Clinical panel assessment of photodamaged skin treated with isotretinoin using photographs.

BACKGROUND AND DESIGN: Evaluation of the treatment of photodamaged skin requires adequate efficacy criteria. This study tested the ability of five independent dermatologists to distinguish the effect of topical treatment with isotretinoin cream (0.05% for 3 months, then 0.1% for 6 months) in 326 patients compared with vehicle for 9 months in 325 patients using high-quality, reproducible photographic slides. Panelists were blinded to the patient's identity, treatment group, and time of the photograph (baseline or end of treatment). A computer randomly projected the baseline photograph to one side of a split screen and the end-of-treatment photograph to the other. OBSERVATIONS: Isotretinoin was significantly better than vehicle for overall appearance, fine wrinkles, and discrete pigmentation by multivariate analysis of the combined results for all panelists. Univariate analysis for each panelist also indicated statistically significant superiority of isotretinoin over vehicle for overall appearance (four panelists), fine wrinkles (five panelists), and discrete pigmentation (three panelists). CONCLUSION: The clinical panel detected significantly better improvement in photodamaged-skin treated with isotretinoin than in such skin treated with vehicle. The panel provided an independent assessment of the effects of treatment uninfluenced by physical findings during treatment or information provided by the patients treated.