanisms of retinoid actions in skin. FASEB J 1996;10:1002-13.
    Pubmed CrossRef
  21. Wohlrab J, Kreft D. Niacinamide - mechanisms of action and its topical use in dermatology. Skin Pharmacol Physiol 2014;27:311-5.
    Pubmed CrossRef
  22. Al-Niaimi F, Chiang NYZ. Topical vitamin C and the skin: mechanisms of action and clinical applications. J Clin Aesthet Dermatol 2017;10:14-7.
    Pubmed KoreaMed
  23. Thiele JJ, Hsieh SN, Ekanayake-Mudiyanselage S. Vitamin E: critical review of its current use in cosmetic and clinical dermatology. Dermatol Surg 2005;31(7 Pt 2):805-13; discussion 813.
    Pubmed CrossRef

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