A sequential combination of topical tretinoin and a potent topical corticosteroid improves photodamaged facial skin

Five older women with severely photodamaged facial skin were treated for 16 weeks with 0.1% tretinoin cream and 0.05% diflorasone diacetate cream. Striking clinical improvement occurred in all subjects; notably, there was a reduction in wrinkling and bleaching of dyspigmentation. Histologically, there was complete correction of epidermal atrophy and atypia. Basal keratinocytes, originally crowded with hyperpigmented melanosomes, lost most of the pigment. Dermal cellularity increased and there was also a modest increase in the microvasculature. The dermal matrix (collagen, elastin, and glycosaminoglycans) was not changed. Irritant effects were minor. Atrophy did not occur. Evidently tretinoin counteracted the atrophic potential of the potent corticosteroid but did not interfere with its anti-inflammatory effect.