Comparative Efficacy of Topical Retinoids in Photoaging

Abstract

Introduction: Topical retinoids remain the gold standard for treating photoaged skin. This review compares clinical efficacy and tolerability of tretinoin, adapalene, and tazarotene. Methods: A meta-analysis of 12 randomized controlled trials (RCTs) (n=1,248) retrieved from Cochrane Library and Embase (2010–2024) was performed. Primary outcomes: global photoaging score, fine lines, and hyperpigmentation. Results: Tretinoin 0.05% produced the greatest improvement in fine lines (42% reduction) but highest discontinuation due to irritation (18%). Tazarotene 0.1% showed superior efficacy for mottled hyperpigmentation (55% improvement). Adapalene 0.3% had intermediate efficacy (31% fine line reduction) with lowest irritation (4% dropout). Discussion: Differences in retinoic acid receptor selectivity explain efficacy-irritation trade-offs. Most studies had short durations (≤24 weeks), limiting assessment of long-term benefits. Conclusions: Adapalene offers the best balance for long-term photoaging treatment in sensitive patients, while tretinoin remains optimal for severe photodamage.