الفهرس 
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Abstract
In the current study we tried to evaluate the efficacy of a combination of topical antioxidants in comparison
to topical tretinoin in treatment of photoaging in a cohort of a non-elderly population from September 2020 till
January 2023. Our study included 76 female patients with mild to moderate photoaging confirmed by clinical
examination and dermoscopic findings. Dermoscopy photoaging scale (DPAS) and Glogau`s photoaging scale
were used to evaluate the degree of photoaging. Photos were taken at the initial evaluation and at the followup visits.
Patients were randomized into 3 groups: group 1, group 2 and group 3 who applied topical antioxidants,
topical tretinoin and topical panthenol cream respectively. The treatment was applied once daily at night for 6
months . Patients were assessed clinically and by DPAS at each month visit. The side effects of each drug were
evaluated. Patient satisfaction score was evaluated at the end of treatment.
The improvement on clinical basis was most prominent in dyschromia, skin translucency and roughness.
These clinical criteria improved with antioxidants at 3-month evaluation which is earlier than topical tretinoin.
Fine wrinkles showed improvement at 6-month evaluation with topical antioxidants only. This gives a good
point for topical antioxidants as they have a more rapid effect which adds to the patient`s compliance for
treatment.
Interestingly, patients who used panthenol only with sunscreens showed improvement in dyschromia at 6-
month evaluation and in roughness and skin translucency at 3-month evaluation. The emollient effect of pantothenic acid plus its antiaging effect synergized by the antiaging effects of sunscreens can explain these results. A disadvantage of clinical evaluation of photoaging is that it depends on subjective evaluation which is
not accurate and there are no available scales for objective evaluation of these criteria.99
Dermoscopic evaluation using DPAS showed statistically significant difference only in pigmentation in the
tretinoin group and in telangectasia in the antioxidants group. Due to the young age of the study population, it
was a difficulty to evaluate several items of DPAS. Topical antioxidants showed comparable improvement in
total DPAS to topical tretinoin. Topical antioxidants showed no significant difference to placebo as regards
the side effects. Patient satisfaction was 100% only in this group.
The current study demonstrated that the topical combination of antioxidants we used (Selenium, Vitamin C and Vitamin E) can be a strong competitor to the standard treatment of photoaging; topical tretinoin,
owing to their more rapid clinical effects and less side effects with more patient tolerance and satisfaction. The
study also presented the important role of dermoscopy in the evaluation of signs of photoaging. Dermoscopy
photoaging scale, although important and interesting, should be more flexible by upgrading the yes or no policy
used in this scale so the improvement can be better documented.100
Conclusion and recommendations
In conclusion, the present study demonstrated that topical antioxidants are comparable in efficacy to topical tretinoin in treatment of photoaged skin with better tolerability and more patient satisfaction.
We recommend that this study can be done on a sample of older patients than ours to better evaluate the
dermoscopic signs of photoaging and observe the effects of treatment on these criteria.
We recommend also that the DPAS be upgraded so the improvement, not only the disappearance, of the
dermoscopic features can be evaluated.