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Topical tazarotene has been shown to offer efficacy in ameliorating multiple effects of photodamage.To evaluate the histological effects of tazarotene cream on photodamaged skin.In this multicentre, double-blind, randomized, vehicle-controlled study, 50 patients with photodamaged facial skin (at least mild fine wrinkling and mottled hyperpigmentation, with at least one of these being moderate) were randomized to apply tazarotene 0·1% cream or vehicle cream to their face, once daily for 24 weeks.Blinded assessments showed that tazarotene was less likely than vehicle to be associated with an increase in keratinocytic and melanocytic atypia, and more likely than vehicle to be associated with a reduction in atypia. Between-group comparisons in distribution of change from baseline categories of severity were in favour of tazarotene (P = 0·055 for keratinocytic atypia,P = 0·034 for melanocytic atypia, andP < 0·001 for the number of granular cell layers). Compared with vehicle, tazarotene was associated with an increase in epidermal polarity (P = 0·008) and epidermal thickness (P = 0·012), and a tendency for stratum corneum compaction. Tazarotene was also associated with widened intercellular spaces (reported as epidermal oedema) relative to vehicle (P < 0·001).Treatment of photodamaged skin with tazarotene is associated with an amelioration of keratinocytic and melanocytic atypia, an improvement in epidermal polarity, and an increase in epidermal thickness. [ABSTRACT FROM AUTHOR]