Recent advances in treatments for photoaging
Recent advances in treatments for photoaging
Recent advances in treatments for photoaging
Photoaging, or photodamage as it is also known, is characterised by features including wrinkles, loss of skin elasticity, redness and a change in skin texture or colour. Photoaging is caused by damage from Ultraviolet (UV) light which comes from exposure to the sun and is one of two main categories in skin ageing; the other being intrinsic ageing which is due to simply getting older.
Thankfully for patients seeking to improve the appearance of their skin there are a number of treatments that are available, many of which are easy to undergo with little risk and rapid recovery.
Treatments include laser treatments, chemical peels, topical agents, injections such as Botox and dermal fillers like Restylane.
Increasingly studies are concluding that combining many treatments for photoaging has beneficial effects beyond simply complementing each other.
Tierney and Hanke, writing for the American Society for Dermatologic Surgery, have reviewed 24 recent studies into the effects of combining treatments for photoaging and conclude that many of the treatments have synergistic benefits, meaning one treatment actually improves the efficacy of the other.
The researchers said the studies' findings were remarkable' and highlighted that 10 of the 24 studies into combination treatments showed histologic evidence of the repair of sun damaged skin. This means that not only were patients and doctors reporting better results with the combined treatments but that tests such as ultrasound and biopsies performed on the skin were actually able to prove their success. In some cases it was proven that new collagen was being produced, that skin thickness had changed or that damaged parts had been eradicated.
One such study by Berlin and colleagues looked at the combination of a skin peel (Erb: YAG, which stands for erbium-doped yttrium aluminium garnet) and intense pulsed light (IPL). Patients underwent three sequential monthly treatments of the combination. Doctors then studied their skin and skin tissue, finding evidence of new collagen production and eradication of disorganised elastic fibres. IPL is one of three primary nonablative laser systems, meaning it doesn't remove skin or tissue. IPL devices target the dermis (a deep inner layer of the skin) and target melanin and haemoglobin pigments which are associated with photoaging and sun damage.
The review also found further evidence to support using topical agents in laser and light treatments. Five separate trials were carried out into combining aminolevulinic acid and IPL = PDT.
All five found using the acid alongside the light improved the efficacy of the treatment. Crow's feet were improved by 55% compared to 28% with IPL alone, skin texture improved by 55% vs. 30%, hyperpigmentation (dark patches) improved by 60% vs. 37% and redness by 84% vs. 54%.
Evidence was also found to support the combination of injectable treatments such as Botox and fillers like Restylane.
A study by Carruthers and Carruthers found that combining BTX-A (Botox) with hyaluronic acid (Restylane) doubled the longevity of the Restylane. The study involved treating women with deep wrinkles with the combination and another group with Restylane alone. It found the average time for the wrinkles to return to their pre-treatment state was 18 weeks with the Restylane alone group but 32 weeks for those who had been treated with both Botox and Restylane. It is thought the Botox may have delayed the Restylane deforming.
Another study by Khoury and colleagues aimed to determine whether Botox could also improve the efficacy of intense pulsed light treatments. Doctors treated one group of women with Botox and IPL and another group with saline and IPL and then evaluated their wrinkles, fine lines, redness, hyperpigmentation, pore size, skin texture and overall appearance over 8 weeks. It found a significantly higher proportion of patients treated with Botox and IPL showed improvement with small wrinkles and fine lines 93% compared to 29% of those treated with saline and IPL. Redness was also more improved with the combination treatment.
Studies also looked at the combination of two laser treatments. Biopsies taken after a combined treatment with a potassium titanyl phosphate laser (KTP) and a neodymium doped laser (Nd: YAG) showed evidence of new collagen formation, in ways that would not have been present had just one of the treatments been used alone. These lasers, like intense pulsed light treatment are non-ablative.
In addition to the studies of combination treatments, the review also looked at studies carried out with ablative lasers, which involved removal of some of the skin's surface. A study by Hedelund and colleagues performed a comparison of a carbon dioxide laser and IPL. The treatment performed with a carbon dioxide laser is often known as C02 laser resurfacing. The study found that skin elasticity increased in both groups and that CO2 laser resurfacing reduced wrinkles better than IPL but induced some side effects. The side effects include redness, dyspigmentation and whiteheads. The study found that consequently a number of patients preferred IPL treatments over carbon dioxide laser resurfacing.
See our pages on laser skin treatments, dermal fillers and chemical peels and resurfacers for more information.
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