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Milton R. Okun, MD
Dermatopathology Foundation Canton, Mass Boston University School of Medicine

JAMA. 1988;259(22):3271-3272.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.

—The article by Weiss et al¹ does not present convincing evidence that application of topical tretinoin improves photoaged skin, even within the context of the small number of patients studied and the short follow-up period.

Photographic factors must be kept constant for valid demonstration of subtle morphological changes in "before" and "after" pictures. The presentation in this article does not meet this requirement. Examination of the published clinical photographs (Figs 1 through 3 in the article by Weiss et al) reveals a significant and consistent increase in photographic contrast in the "after" pictures (apparently due mainly to lighting, with a possible development factor). This results in "washing out" of the highlighted areas and a darkening of the shadow areas, with consequent loss of photographic detail, which could easily account for the apparent diminution of fine wrinkling and pigmented spots after treatment with tretinoin. The disappearance of . . . [Full Text PDF of this Article]

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