Abstract
Chronic ultraviolet (UV) exposure is the primary cause of skin photoaging, leading to wrinkles, pigmentation changes, and loss of dermal elasticity. This systematic review and network meta-analysis evaluated the efficacy and safety of topical compounds for treating skin photoaging. A comprehensive search identified 23 RCTs with 3905 participants, comparing anti-aging agents. Bayesian network meta-analysis showed isotretinoin, retinol, and tretinoin significantly improved fine wrinkles, with isotretinoin ranked highest. Tazarotene was most effective for coarse wrinkles, while glycolic acid reduced roughness. Tretinoin and retinol were superior for hyperpigmentation. Safety analysis indicated tretinoin had the most favorable profile, whereas tazarotene and glycolic acid had higher adverse event risks. Isotretinoin and tretinoin emerged as the most balanced treatments across efficacy and safety. These findings provide evidence-based guidance for clinical decision-making in anti-photoaging therapy and underscore the potential for these agents to be integrated into routine dermatologic practice, particularly for patients seeking effective and well-tolerated topical interventions. However, limitations included limited racial diversity, potential commercial bias, and variability in dermatological assessments. These findings provide evidence-based guidance for clinical decision-making in anti-photoaging therapy.