18 Trichloroacetic Acid Combined with Jessner’s Chemical Peel Safety



10.1055/b-0040-177260

18 Trichloroacetic Acid Combined with Jessner’s Chemical Peel Safety

Erez Dayan and Rod J. Rohrich


Abstract


Trichloroacetic acid (TCA) is a versatile agent, efficacious in treating a spectrum of facial rhytids at varying concentrations. TCA is commonly used in a 30 to 35% concentration to achieve a medium-depth peel into the upper reticular dermis. The addition of Jessner’s solution prior to the TCA peel application leads to partial removal of the epidermis, allowing for deeper penetration of the TCA. This combination is beneficial, as lower concentrations of TCA can be used for the same depth of peel, minimizing complications such as scarring.




Key Points for Maximizing Chemical Peel Safety




  • The type of chemical peel selected is based on the depth of penetration required to effectively treat a given condition as well as the skin type and skin thickness. As such, chemical peels are frequently classified based on depth of penetration (superficial, medium, and deep) (▶ Table 18.1 ).



  • TCA is commonly used in a 30 to 35% concentration to achieve a medium-depth peel into the upper reticular dermis.



  • A number of factors other than the concentration of TCA contributes to the depth of peel obtained, such as skin preparation, pretreatment skin type, and method of application.






























Table 18.1 Types of chemical peels and depth of penetration


Depth of penetration


Peeling agent


Conditions


Superficial


Stratum corneum to papillary dermis (60 µm)




  • Alpha hydroxyl acids



  • Beta hydroxyl acids



  • Jessner solution




  • Mild photoaging



  • Mild acne scarring



  • Pigmentary disorders


Medium


Papillary dermis to upper reticular dermis (450 µm)




  • TCA 35–50%



  • TCA 35% + glycolic acid 70%



  • TCA 35% + Jessner’s solution




  • Mild-to-moderate photoaging



  • Actinic keratosis



  • Fine rhytids



  • Solar lentigines



  • Pigmentary disorders


Deep


Mid-reticular dermis to 600 µm




  • Baker-Gordon



  • TCA > 50%




  • Severe photoaging



  • Pigmentary disorders



  • Premalignant skin tumors



  • scars



18.1 Safety Considerations




  • A careful history and physical examination allows for the clinician to determine the patient’s candidacy (▶ Table 18.2 ).



  • The senior author’s (R.J.R.) preference is to pretreat all patients for 4 to 6 weeks prior to chemical peeling. 1 , 2 This regimen includes topical tretinoin (0.05–0.1%), hydroquinone (2–4%), sunscreen, and alpha hydroxyl acid (4–10%). Pretreatment improves skin tolerance, regulates fibroblast and melanocyte function, improves dermal circulation, and allows for the treated skin to heal 3 to 4 days faster due to increased cellular division and new collagen formation. 1 , 3 , 4



  • Safety and consistency are prioritized to ensure optimal results. In the case of 35% TCA peel combined with Jessner’s solution, this begins with a set-up of four clearly labeled glasses ordered from left to right in the appropriate sequence of usage.



  • The glasses are filled by the operating surgeon with:




    1. 70% ethyl alcohol (cleanser).



    2. acetone (degreasing agent).



    3. Jessner’s solution (provides a uniform superficial exfoliation).



    4. 35% TCA acid solution. 1



  • The addition of Jessner’s solution prior to TCA peel application leads to partial removal of the epidermis, allowing for deeper penetration of the TCA. This combination is beneficial, as lower concentrations of TCA can be used for the same depth of peel, minimizing complications such as scarring. 4



  • All patients are given 24 hours of prophylactic antibiotics. Acyclovir is initiated 2 days prior to chemical peel and continued 5 days after the peel in patients with a prior history of herpetic lesions.



































Table 18.2 Indications and contraindications of chemical peel

Indications for chemical peel


Contraindications


Superficial or deep rhytids/photoaging


Isoretinoin therapy within the previous 6 months


Preneoplastic or neoplastic lesions (i.e., actinic keratosis and lentigines)


Absence of pilosebaceous units on the face


Underlying skin disease (i.e., acne)


Infection or open wounds (herpes, open acne cysts)


Pigmentary dyschromias


Medium or deep resurfacing procedure within 3–12 months*

 

Recent facial surgery involving undermining*

 

History of therapeutic radiation exposure

 

Fitzpatrick skin types IV, V, and VI*


*Relative contraindication

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Jul 18, 2020 | Posted by in Dermatology | Comments Off on 18 Trichloroacetic Acid Combined with Jessner’s Chemical Peel Safety
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