Recent Advances in Combination Treatments for Photoaging: Review of the Literature

BACKGROUND Photoaging of the skin is a condition characterized by a combination of physical findings including dyspigmentation, fine wrinkles, telangiectasias, tactile roughness, and precancerous change. A combination approach, treating these changes in skin pigmentation and texture simultaneously, is often required to ensure patient satisfaction. OBJECTIVE To review the dermatologic literature on the use of combination treatments in photoaging using Medline. RESULTS Review of the Medline literature identified 24 studies of combination approaches to photoaging in which physician and patient evaluation of efficacy of the treatment approaches were performed. Ten studies contained histologic evidence that combination approaches to photoaging, including non-ablative and ablative laser resurfacing, topical retinoids, and topical photosensizers with lasers and light sources, produced cutaneous repair of photodamaged skin. These studies documented histologic improvement in various features of photodamaged skin, including change in epidermal and dermal thickness and stratum corneum compaction, greater type I and III collagen production, and less sunburn cell and thymine dimer formation after ultraviolet light exposure. CONCLUSIONS Review of the literature demonstrates the progress of dermatologic science in understanding the cellular and molecular mechanisms of ultraviolet light-induced damage and in the development of novel combination approaches for repair of photodamage and prevention of cutaneous malignancy.