الفهرس 
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Abstract
Skin aging is a complex biologic process influenced by a combination of intrinsic and extrinsic factors. Aging skin shows wrinkles, uneven tone, loss of elasticity, and thinning. Skin health is considered one of the principal factors representing overall wellbeing, therefore, anti-aging strategies to combat aging signs and dysfunction have been developed over the last decades. Many different treatment modalities have been used such as preventive measurements, cosmetologic strategies, and photoprotection as well as topical pharmaceutical agents, such as antioxidants (vitamins, retinols, peptides, hormones, and botanicals) and other invasive techniques. The aim of the current study was to compare the efficacy of topical preparation containing 4% niacinamide versus other containing 3% DMAE as antiaging treatment for facial skin. The study included 50 female patients with early facial skin aging and fine wrinkles. The patients were collected from the Outpatient Clinics of Dermatology and Venereology Department, Tanta University Hospitals from January 2018 to January 2019. They were divided into 2 equal groups. group A included 25 patients who applied topical preparation containing 4% niacinamide to right half of the face and placebo to the left half of the face as control. group B included 25 patients who applied topical preparation containing 3% DMAE to right half of the face and placebo to the left half of the face as control. Niacinamide was formulated as 4% w/w cream and DMAE was formulated as 3% w/w cream. Patients of both groups used the topical treatment once at every night for 4 months and follow up for 2 months after the end of the treatment. They were instructed to avoid direct sun exposure and to apply sunblock (SPF+50) on exposure. 1. Patients were subjected to complete history taking including personal history, history of sun exposure, family history, present history (onset, course, duration of facial aging and any associated medical condition) and past history of any previous medication for facial wrinkles. 2. Objective evaluation of facial skin was performed regarding Fitzpatick’s skin type and Glogau’s clasification of facial aging. 3. Digital photographing of each side of the face was performed at baseline, after fourth month of treatment and at follow up (2 months after the end of treatment) 4. Evaluation of treatment response was performed as follows: Oiliness of skin, wide pores, fine wrinkles and pigmentation through using Enrique Hernandz-Perez and Erick Valencia Ibiett score Dermoscopic photos using DPAS (dermoscopic photoaging scale). Patient satisfaction Side effects during treatment protocol in the form of erythema, irritation or burning sensation were all reported. The results were as follows: A total of 50 female patients completed the study. The age of the patients in group A ranged between 31 and 58 years (Mean ± SD =47.64 years ± 8.30), while in group B the age ranged between 33 and 56 years (Mean ± SD =49.04 years ± 5.90). Regarding the Fitzpatrick’s skin type of the studied patients, it ranged from 2 to 4 with a mean of 3.08 ± 0.57(SD) in group A, while in group B, it ranged from 2 to 4 with a mean of 3.12 ± 0.73(SD). Regarding Glogue scale, it ranged from 1 to 4 with a mean of 2.72 ± 0.74 (SD) in group A, while in group B, it ranged from 2 to 3 with a mean of 2.84 ± 0.37 (SD). Regarding to sun exposure, there were 8 patients (32%) in group A and 6 patients (24%) in group B, who gave history of mild sun exposure, 13 patients (52%) in group A and the same percentage in group B gave history of moderate sun exposure, and 4 patients (16%) in group A and 6 patient (24%) in group B gave history of severe sun exposure. The mean age of onset of facial skin aging in group A was 39.20 years ± 5.79(SD) and 41.96 years ± 3.89(SD) in group B. The mean duration of aging in group A was 7.64 years ± 2.86(SD), and 7.36 years ± 2.23(SD) in group B. Non of cases in both groups received any topical or systemic medication for facial skin aging before joining the study. Physician’s evaluation of improvement in group A: There was a statistically significant improvement of degree of oiliness of the skin, dilated pores, fine wrinkles and pigmentation in right side of the face after treatment than pretreatment (P=0.004), (P=0.008), (P=0.002) and (P=0.001) respectively. There was also a statistically significant better improvement of the 4 previous parameters on the right than the left side of the face after treatment (P=0.006), (P=0.021), (P=0.004) and (P=0.001) respectively. There was a statistically significant improvement in total scores (sum of the 4 parameters of skin aging) on the right side of the face after treatment than pretreatment (P<0.001). There was a statistically significant better improvement on the right side than the left side of the face after treatment (P<0.001). Physician’s evaluation of improvement in group B: There was a statistically significant improvement of degree of oiliness of the skin, dilated pores, fine wrinkles and pigmentation in right side of the face after treatment than pretreatment (P=0.001), (P=0.002), (P=0.002) and (P=0.003) respectively. There was also a statistically significant better improvement of the 4 previous parameters on the right than the left side of the face after treatment (P=0.028),(P=0.028), (P=0.045) and (P=0.017) respectively. There was a statistically significant improvement in total scores (sum of the 4 parameters of skin aging) on the right side of the face after treatment than pretreatment (P<0.001). There was a statistically significant better improvement on the right side than the left side of the face after treatment (P=0.002). There was no statistically significant improvement of four parameters on the left side of the face after treatment in the both studied groups. There was no statistically significant difference between group A and B according to the 4 parameters of skin aging and total scores on the treated right side (P>0.05). Regarding the degree of overall improvement: In group A, the mean overall improvement in right side was 1.28 ± 1.22(SD), while the mean overall improvement on left side was 0.64 ± 0.59(SD) with a statistically significant improvement on the right side in comparison to the left side (P=0.001). The mean overall improvement at evaluation at follow up (after 2 additional months after the end of treatment) on the right side was 5.36 ± 1.53(SD), while the mean improvement at follow up on left side was 5.68 ± 1.58(SD) with a statistically significant difference with higher response on the right side (P=0.005). In group B, the mean overall improvement in right side was 1.10 ± 1.10(SD), while the mean overall improvement on left side was 0.52 ± 0.55(SD) with a statistically significant better improvement on right side than left side of the face (P<0.001). The mean overall improvement at evaluation at follow up (after 2 additional months after the end of treatment) on the right side 5.28 ± 1.44(SD), while the mean improvement in left side was 5.48 ± 1.47(SD) with statistically significant improvement (P=0.028). It has been noticed that there was some overall improvement on the left side of the face of some cases however, it couldn’t gave statistically significant difference (P > 0.005). There was no statistically significant difference (P > 0.005) in overall improvement at the end of treatment and at follow up after 2 months between the two studied groups in the treated right side. Regarding improvement in DPAS in the both study groups: There was no statistically significant difference between right and left sides of the face before treatment (P=0.317), (P=0.739) in group A and B respectively. A statistically significant improvement in DPAS was noticed only on the right side of the face after treatment (P<0.001), (P=0.041) in group A and B respectively and the change on the left side was statistically insignificant after treatment in both groups.